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HomeMy WebLinkAboutAmended Insurance Certificate: OUZEL LLC State Farm at CityLine . u PO.Box 853925 Richardson,•TX 75085-3925 O State Farris AT1 000541 1200 01 State Farm Fire and Casualty Company CITY OF ASHLAND A stock Company with horrieoffice'stin'<BloOrriington,FIllinois 20 E MAIN ST ASHLAND OR 97520-1814 . IIIIIrlrllI'IIIIIIiliI�iuIIlll 1.01IIIiilIlulllinrlllIidlli ii 0o Amended Declarations Policy number: 97-CP-R296-3 Effective date: July 23, 2021 Policy period: 12 months Expiration date: April 1, 2022 - •. • - The policy period begins and ends at 12:01 am standard time at the premises location. ' OFFICE POLICY '. Automatic renewal-If the State Farm!policy,period isshown as-12.months;.this'policy will;be,renewed.automatically..aubject•to.the ;rules�agd forms-in,effect-for each sucpeeding'policy period If this policy is terminated, we will giveyou and the Mortgagee/Lienholder written notice in compliance with the policy provisions or as required,by law`. r NAMED INSURED • . . . OUZEL LLC 2800 Biddle Rd .., .-.-. Medford OR 97504-4115 . ENTITY Limited Liability Company REASONS FOR DECLARATIONS Your policy is amended effective July 23,•2021 due to some recent policy changes you requested; Enclosed is a copy'of your new endorsements, if any. POLICY PREMIUM, This isnot a bill.if an amount is due, then a separate'statement will besent prior to the due date. The premium(s)shown below is the.12;months; premium(s)for the-characteristics of the policy as described in this Declarations. Total.Premium: $766.00 _ Discounts applied: Business Experience Rating Renewal Discount ` ' Years in Business • • Policy Number:97-CP-R296-3 Page'1 of 5 Prepared:August 2,2021 ©.Copyright,State Farm Mutual Automobile Insurance Company;2008 . CMP Dec 3P OR.1 1009482 2003 153090 203 04-10-2021 CMP-4000 " 002137 , State a mo • ...,s SECTION ;PROPERTY SCHEDULE Location Location of described premises Limit of Insurance* " Limit.of Insurance* ` Seasonal increase number Coverage A- Coverage B-Business Business Personal Property • Building Personal Property 001 2800 BIDDLE RD $492,700 $36,900 25%; MEDFORD OR 975044115 *As of the effective date of this policy, the Limit of Insurance as shown includes any increase in the limit due to Inflation Coverage. SECTION I-INFLATION COVERAGE INDEX(ES) Cov A-Inflation Coverage Index: 190.6 ' Cov B-Consumer Price Index: 260.4 • SECTION I-DEDUCTIBLES BASIC DEDUCTIBLE $1,000 SPECIAL DEDUCTIBLES: Employee Dishonesty: $250 . . , Equipment Breakdown: $1,000 Money and Securities: $250 . Other deductibles may apply-refer to policy. , SECTION I`=EXTENSIONS OF COVERAGE-LIMIT OF INSURANCE-EACH DEscRIogp PREMISES - The coverages and corresponding limits shown below apply separately,to each described'premises shown in.these'Declarations, unless indicated by"See schedule If a coverage does not have a corresponding limit shown'below, but h'as"Included" indicated, refer to that policy provision for an explanation of that coverage. Coverage Limit of Insurance Accounts Receivable On Premises $50;000 Off Premises , . $15,000 , Arson Reward $5,000 • Back-up of Sewer or Drain $15;000 , Collapse. Included. , , •. Damage to Non-owned Buildings from Theft,Burglary or Robbery Coverage B Limit '' =� '' Debris Removal "' 25%of covered loss Equipment Breakdown , Included. , Fire Department Service Charge $5,000. Fire Extinguisher Systems Recharge Expense " ' , $5,000 Forgery or Alteration $10,000 Glass Expenses Included Policy Number:97-CP-R296-3 ' ' . . . • - ' Page 2of 5 Prepared:August 2,2021 ''..