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HomeMy WebLinkAboutAmended Insurance Certificate: Straw, Donald (6) State Farm Insurance u PO Box 2915 Bloomington, !L 64702-2915 090 StateFarme AT1 000607 1200 01 ,,.,,State Farm Fire and Casualty,Company L CITY OF ASHLAND A stock company with home offices in Bloomington, Illinois • 90'N MOUNTAIN AVE ASHLAND OR 97520-2014 • i_$ iiIiiiiiiiiiiiliiiivithlliilliliiiiiillliI1'Ililliiiiill'IIrili. _ . . , .o • Amended Declarations- ;V � •,- . . .. . . , ' . , , , f2-...-n„.::.:,,.„,:.,,,t.,,,:,..„,..5.. .,,,-.,,,,, ..).1ilt. , ,-,. ;,,,., t. Policy number:97-CP-D437-8 • Effective date:February 18, 2023 Policy period: 12 months Expiration date:February 18, 2024 The policy period begins and ends at 12:01 am standard time at the premises location: r`: „:, . ,e,.;,, ;i,N.. ,1,7 HOME PRODUCT SALES POLICY Automatic renewal -If the State Farm°policy period is shown as 12 months, this policy will be.renewed autometicallysubject to the • . premiums, rules and forms in effect for eachsucceedingpolicy 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, , NAMED INSURED .. , . '.31, :;,. :I .,i-., .:,':::Yi 'Ii' ._ . _.:,,r'. :,•; „1:.. DONALD STRAW , . ENTITY . . , , :• • Sole Proprietorship-Individual V • REASONS FOR DECLARATIONS . :.:•. " „ _ . _ _ .- _ Your policy is amended effective February 18, 2023 due to some regent policy changes you requested. Enclosed is a copy of your • new endorsements, if any. ti POLICY PREMIUM • This is not a bill.If an amount is due, then a separate statement will be sent prior to the due date. The premium(s)shown below are for the policy period and-policy characteristics as described in this Declarations. Increase in premium: $192.00 - - : Discounts applied: Business Experience Rating Renewal Discount . - ` Protective Devices . V " . ._. _ . Years in Business _ . Policy number:97-CP-D437-8 Page 1 of 6 Prepared:February 3,2023 ©Copyright,State Farm Mutual Automobile Insurance Company, 2008 • CMP Dec 3P OR.1 CMP-4000 V 1009482 2006 153090 206 08.21-2021 06'StateFarm® SECTION I-PROPERTY SCHEDULE-BLANKET Limit of Insurance* Coverage A-Buildings: $1,093,200 5 Coverage B-Business Personal Property: $491,400' Location Location of described premises Seasonal Increase number Business Personal Property 001 '427.N RIVERSIDE AV 25% t MEDFORD OR 97501-4602 • 003 516 S FIR ST - 25% -MEDFORD OR 97501-3616 *As of theeffective 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: s 216.3 Coy B-Consumer Price Index: "298 SECTION I—DEDUCTIBLES • BASIC DEDUCTIBLE $1,000 • SPECIAL DEDUCTIBLES: . :<s.1. V. :+{" Employee Dishonesty: . $250. , . ' Equipment Breakdown: Money and Securities:'` $250 Other deductibles may apply-refer to'policy, • ' ' • SECTION I—EXTENSIONS OF COVERAGE-LIMIT OF INSURANCE-EACH DESCRIBED PREMISES '' ' ' ' r 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 has"Included" indicated;,refer to that policy provision for an explanation of that coverage. ' Coverage Limit of Insurance t., Accounts Receivable . See Schedule ' Arson Reward $5,000 - • Back-up of Sewer or Drain See Schedule • • _' Collapse , :. • .. 'Included' '. ' , ' Damage to Non-owned Buildings from Theft;Burglary or Robbery.. Coverage BLimit Debris Removal 25%of covered loss Equipment Breakdown 'Included r .' Fire Department Service.Charge $2,500 Fire Extinguisher Systems Recharge Expense $5,000 Forgery or Alteration .• • $10,000 Glass Expenses• . Included Policy number:97-CP-D437-8 Page 2 of 6 Prepared:February 3,2023 ©.Copyright,'State'•Farm,MutualAutomobile.Insurance Company, 2008 ' , • • CMP-4000 • . . U a StateFarrri® Coverage Limit of Insurance • , , . .. LA • Increased 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, . _. . S Money and Securities - . See Schedule. • 0 coo 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 • - - . • See.Schedule • - Personal Effects(applies only to those premises provided Coverage B-Business Personal Property)- $2;500 • . Personal Property Off Premises - - • $25,000 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 See Schedule,. ,.. ' . • •• - Property) - . .. _. . ' Signs • • - -•. -- - ,• - • - -, . . . .• See Schedule - - Valuable Papers and Records - - See Schedule Water Damage, Other Liquids,Powder or Molten Material Damage -- - -- Included - SECTION I—EXTENSIONS OF COVERAGE-LIMIT OF INSURANCE-SCHEDULE The coverages and corresponding,limits shown below apply,only to the described premises as shown. Location Coverage Limit of Insurance number ' • 001 -- • - Accounts Receivable- - - -- - - -:-• --• - - • •• • • - - On Premises Limit • • - - - - - • - $10,000 - . • - Off Premises Limit - • - :- $5;000 .... •-Back-up of Sewer or Drain - - - -. $15,000 -- - - - • .-_ -- - --- ----Money and Securities - - - - -- . . ... .