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HomeMy WebLinkAboutInsurance Certificate: Rogue Boiler Works LLC STATE FARM.FIRE AND CASUALTY COMPANY AMENDED AUG 11 2023 A STOCK COMPANY WITH HOME OFFICES IN BLOOMINGTON,.ILLINOIS, DECLARATIONS 0'0® Po Box 2915 • • Policy Ntimber 97-CP-V962-2 Bloomington IL 61702-2915 • •r • o %,„; , ; , • - • ". Addl Insured-Section II Only Policy Period Effective Date Expiration Date M-15-2275-FAE6 F E 1 Year JAN 2 2023 JAN 2 2024 001325 3123 The policy period beginsAnd ends at12:01'am standard THE CITY OF ASHLAND, OREGON time atthe premises-Location. ITS OFFICERS, AGENTS AND EMPLOYEES 90 N MOUNTAIN AVE Named Insured ASHLAND OR 97520-2014 ROGUE. BOILER WORKS LLC 0411.11phhhwidvd h11.141111-0..01.h011HullPI - • (I0 Artisan And Service Contractor Policy:, Automatic Renewal If the policy period is shown as 12 months,this policy will be renewed automatically subjectto the premiums rules and forms ilieffect for each succeeding pokey period:If this policy ia terfninated we will give you and the Mortgidee/Lienholder Writfen notice in .; compliance with the policy provisions or as required by law.,, • , -Entity: Limited Liability Company Reason for Declarations: Your policy is amended AUG 1:1'2028 • LOCATION ADDRESS Q171ANGED • • e . • e - A I , ,A • +•, • • g •A, • • A • • • • • • . • . • Endorsement Premium Increase $ 37.13 Audit Period:Annual Discounts Applied: • Renewal Year Years in BOsiness Claim Record • • • • • • • Prepared OCT 12 2023 ©Copyright State Farm Mutual Automobile Insurance Company,2008 • CMP-4000 OR Includes copyrighted material of Insidance SerVibes Offiee,Inc.,with its permission. ' 009808 296 Al Continued dri ReVerse Side of Page Page 1-Of' 6 DECLARATIONS'(CONTINUED) ' Artisan And Service Contractor Policy'for'THE CITY OF ASHLAND,OREGON • Policy Number 97-CP-V962r2 • SECTION I- PROPERTY SCHEDULE • Location Location of Limit of Insurance* Limit of Insurance* Seasonal Number 'Described ' - Increase- Premises . Coverage A •CoverageB•: Business Buiid�ngs `Business Personal " "Personal ., ... ' i.';. _ . . ,. .Property f •Property "001-- 615 ROGUE AIR DR No Coverage ' " $. 85,500 SHADY COVE OR 97539-9822 *As of the effective date of this policy,,the Lirbit 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: 296.8 SECTION I- DEDUCTIBLES Basic Deductible .$1,000' Special Deductibles: Equipment Breakdown $1,000 Other deductibles may apply- refer to policy. „ r., • • • Prepared ' OCT 12 2023 O Copyright,State,Farm Mutt;el Automobile Insurance Company,2008. CMP-4000 OR' Includes copyrighted material of Insurance Servicuus office,Inc,,with its;permission. 009808 Continued on Next Page Page 2 of 6. O O'o® DECLARATIONS(CONTINUED) Artisan And Service Contractor Policy for THE CITY OF ASHLAND,',OREGON Policy Number 97-CP-V962-2' • SECTION I- EXTENSIONS OF.COVERAGE LIMIT OF INSURANCE- EACH DESCRIBED:PREMISES • The coverages and corresponding limits shown below apply separately toeach described premises shown in these a Declarations,unless indicatedby"See Schedule. If a coverage does not have a corresponding limit shown below,. Io but has"Included indicated,,please,refer.to that.policy provision'.for an explanation of.that coverage.CO . LIMIT OF COVERAGE INSURANCE Accounts.Receivable ,On Premises ;; $10,000 ' .Off Premises $5,000 Arson Reward , . 45,000 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 $2 500 Fire Extinguisher Systems Recharge Expense • $5,000 • Forgery Or Alteration r_s:, - - . $10,000 Glass Expenses Included •Increased Cost Of Construction And Demolition Costs (applies only when buildings are: ,.. .-} . 10% insured on a replacement cost basis) 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) Ordinance Or Law Equipment Coverage Included Outdoor Property . $5,000 Prepared OCT 12 2023 .' ©Copyright,State Farm Mutual Automobile Insurance Company,2008 CMP-4000 OR Includes copyrighted material of Insurance Services Office,Inc.,with its permission. • Oo9809 290 Continued on Reverse Side of Page Page 3 of 6 DECLARATIONS,(CONTINUED) Artisan And Service Contractor PoliCylor,..RiE CITY OF ASHLAND,,OREGON Policy Number 97-CP-V962-2 - • " • ," . • ' • Personal Effects (applies only to those premises provided Coverage B- Business $2,500 Personal Property) „ Personal Property Off Premises $15,000 •— Pollutant.ClearibbAndReinbVai: : • . •1 :$10,090--'-sj • Preservation Of Property 30 Days < 'Property Of Others thciSe'bretn.ises'Pi.CVidecl'bsoVe'tage B'2.134.1SineS's ' ' $2',500 ' Personal Property) Sighs .