©:Copyright,State Farm Mutual Automobile Insurance Company,2008 ' CMP-4000 • • u • - R Q0 StateFarrn° . Coverage Limit of Insurance °-`' - ''`' Increased Cost of Construction'and Demolition Costs(applies only when buildings are insured on a 10% ' • Y • - replacement cost basis) .._ . .- _ ... _. .- . . ..... _. Money Orders and Counterfeit Money $1,000 g Money and Securities ••- --• - - • - .. 0 o On Premises $10,000 Off Premises • - t, ` ,, . $5,000 • Newly Acquired Business Personal Property` (applies only if this policy provides Coverage B;Business •$100,000 '''. . Personal Property) ' Newly Acquired or Constructed Buildings•(applies only if this policy provides Coverage A-Buildings) $250,000 • Ordinance or Law-Equipment Coverage " ' ` " ' ' ` ' ' - ' — " -. `,.Included` ' • " •" " Outdoor Property $5,000 Personal.Effects(applies only to those premises provided Coverage B-Business Personal Property) $5,000 - - '' • Personal Property Off Premises $15,000 . Pollutant Clean Up and Removal: ,, . , :, , • $10,000 • Preservation of Property .' ' 30 days • ' Property of Others'(applies only to those premises provided Coverage B-'Business Personal Property)1 '.$2,500 '"'' ' ' ' ' '' ' Signs $2,500 Unauthorized Business Card Use _ $5,000 Valuable Papers and Records On Premises $50,000 '- ' Off Premises • Water Damage, Other Liquids;Powder or Molten Material Damage - ' 1- -Included• : • SECTION I-EXTENSIONS OF COVERAGE-LIMIT OF INSURANCE-PER POLICY • ' = • The coverages and corresponding limits shown below are the most we will payregardless of the'number of'described•premises shown in these Declarations. , Coverage Limit of Insurance • • Dependent Property-Loss of Income $5,000 ' , Employee Dishonesty $10,0'00 ,;+° :.,:_. , Loss of Income and Extra Expense • 12 Months Actual Loss,Sustained., „ Utility Interruption-Loss of Income $10,000 • Policy Number:97-CP-R296-3 Page 3 of 5 , Prepared:August 2,2021 ©Copyright,State Farm Mutual Automobile Insurance.Company,.2008 • - CMP-4000 . 002138 • , . StateFarine 'SECTION II LOCATION SCHEDULE. Location Location of described premises,. ,. . :. : r ,,,,..;.., „ ' number 001 2800.BIDDLE RD , ; . MEDFORD OR 97504-4115 - SECTION II-LIABILITY - - Coverage Limit of Insurance , Coverage L-Business Liability Per Occurrence " . . - •.$2,000,000 , „Coverage M-Medical Expenses .' . . -- • . . .. $10,000 Any One Person:.. Damage to Premises Rented to You. ... $300,000 Aggregate Limits Limit of Insurance • , Products/Completed Operations.Aggregate : -.:$4,000,000 , , General Aggregate $4,000,000 Each paid claim for Liability Coverage reduces the amount of insurance we provide during the applicable annual period. Please refer to'S ection'li— Liabilityin the Coverage Form and any attached endorsements __ , Your policy consists of these Declarations,the BUSINESSOWNERS.COVERAGE FORM shown below,and,any other forms and endorsements that apply, including those shownbelow as-well•as those issued subsequent to the issuance of this'policy. • - ,FORMS AND ENDORSEMENTS -• • . CMP-4100 Businessowners Coverage.Form CMP-4237.1 Amendatory Endorsement(Oregon) { , CMP-4527.. Marijuana Exclusion . .. .- . : - . . . . CMP-4561.1 . Policy Endorsement. , . , • . CMP-4683.1 Additional.Insured.