Loading...
HomeMy WebLinkAboutAmended Insurance:Studio Fuwafuwa LLC State Farm at CityLine `J PO Box 853925. Richardson, TX 75085-3925 OCJ State Farms All 000543 1200.01 State Farm Fire and Casualty Company CITY OF ASHLAND A stock company with hori'ie,offices''in'Bloomington;Illinois 20EMAIN ST ASHLAND OR 97520-1814 0 �o IIIIIhIIrtIIIIlIIIhh1IIIhIIrhIlIIIIIIhIIhIIIIh111111rIIIIIIIIrIh1 • • Amended :Declarations Policy number: 97-CP-D380-6 Effective date: July 8, 2021 .• ' Policy period: 12 months, Expiration'date: February 14, 2022 '.. . , ' The policy period begins and ends at 12:01 em standard time at the premises location. OFFICEPOLICY Automatic renewal If the State Farm®policy,period.is4shown;a0,12.months ithis polipy,will bei,renewed automatically;subject;toAheK.. premiums,rules,and,forms in effect for each succeeding.policy period If this policy is terminated, we will give you and the. MortgageelLienholder written_notice in compliance with the policy provisions'oras required by law "' " NAMED INSURED STUDIO FUWAFUWA, LLC POBOX 103 , ' MEDFORD OR 97501-0007 ENTITY Limited Liability. Company REASONS FOR DECLARATIONS Your policy is amended effective July 8,2021 due to some recent policy changes you.requested, Enclosed is a copy of your new endorsements, if any. POLICY PREMIUM This is not a bill.Ifari amount is,due, then a separate statement will be sent prior to the due'date. The premiums)shown below is the 12 months premium(s)for the characteristics-of the policy as described in this Declarations. . . .. ' - Total Premium: $325.00 Minimum Premium Discounts applied: Business Experience Rating Renewal Discount • Years in Business - Business in Residence Premises- Policy Number:97-CP-D380-6 i Page 1 of 5 Prepared:July 8,2021, ..©.Copyright,State Farm Mutual Automobile Insurance Company,2008 CMP Dec 3P OR.1 1009482 2003 153090 203 04-10-2021 CMP-4000 002138 OF'CJ State Fal 11I SECTION I=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. 27 SUMMIT AVE 'No Coverage , $17,000 . 25% • •MEDFORD OR 97501-2647 *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: N/A' , Coy B-Consumer Price Index: ' 260.4 • SECTION I—DEDUCTIBLES BASIC DEDUCTIBLE ,$1,000 SPECIAL DEDUCTIBLES: Employee.Dishonesty: $250 s: Equipment Breakdown: $1,000 " ' Money and Securities: $250 Other deductibles may apply-refer to policy. ;, ; SECTION"-EXTENSIONS'OF COVERAGE LIMIT OF INSURANCE•EACH DESCRIBED PREMISES The coverages and corresponding limits shown below apply separately to each described premises fshdwn in these Declarations, " unless indicated by"See schedule".'If a coverage does not have a correspondingllimit'shown"below;'but has"Included" indicated`,`refer to that policy provision for an explanation of that coverage. •4,2 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- ' CollapseIncluded ' 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-D380-6 Page 2 of 5 Prepared:July 8,2021 ©'Copyright,State Farm Mutual Automobile Insurance Company,2008 , .• . CMP-4000 LI 090 StateFarm® Coverage Limit of Insurance'':•> 'IC s '-1 ; ., EktIncreased Cost of Construction and Demolition Costs(applies only when buildings are insured on a 10% ' • ' replacement cost basis) _ Money Orders and Counterfeit Money • $1,000 § Money and Securities • - • -- - . • - - 1—N On Premises $10,000 "1 'r`' ' (0o Off Premises $5,000 Newly Acquired Business Personal Property(applies'only if,this policy provides Coverage.B-Business $100,000 .' . • '• • ' Personal Property) , ' ,'Newly Acquired or Constructed Building's(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) $2,500 - . . Signs $2,500 Unauthorized Business Card Use $5,000 .• Valuable Papers and Records ' On Premises $50,000' ' •• • ; • Off Premises $15,000 . •• Water Damage, Other Liquids,Powder or Molten Material Damage ' .o.'' Included• - , ' ' ' . ' 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'nyrnber.of described premises'shown in these Declarations. , ; . Coverage ' Limit.of Insurance.' - Dependent Property-Loss of Income $5,000 • V V Employee Dishonesty $10,000 'j' t, i ,..ii,`! t„.• << :,` Loss of Income and Extra Expense 12 Months Actual Loss_Sustained. ,. .- , •., Utility Interruption-Loss of Income . ' $10,000 • •Policy Number:97-CP-D380-6 Page 3 of 5 • • Prepared:July 8,2021 ©.Copyright,State Farts Mutual Automobile Insurance Company,2008 . ' • CMP-4000 1 ' 002139 StateFarme SECTION II-LOCATION SCHEDULE . Location Location of described premises number 001 27 SUMMIT AVE MEDFORD'OR 97501-2647 -. `. SECTION II-LIABILITY , • Coverage Limit of Insurance Coverage L-Business Liability Per Occurrence .. , . ' $2,900,000 , ,. Coverage M-Medical Expenses . $5,000 Any One Person -. • Damage to Premises Rented to You $300,000 .: . . Aggregate Limits . . . • Limit of Insurance , Products/Completed.Operations Aggregate $4,00,0,000; . General Aggregate $4,000,000 t 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 shownbelow,and any other forms andendorsements 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 CMP-4705.2 - Loss of Income and Extra Expense .' - ° . - . CMP-4706 Back-up of Sewer or Drain CMP-4709 Money and Securities ;? ..'� ..t F'°C: t .. , ,, • ''•••:;.; ',. �:P'''' � ; .'re 1!! . . . CMP-4710 Employee Dishonesty ;,. - CMP-481.9.1 Unauthorized Business Curd Use • CMP-4875, Loss Payable ' 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: . Loss Payable-All Other ` . . . "' ' ' Endorsement number: CMP-4875 , Loan number: N/A City of Ashland .. ... 20 E Main St Ashland OR 975201814 • Policy Number:97-CP-D380-6. •' . Page 4 of 5 Prepared:July 8,2021 ©Copyright,State Farm Mutual Automobile Insurance Company,2008 CMP-4000 • Q90 Statefarrn! • This policy is issued by the State Farm Fire and Casualty Company. EINVeg PARTICIPATING POLICY •• 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 �o Bloomington, Illinois. ' )6/40.4440., /vr �ACeI �- rn' President Secretary • • • • • Policy Number:97-CP-D380-6 Page 5 of 5 Prepared:July 8,2021 ©Copyright,,State Farm Mutual Automobile,Insurance Company,2008 CMP-4000 002140 State Farm at CityLine • PO Box 853925 Richardson, TX 75085-3925 090 StateFarmn® • 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 • 0 4 Inland Marine Attaching Declarations Policy number: 97-CP-D380-6 . • • Effective date: July 8, 2021 • Policy period: 12 months Expiration date:February 14, 2022 The policy period begins end 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 MortgageelLienholder 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-CP-D380-6 Page 1 of 1 Prepared:July 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 002141