• " $2,500 • Valuable.Papers And Records • , “On' Ptemises . • "$10,900 'Off Premises : • $5,000 Water Damage, Other Liquids, Powder Or Molten Material Damage • Included , SECTION II- DEDUCTIBLES Business Liability- Property carnage $500 Other deductibles may apply- refer to policy. SECTION II LIABILITY LIMIT OF COVERAGE INSURANCE Coverage L- Business Liability' — ' • " : $2,000 000 ".: • Coverage M - Medical Expenses'(Any One Person) : ,, , $10,0,09, rt •. Damage To Premises Rented To You ; $100,000 • , LIMIT OF ' AGGREGATE LIMITS • INSURANCE ' - Products/Completed Operations Aggregate • • $4,000;000 • -. Prepared OCT 12 2023, , copyright,St p FarmIViuttialAutdionile Insurance Company,2008 CMP-4000 OR includescopyrighted material Of,!nstiranOe'8,eryicee'ptfiCe,Inc with its permission. • . . 009809 • Continued on Next Page Page, 4 of ,6 O _ . . . ovo. DECLARATIONS(CONTINUED) . ' sl . • Artisan And Service Contractor Policy foe,THECITY'OF ASHLAND,'OREGON �'!` " `' ; •:; "- Policy Number 97-CP-V962-2 ` • General Aggregate $4,000,000 • Each paid claim for Liability Coveragereduces the amount'of•insurance°we•� ro'vide duriri' the'a'` licable • annual period. Please refer to Section II - Liability in the Coverage Form and'any'attached endorsements. tC8j}'. (•.1 u ...il. _ 1. :.i ., :_!^".r Y Ir r lt._ .1 .. i ih„ ' CO 0 Your policy consists of these Declarations, the BUSINESSOWNERS.COVERAGE FORM'.shown below;`arid 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 Forrn • CMP-4600 Artisan and Service Contractor FE-6999.3 . Terrorism Insurance Coy Notice CMP-4237.1 Amendatory Endorsement FE-3650 . ' Actual Cash Value.Endorsement CMP-4561.1Policy Endorsement CMP-4683.1 Addl ins Owners Lessee Blkt CMP-4684:1 Addl Insd Owners Lessee Sched • CMP-4787 'Waiver of Trans'Rgt of Recov CMP-4527 Excl Ctrl Substances CMP-4875 Loss Payable FD-6007 Inland Marine Attach.Dec. " • • • • ,C; Prepared OCT 12 2023 ©Copyright State Farm Mutual Automobile Insurance Company,2008 CMP-4000 OR Includes copyrighted material of Insurance Services Office,Inc.,with its permission. k• '' 009810 290 Continued on Reverse Side of Page Page 5'6f 6 DECLARATIONS;(CONTINUED) Artisan And Service Contractor Policy for THE.CITY,OF ASHLAND, OREGON ;,. . , Policy Number. 97-CP-V962-2 . .:� _ _ - . ,ti,, • This policy is issued b.y,the.State'Farm.Fire,and;Casualty Company, ;. i , Participating Policy • You are entitled toparticipate in.a distribution of the earnings Of the company as determined by our Board of Directors in accordance with the Company's Articles Qf 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;Bloornington;Illinois: -, x, Secretary President •- . . ' 1. , '1, • Prepared • 9 Copyright,State farm Mutual Automobile Insurance Company,2008 OCT 12 2023. Mutual CMP-4000 OR includes copyrighted.material of Insurance Services Offpe;lnc.;with its permission. ' 099910 290 Page 6 of_ 6 N . juncra►n► STATE FARM;FIRE AND CASUALTY COMPANY OO® ASTOCK COMPANY WITH'HOME OFFICES 1NBLOOMINGTON ILLINOIS•INLAND MARINE ATTACHING DECLARATIONS Eggox 2915 .Polic• Number 97-CP-V962-2 mington IL 67702-2915 - y' Named Insured Policy Period Effective Date Expiration Date M-15-2275-FAE6 F E 1 Year . JAN 2 2023 JAN 2 2024 The policy period begins and ends at 12:01 am standard ROGUE BOILER WORKS LLC - time attne premises location. • f ATTACHING INLAND MARINE • Automatic Renewal-If the policy period is shown as 12 months,this policy willbe 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'andthe Mortgagee/Lienholderwritten notice in compliance with the policy provisions or as requiredby law. Annual Policy Premium $ 100.00 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, • Fonns,Options,and Endorsements FE-8739 - Inland Marine Conditions • FE-6867 Amend of Inland Marine Condtns FE-8743.1 '' Inland Marine Computer Prop FE-8756.1 Installation Endorsement FE-8760 Mobile Equipment Form • See.Reverse for Schedule Page with Limits Prepared :. OCT 12 2023 ©Copyright,StateFarm Mutual Automobile Insurance Company,2008 FD-6007 Includes copyrighted material of insurance Services'Office',Inc„with its permission. 009811, yiwr-vyvz-c ,• , ' 'ATTACHING-INLAND MARINE SCHEDULE PAGE - ' • i • - . ATTACHING INLAND MARINE._.. '_ ENDORSEMENT - LIMIT OF' `DEDUCTIBLE`, ANNUAL NUMBER , COVERAGE - '. INSURANCE AMOUNT PREMIUM FE-8743.1 'Inland Marine Computer Prop $ ' 25,0 0 0 ' $ 5 0 0- Included f ' FE-8760 .Mobile Equipment'Form.' • . $ 20.,.0 0,0. $ 500 $ 10.0 .0 0. FE-8756:1. Installation Endorsement •• , $ 5,000 ' .S , 500 ,; _Included . , Property in Transit . , $ , 5,0 0.0 . . ,'- , - ' Number of Job-Sites: 1 - -- - - , • • OTHER LIMITS AND EXCLUSIONS MAY APPLY: REFER TO YOUR POLICY ' ' Prepared OCT 12'2023 r ©Copyright,State Farm Mutual Automobile Insurance, Company,2008 . FD-6007 Includes copyrighted material of Insurance Services Office,,Ino,,with its permission. ' ' 009811 • 530.566 a,2 65-31-2011(QUF3233c1.