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HomeMy WebLinkAboutInsurance Certificate: Ashland Food Angels mare,-arm STATE FARM FIRE AND CASUALTY COMPANY U Q A STOCK COMPANY WITH HOME OFFICES IN BLOOMINGTON,ILLINOIS DECLARATIONS 00® Po Box 85392�5g� Policy Number . . ,. 97-CL-L656-3 ., Richardson, TX 75085-3925 Addl Insured-Section II Only_ Policy Period . Effective Date Expiration Date M-15-9C9E-FAE6 F N ' 12'Months JUL 29 2019 JUL 29 2020 001765 3123 The policy period begins and ends at 12:01 am standard CITY OF ASHLAND 'ITS OFFICERS & .. time atthe premises-Wootton. EMPLOYEES Y.' 20 E MAIN ST ASHLAND OR' ' 97520-1814 Named Insured r-. ' . ASHLAND FOOD ANGELS 472 WALKER;'.AVE - r .. •, 11.I.1h1PI1IIIIII11II1'II0I.1i1IllldlilllIIIIIIIlllhl'I' '" ASH'LAND OR .~ 975.20 2324 S Businessowners.Policy" , Automatic Renewal-'If the policy period is shown as 12'months,this policy will be renewed automatically subjectto the premiums,rules and forms in effect for each succeedingpolicy period.If this policy is terminated,we will give you and the Mortgagee/Lienholder written noticein compliance with the policy provisions or as required by law. Entity: NON-PROFIT POLICY PREMIUM ' $ ' 465.00 >' Minimum Premium Discounts Applied: Years in Business` Protective Devices • Prepared AUG 01 2019 ©Copyright,State Farm Mutual Automobile Insurance Company,2008 CMP-4000 OR Includes copyrighted material of Insurance Services Office,Inc.,with its permission." • • 014186 290 Al Continued`onReverse Side of Page Page 1 of 6 DECLARATIONS(CONTINUED) Businessowners Policy for CITY OF ASHLAND ITS OFFICERS & Policy Number 97-CL-L656-3 , SECTION I-PROPERTY SCHEDULE Location Location of Limit of Insurance* Limit of Insurance* Seasonal Number Described Increase Premises BCoverage A- Coverage B Business .. uildings.: Business Personal Personal Property Property 001 472 WALKER AVE • No Coverage •- $ 10,000 25% • ASHLAND OR 97520-2324 *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: 256.1 SECTION I-DEDUCTIBLES • Basic Deductible . $1,000 • Special Deductibles: Money and Securities $250 Equipment Breakdown $1,000 . , Other deductibles may apply- refer to policy. Prepared AUG 01 2019 ®Copyright,State Farm Mutual Automobile.Insurance. Company,2008. CMP-4000 OR Includes copyrighted material of Insurance Services Office;Inc,with its permission. 014186 Continued on Next•Page - Page '2 of 6 3rarerarmu O .. . . _ t 0'0® . DECLARATIONS(CONTINUED) ' Businessowners Policy for CITY OF ASHLAND ITS OFFICERS& - Policy Number 97-CL-L656-3 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,• F.-8 but•has"Included" indicated, please refer to that policy provision for an explanation of that coverage. . coo . ..LIMIT OF • COVERAGE INSURANCE Accounts Receivable . On Premises • . . $10,000 ,'Off Premises $5,000 Arson Reward - , • $5,000 . Collapse - Included Damage To Non-Owned Buildings From Theft, Burglary,Or Robbery. •. - Coverage B Limit Debris Removal .25%of covered loss Equipment Breakdown V Included Fire Department Service Charge , . - . ' $2,500 Fire Extinguisher.Systems,Recharge Expense .,. . . .,$5,000 Forgery Or AlterationV • V $10,000 V Glass Expenses . Included -Increased Cost Of Construction And Demolition Costs (applies only when buildings are ' . 10% . insured on a replacement cost basis) . Money And Securities (Off Premises) $2,000 Money And Securities (On Premises) $5,000 Money Orders And Counterfeit Money . $1,000 - Newly Acquired Business Personal-Property(applies only if this policy provides $100,000 Coverage B- Business Personal.Property) Newly Acquired Or Constructed Buildings (applies only if this policy provides $250,000 Coverage A- Buildings) V , Prepared - AUG 01 2019 ©Copyright,State Farm Matual Automobile Insurance Company,2008 • • n.CMP-4000 OR Includes copyrighted material.oi Insurance Services Office,Inc.,' with its permission. , 014187 290 • Continued on Reverse Side of Page Page ''3 of 6 Al DECLARATIONS(CONTINUED), Businessowners Policy for CITY OF ASHLAND ITS OFFICERS&, Policy Number 97-CL-L656-3 • Ordinance Or Law- Equipment Coverage Included Outdoor Property . $5,000 Personal Effects (applies,only to those premises provided Coverage B- Business; ., . $2,500 , Personal Property) • . ' 'Personal: Property Off Premises y = $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 . _$2,500 ' Personal Property) Sighs .. $2,500 Valuable Papers And Records On Premises $10,000 Off Premises $5,0000 . Water Damage;‘Other Liquids, Powder Or'Molten Material Damage ': • =• 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 number-•of described premises shown in these Declarations. . LIMIT OF COVERAGE ' " INSURANCE Loss Of Income And Extra Expense Actual Loss Sustained.