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HomeMy WebLinkAboutInsurance Certificate: Emerging Futures Youth Network L, State Farm at CityLine PO Box 853925 •Richardson,"TX 75085-3925 CFO StateFarme ,AT2 000929 1200 01 V State Farm Fire and Casualty Company CITY OF ASHLAND A stock company with home'offices+in'Bloomington .lIIin'ois VA— 20EMAIN ST . ASHLAND,OR 97520-1814" O o 111"1IIIIrlrnlIIIIIIiIIIIIIII1IInIIil1IIiIIuIIIIIiiiIIIiiiIIl U)o • Renewal Declarations • Policy number: 97-CK-S482-9 ,Effective date: October 16, 2021 Policy period: 12 months Expiration date: October 16, 2022 The policy period begins and ends at 12:01 am standard time at the premises location, V BUSINESSOWNERS POLICY Automatic renewal -If the State Farm®policy period is shown as 12 months, this policy'will be renewed automatically subject to the premiums,:rulesand forms in effect for each,succeeding policy period, If_this-policyis terminated, we will_give you and:the -' . _ T MortgageelLienholder written notice in compliance With the policy provisions or as,required by NAMED INSURED EMERGING FUTURES YOUTH NETWORK 1180 Park St Ashland OR 97520-3535 • - ENTITY • Nonprofit IMPORTANT MESSAGE(8) • Notice Inforination'concerning changes in your policy language is included:Please call"your agent if'you have; any questions. POLICY PREMIUM" This isnot a bill.If an amount is due,then a separate statement will be sent 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: $325.00 - Miinimum Premium Discounts applied: Business Experience Rating • Years in Business Business in Residence Premises Policy Number:97-CK-S482-9 Page 1 of 5 Prepared:August 8,2021 ©Copyright,State Farm Mutual Automobile Insurance Company,2008 CMP Dec 3P OR.1 V 1009482 2003 153090 203 04-10-2021 CMP-4000 004102 Q96StateFarme SECTION I=PROPERTY SCHEDULE 0, 5 , 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 1150 Park St No Coverage $1,200 ‘ 25% . • Ashland OR 97520-3535 *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) ' Coy A-Inflation Coverage Index: N/A Coy B-Consumer Price Index: 269.2 0 SECTION I—DEDUCTIBLES BASIC DEDUCTIBLE $1,0g0 . . SPECIAL DEDUCTIBLES• : • , • Equipment Breakdown: $1,000 Money and Securities: $250 ' Other deductibles may apply-refer to policy. SECTION I—EXTENSIONS OF COVERAGE-LIMIT OF INSURANCE-EACH DESCRIBED 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 ha "Included" indicated, refer to that policy provision for an explanation of that coverage. ,J Coverage Limit of Insurance • Accounts Receivable On Premises $10,000 , , Off Premises $5,000 Arson Reward $5,000 Collapse Included Damage to Non-owned'Buildings from Theft,Barglarji or Robbery Coverage 13 Limit Debris Removal 25%of covered loss .0 , Equipment Breakdown , , , Included Fire Department Service Charge $2,500 Fire Extinguisher Systems Recharge Expense Forgery or Alteration $10,000. . Glass Expenses r Included Increased Cost of Construction and Demolition Costs(applies only when buildings are insured on a 10% replacement cost basis) • Policy Number:97-CK-S482-9 • Page 2 of 5 Prepared:August 8,2021 ©Copyright,State Farm Mutual Autoniobile Insurance Company,2008 CMP-4000 ' u 090 StateFarm® Coverage . Limit.of Insurance - Money Orders and Counterfeit Money - $1,000 , Money and Securities , .' : , On Premises , $5,000 m Off Premises : ., $2,000 - NewlyAcquired Business Personal Pro er h-(aPPlies•, nl 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 - . , '• ,.r • $5,000 Personal Effects(applies only to those premises provided Coverage B-Business Personal Property) $2,500 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).' $2,500 • Signs , $2,500 Valuable Papers and Records On Premises . - . $10,000 ' Off Premises $5,000 . Water Damage, Other Liquids,Powder or Molten Material Damage Included'; : ;'`!"