-Owners,Lessees or Contractors(Blanket)_ . CMP-4684.1. Additional,Insured-Owners,Lessees or Contractors(Scheduled) , . CMP-4703.1 - Utility Interruption-Loss of Income .. . - . CMP-4704:1 Dependent Property-Loss of Income r" CMP-4705.2 Loss of Income and ExtraExpense . - - - - . . .. - - ._ . . . - - . . CMP-4706 Back-up of Sewer or Drain ,, f A • CMP-4709 Money.and Securities. ,_ , .,.„it_. i ,CMP-47:10 , Employee Dishonesty, •. ,. CMP-4787 Waiver of Transfer of Rights of Recovery Against Others To Us CMP-4819.1 Unauthorized,Business Card'Use • ' FD-6007 Inland Marine Attaching Declarations FE-3650 Actual Cash Value Endorsement . • ' -FE=6999.3' ..' Policyholder Disclosure Notice-of Terrorism Insurance Coverage :. "' .- , SCHEDULE OF ADDITIONAL INTEREST(S) • "" ' Interest type: , • Owners,Lessees, or Contractors(Schedul ' •. - '• " , ' Endorsement number: CMP=4684.1 ' • Loan number:.• N/A .. . CITY OF ASHLAND 2_.E Main 5{. - --- .. __ _. " . . _ Ashland OR 97520-1814 • • Policy Number:97-CP-R296-3 Page 4 of 5 Prepared:August 2,2021 . ' • ' ©Copyright,State Farm Mutual Automobile Insurance Company;2008 . • CMP-4000 u 09D,State Farmo This policy is issued by the State Farm Fire and Casualty Company. r •PARTICIPATING POLICY You are entitled to participate in a distributionof the earnings of the company as determined by our Board of Directors in accordance with the Company's Articles of Incorporation, as amended. . In Witness Whereof, the State Farm Fire and Casualty Company has caused this policy to be signed by its President and Secretary at F-s Bloomington, Illinois, co *)144A)11. President Secretary • • Policy Number:97-CP-R295-3 Page 5 of 5 Prepared:August 2,2021 ©Copyright,State Farm Mutual Automobile Insurance Company,2008 CMP-4000 rinoiQQ u State Farm at CityLine PO Box 853925 Richardson, TX 75085-3925 090 StateFarm® State Farm Fire and Casualty Company CITY OF ASHLAND A stock company with home offices in Bloomington, Illinois 20 E MAIN ST ASHLAND OR 97520-1814 S • O Inland Marine Attaching Declarations Policy number: 97-CP-R296-3 , Effective date: July 23, 2021 Policy period: 12 months Expiration date:April 1, 2022 The policy period begins and ends at 12:01 am standardtime at the premises location. ATTACHING INLAND MARINE Automatic renewal -If the State Farm®policy period is shown as 12 months,this policy will be renewed automatically subject to the premiums, rules and forms in effect for each succeeding policy period. If this policy,is terminated,we will give you and the Mortgagee/Lienholder written notice in with the policy provisions or as required by law. Annual policy premium: Included The above premium amount is included in the Policy Premium shown on the Declarations, Your policy consists of these Declarations, the INLAND MARINE CONDITIONS shown below, and any other forms and endorsements that apply, including those shown below as well as those issued subsequent to the issuance of this policy. FORMS,OPTIONS AND ENDORSEMENTS FE-6867 Inland Marine Amendment of Inland Marine Conditions FE-8739 Inland Marine Conditions FE-8743.1 Inland Marine Computer Property Form See below for schedule page with limits ATTACHING INLAND MARINE SCHEDULE PAGE ' Endorsement Coverage Limit of insurance Deductible amount Annual premium number FE-8743.1 'Inland Marine Computer Property Form $25,000 ' $500 Included Loss of Income and Extra Expense $25,000 Included Other limits and exclusions may apply-refer to your policy. Policy Number:97-CP-R296-3 Page 1 of 1 Prepared:August 2,2021 ©Copyright,State Farm Mutual Automobile Insurance Company,2008 CIM Att Dec 3P OR.1 1009481 2002 153089 202 03-06-2021 FD•6007 0 nrm An 0 0