-12 Months r• SECTION II- LIABILITY . . .. LIMIT OF COVERAGEINSURANCE Coverage L- Business Liability '$1;000,000 Prepared . AUG 01 2019 ,©Copyright,State Farm Mutual Automobile,Insurance Company,2008 CMP-4000 OR Includes copyrighted material of Insurance Services Office,Inc.,with its permission. 014187.' Continued on Next Page Page. 4 of 6 rarerarm u o o-o® DECLARATIONS(CONTINUED) ` . Businessowners Policy for CITY OF ASHLAND ITS OFFICERS & ' • - . • . Policy Number 97-CL-L656-3 Coverage M - Medical Expenses (Any One Person) , $5,000 IliDamage To Premises Rented To You $300,000 LIMIT OF AGGREGATE LIMITS • • ' INSURANCE $ Products/Completed Operations Aggregate 0 : $2,000,000 General Aggregate $2,000,000 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 CMP-4561.1 Policy Endorsement CMP-4705.2 Loss of Income & Extra Expnse FE-3650 Actual Cash Vlue Endorsement CMP-4709 Money and Securities CMP-4527 Excl Ctrl Substances FE-6999.2 Terrorism Insurance Cov Notice CMP-4798 Addl Insd Grantor of Franchise FD-6007 Inland Marine Attach Dec ' .. • Prepared ' AUG 01 2019 ©Copyright,State Farm Mutual Automobile Insurance Company,2008 • CMP-4000 OR Includes copyrighted material of Insurance Services Office,Inc.,with its permission. 014188 290 Continued on Reverse Side of Page Page 5 of 6 DECLARATIONS(CONTINUED) Businessowners Policy for CITY OF ASHLAND ITS.OFFICERS&. Policy Number ' 97-CL-L656-3 • This policy is issued by the State Farm Fire and Casualty Company. 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 Bloomington, Illinois. 1 -'-rt,Itg,)11-1f44440- • . . Secretary • President 1. Prepared ©Copyright,State Farm Mutual Automobile Insurance Company,AUG 01 2019p v.2008 CMP-4000 OR Includes copyrighted material of Insurance Services Office,Inc.,with its permission. 014188 290 Page 6 of 6 N ararerarm STATE FARM FIRE AND CASUALTY COMPANY • ' LJ O A STOCK COMPANY WITH HOME OFFICES IN BLOOMINGTON,ILLINOIS INLAND MARINE ATTACHING DECLARATIONS 00® Po aox 853925, Policy Number 97-CL-L656-3 Ric ardson, 75085-3925 Named Insured • Policy Period Effective Date Expiration Date M-15-9C9E-FAE6 F N 12 Months JUL 29 2019 JUL 29 2020 The polipy period begins and ends at 12:01 am standard ASHLAND FOOD ANGELS • time atthe premises location. 472 WALKER AVE • ASHLAND OR 97520-2324 S O ATTACHING INLAND MARINE 0 Automatic Renewal-If the 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 subsequentto the issuance of this policy. Forms,Options,and Endorsements FE-8743.1 Inland Marine Computer Prop FE-8739 'Inland'Marine Conditions FE-6867 Amend of Inland Marine Condtns • See Reverse for Schedule Page with Limits • • Prepared , AUG 01 2019 ©Copyright;State Farm'Mutual Automobile Insurance Company,2008 FD-6007 ' Includes copyrighted material of Insurance Services'Office,Inc.,with its permission. • 014189 • 5311-firm n:7 nH-31-7n11 In1F3737c1 v�-vim-r.vvv-v - ATTACHING INLAND MARINE SCHEDULE PAGE• • ATTACHING INLAND MARINE • • • ENDORSEMENT LIMIT OF DEDUCTIBLE ANNUAL NUMBER COVERAGE INSURANCE AMOUNT PREMIUM FE-8743.1 Inland Marine Computer Prop • $ 25,000 $ 500 Included Loss of Income and Extra Expense $ 25,000 Included • - • • • • OTHER LIMITS AND EXCLUSIONS MAY APPLY.-REFER TO YOUR POLICY Prepared AUG 01 2019 ®Copyright,State Farm Mutual Automobile Insurance Company,2008 FD-6007 Includes copyrighted material of Insurance Services Office,Inc.,with its.permission. 014189 530-666 8.2 05-31.2011 1o1f323f marerarm 97-CL-L656-3 014190 CMP-4798 u 0(D® Page 1 of 1 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. t1.YCCtAla eje INIa,R.0N4CMP-4798 ADDITIONAL INSURED— GRANTOR OF FRANCHISE r.. t This endorsement modifies insurance provided under the following: BUSINESSOWNERS COVERAGE FORM . SCHEDULE Policy Number: 97-CL-L656-3 ,114 (no Named Insured: ASHLAND FOOD ANGELS 472 WALKER AVE ASHLAND OR 97520-2324 Name And Address Of Additional Insured Person Or Organization: CITY OF ASHLAND ITS OFFICERS& EMPLOYEES 20 E MAIN ST ASHLAND OR 97520-1850 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 their liability as grantor of a franchise to you. . 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 pro- vided by you. All other policy provisions apply. CMP-4798 ©,Copyright,State Farm Mutual Automobile Insurance Company,2008 Includes copyrighted material of Insurance Services Office, Inc.,with its permission.