-- - - _- . On Premises Limit $10,000 Off Premises Limit $5,000.' ' ' " ' • Outdoor Property $5,000 • , Property of Others(applies only to those premises provided Coverage , $2,500 - , - ,- • B-Business Personal Property) ..... . - . .. ._. - • Signs $5,000 ' . - • Policy number:97-CP-D437-8 Page 3 of 6 Prepared:February 3,2023 ©Copyright, State Farm,Mutual Automobile„Insurarice,Company, 2008 . CMP-4000 e StateFarm® Location Coverage ' ' .Limit of Insurance number Valuable Papers and Records On Premises Limit ' $10,000 Off Premises'Limit . • $5,000 . . . 003 Accounts Receivable • . . . ' • . • . ' • -On Premises Limit _ •- .. $10,000 , • , - -Off Premises Limit $5,000. _-- • Back-up of Sewer or Drain , _ $15,000 • Money and Securities . On Premises Limit $10,000. - Off Premises Limit • $$,000 • Outdoor Property . .. - - .$5,000 - • , - Property of Others(applies only to those premises provided Coverage $2,500 . • . B-Business Personal Property), Signs _ _ $§,000. - . Valuable Papers and Records. - • On Premises Limit -$10,000 - . . . . .-Off Premises Limit--- ... - ._.. . • • $5,000 - .. 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 Chown in these Declarations; .Coverage - ... ,. .. . . . .. Limit of Insurance' Dependent Property-Loss of Income -- " - $5,000 -- '• . Employee Dishonesty . •. $10,000 Loss of Income and Extra Expense 12 Months Actual Loss Sustained Utility Interruption-Loss of Income • $10,000 SECTION II-LOCATION SCHEDULE . . Location Location of described premises number 001 427 N RIVERSIDE AV ' MEDFORD 0R 97501-4602 003 516 S FIRST MEDFORD0R 97501-3616 Policy number:97-CP-D437-8 , - Page 4 of 6 Prepared:February 3,2023 ©'Copyright,'State FarmMutualAutomobile,insurance Company,-2008 • ' CMP-4000 II StateFarmo SECTION II-DEDUCTIBLES nProperty Damage: $250 Other deductibles may apply-refer to policy. SECTION II-LIABILITY § Coverage Limit of Insurance 1,75 c8 Coverage L-Business Liability Per Occurrence . ,. $1,000,000 Coverage•M-Medical Expenses , $10,000 Any One Pecson . Damage to Premises Rented to You $300,000 Hired Auto Liability ' Included in Coverage L . „ . . Aggregate Limits Limit of Insurance General Aggregate , o $2,000,000 • Products/Completed Operations 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(Oregon) CMP-4527 Marijuana Exclusion CMP-4561.1 Policy Endorsement CMP-4610.1 General Aggregate Limits of Insurance(Per Project) 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 CMP-4710 Employee Dishonesty CMP-4746.1 Hired Auto Liability CMP-4787 'Waiver of Transfer of Rights of Recovery Against Others'To Us CMP-4839 Loss Payable 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: Owners,Lessees, or Contractors(Schedul Endorsement number: CMP-4684.1 Loan number: N!A CITY OF ASHLAND 90 N Mountain Ave Ashland OR 97520-2014 Policy number:97-CP-D437-8 Page 5 of 6 Prepared:February 3,2023 ©Copyright, State Farm Mutual Automobile,Insurance Company, 2008 CMP-4000 80 StateFarme FULL NAMED INSURED ;t Named Insured: DONALD E STRAW DBA FASHION FLOORS This'policy is issued by the State Farm Fire and Casualty Company, PARTICIPATING POLICY '. You are entitled to participate-in a distribution'of theearnings 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///tete.44;1-t;0 President Secretary 'J a y ani' • • Policy number;97-CP-D437-8 ' Page 6 of 6 Prepared:February 3,2023 ' ©Copyright,State FarmMutualAutomobile.Insurance Company,20D8 CMP 4000 • State Farm Insurance U . PO Box 2915 . r /� ,Bloomington, lb 61702-2915 C O StateFarnr State Farm Fire and Casualty Company 'CITY OF ASHLAND ' ` ' A stock company with home offices iritloorriington, Illinois 1 Li -90 N-MOUNTAIN AVE • - . . .- . , . - . - . . - ASHLAND OR 97520-2014 .. • S , +f ' R • Inland Marine Attaching Declarations : • ' • . . . • Policy number: 97-CP-D437-8 Effective;date: February 18, 2023 • Policy period: 12 months •Expiration date: February 18, 2024 • 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: $374.00 The above premium amount is included in the Policy Premium shown on the Declarations. FULL NAMED INSURED . Named Insured: DONALD.E STRAW DBA FASHION FLOORS 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 Amendment of Inland Marine Conditions FE-8739 Inland Marine Conditions FE-8743.1 Inland Marine Computer property Form FE-8754 Inland Marine Dealers-Service 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 • FE-8754' Inland Marine Dealers-Service Form $500 $374 Policy number:97-CP-D437-8 .Page 1 of 2 Prepared:February 3,2023 ©'Copyright,-,State.-Farm Mutual Automobile;Insurance Company, 2008 _ CIM Att Dec 312 OR.1 FD-6007 1008481 2002 153089 202 03-06-2021 °°o StateFarmo Endorsement Coverage Limit of insurance Deductible amount Annual premium number Description of Property:FLOOR COVERINGS&TOOLS 1.Insureds property on customers premises limit $10,000 2.Customers property in insureds custody limit $10,000 3.Property in transit limit $5,000, 4.Tools,Servicing Equipment,Spare Parts limit $2,000 Other limits and exclusions may apply-refer to your policy. • • •' ' • • • ^r: • Policy number:97-CP-D437-8 Page 2 o 2 Prepared:February 3,2023 ©Copyright; State.Farre Mutual•Autoriiobile Insurance Company, 2008 r FD-6007