..Y -'1'`c*' SECTION I-EXTENSIONS OF COVERAGE-LIMIT OF INSURANCE-PER POLICY >.." The coverages and corresponding limits shown below are the most we will pay regardless of the number of described premises shown in these Declarations. Coverage Limit of Insurance, Loss of Income and Extra Expense, '12 Months Actual Loss Sustained - , SECTION II-LOCATION SCHEDULE '`" -;-•• ` '�` "' ., Location 'Location of described premises : - ' number 001 1180 Park St Ashland OR 97520-3535 • , SECTION II-LIABILITY • • •• Coverage Limit of Insurance Coverage L-Business Liability Per Occurrence , ` $2,000,000. Policy Number:97-CK-S482-9 , Page3 of 5 Prepared:August 8,2021 ©Copyright,State Farm Mutual Automobile Insurance Company,2008 . CMP-4000 ' 004103 • . State Farm® • • Coverage Limit of Insurance - Coverage M-Medical Expenses • $5,000 Any One Person' ' Damage to Premise's 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 Section II Liability in 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 shown below 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-4543 Additional Insured-Designated Person or Organization . CMP-4561.1 'Policy Endorsement CMP-4705:2 Loss of Income and Extra Expense ' ' ' •' - CMP-4709 • Money and Securities • , .CMP-4787 Waiver of Transfer of Rights of.Recovery Against Others To Us. ' CMP-4788 Additional Insured-Managers or Lessors of Premises ' FD-6007 Inland Marine Attaching Declarations ' FE-3650" ' " Actual Cash Value Endorsement * FE-6999.3 Policyholder Disclosure Notice of Terrorism Insurance Coverage *New Form Attached ' SCHEDULE OF ADDITIONAL INTEREST(S) . . - . Interest type: Designated Person or Organization ' Endorsement number: CMP-4543 s Loan number: NIA • City of Ashland • ' ' .. 20 E Main St ' Ashland OR 97520-1814 This policy is issued;by-the State Farm Fire•and Casualty Company. . PARTICIPATING POLICY :i ,ti .: ;. . You are entitled to participate in,a distribution of 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 Bloomington, Illinois.• ' /fr/t e it.e.. .sQ, Zi.,1,.AD . . . .. *frtAti2d. Ill 114444111.1 _. President . . . . . .-. . -.- .- Secretary - . - • - - - Policy Number:97-CK-S482-9 ' Page 4 of 5 Prepared:August 8,2021 ©Copyright,State Farm Mutual Automobile Insurance Company,2008 ' • CMP-4000 . ' u 00 State Fame' NOTICE TO POLICYHOLDER: For a comprehensive description of coverage and forms, please refer to your policy. Policy changes requested before the"Date Prepared", which appear on this notice, are effective on the Renewal Date of this policy unless otherwise indicated by a separate endorsement, binder, or amended declarations. Any coverage forms attached to this notice are also effective on the Renewal Date of this policy. Policy changes requested after the "Date Prepared"will be sent to you as an amended declarations or as an endorsement to your policy. Billing for any additional premium for such changes will be mailed at a later date. If, during the past year, you've acquired any valuable property items, made any improvements to insured property, or have any questions about your insurance coverage, contact your State Farm agent. Please keep this with your policy. Your coverage amount.... , It is up to you to choose the coverage and limits that meet your needs. We recommend that you purchase a coverage limit equal to the estimated replacement cost of your structure. Replacement cost estimates are available from building contractors and replacement cost appraisers, or, your agent can provide an estimate from Xactware, Inc. using information you provide about your structure. State Farm does not guarantee that any estimate will be the actual future cost torebuildyour structure. Higher limits are available at higher premiums. Lower limits are also available, as long as the amount of coverage meets our underwriting requirements. We encourage you to periodically review your coverages,and limits with your agent and to notify us of any changes or additions to your structure, • Policy Number:97-CK-S482-9 Page 5 of 5 Prepared:August 8,2021 ©Copyright,State Farm Mutual Automobile Insurance Company,2008 CMP-4000 004104 State Farm at CityLine U PO Box 853925 Richardson, TX 75085.3925 090 State ear f ° • • State Farm Fire and Casualty Company CITY OF ASHLAND A stock company with home offices in Bloomington, Illinois 20 E MAIN ST ki• ASHLAND OR 97520-1814 . • S O O th cOo • Inland Marine Attaching Declarations , Policy number: 97-CK-S482-9 • Effective date: October 16, 2021 Policy period: 12 months Expiration date: October 16, 2022 The policy period begins and ends at 12:01 am standard time 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 compliance 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-CK-S 482-9 • Page 1 of 1 Prepared:August 8,2021 ©Copyright,State Farm Mutual Automobile Insurance Company,2008 CIM Att Dec 3P OR.1 1009481 2002 153089 202 03-06-2021 FD-6007 . nnA Inc , CMP:4787 Page 1 of THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. WAIVER OF TRANSFER OF RIGHTS OF RECOVERY AGAINST OTHERS TO US This endorsement modifiesinsurance provided under the following:. BUSINESSOWNERS COVERAGE FORM CO u) SCHEDULE., Policy Number:97-CK-S482-9 Named Insured: EMERGING FUTURES YOUTH NETWORK 1180 Park St Ashland OR 97520-3535 Name And Address Of Person Or Organization: City of Ashland j 20EMain St Ashland OR 97520-1814 The following is added to.Paragraph 10.b. of SECTION I AND SECTION II —COMMON POLICY CONDITIONS: We waive any right of recovery we may have against the person or organization shown in the Schedule because of payments we' • make for injury or damage'arising out of: f. a. Your ongoing operations; or b. "Your work" done under contract with that person or organization and included in the."products-completed operations hazard". This waiver applies only to the person or organization shown in the Schedule: All.other policy provisions apply. - j CMP-4787 151575 05-22-2017 @,Copyright, State Farm Mutual Automobile Insurance Company,2008 Includes copyrighted material of Insurance Services Office,'Inc.,with its permission. 004106 • u • CMP-4543' Page 1 of,1 THIS ENDORSEMENT'CHANGES THE POLICY. PLEASE READ IT CAREFULLY. • •:•r• r• 1 • ADDITIONAL INSURED—DESIGNATED PERSON OR ORGANIZATION • This endorsement modifies insurance provided under the,following: BUSINESSOWNERS COVERAGE FORM , • '§ SCHEDULE • Policy Number: 97-CK-S482-9 Named Insured: EMERGING FUTURES YOUTH NETWORK 1180 Park St Ashland OR 97520-3535 Name And Address Of Additional Insured Person Or Organization: City of Ashland . 20EMain St ' Ashland OR 97520-1814 1• SECTION II —WHO IS AN INSURED of SECTION II -LIABILITY is amended to include, as an additional insured, any person or organization shown in the.Schedule, but only with respect to.liability for "bodily injury", "property damage" or "personal and advertising injury" caused, in whole or in part,.by: a. Premises And Ongoing Operations • Your acts or omissions or the acts or omissions of those acting on your behalf: • (1) In connection with your premises; or (2) In the performance of your ongoing operations; or b. Products-Completed Operations "Your work" performed for that additional insured and included in'the "products-completed operations hazard". 2. Any insurance provided to the additional insured shall only apply'with respect to a claim made or a"suit" brought for damages for which you are provided coverage. 3. Primary Insurance. The insurance afforded the, additional insured, shall be primary insurance. Any insurance carried by the additional insured shall be noncontributory with respect to coverage provided by you.. All other policy provisions apply, • • CMP-4543 154961 04-17-2018 ©, Copyright, State Farm Mutual Automobile Insurance Company, 2018 Includes copyrighted material of Insurance Services Office, Inc.,with its permission.