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HomeMy WebLinkAboutInsurance Certificate: Studio Fuwafuwa LLC State Farm at CityLine LJ • PO Box 853925 ' . Richardson, TX 75085-3925 Q_Q StateFarm' AT2 000583 1200 01 State Farm Fire and Casualty Company k.gi , CITY OF ASHLAND A stock company with home"offices-in Bloomington,-IIlirials 20 E MAIN ST M: ASHLAND,OR 97520-1814 . , icA 0 111111111111191"111114111111111111111111111111111111110-111111 • ' 0o :C:=.�y':. .. •.,r; .,.. fit'^`. ';'•)1'',...'.:•',• Declarations • -- - ' :- ---- - Renewal • . ' ' , , - • , - , , ._ 't 300.,.r,J 3;{-..i;., li: • Policy number: 97-CP-D380-6 Effective date: February 14, 2022 ' - ' • Policy period: 12 months Expiration date: February 14, 2023 .: The policy period begins and ends at 12:01 am standard time at the premises location. OFFICE POLICY • . Automatic renewal -If the State Farm°•policy perjod=isshown;as.12 months; this policy,will be renewed automatically, subject,to,tbe:' :==-..:-•premiums, rules.and forms in effect-•forJeach:succeeding,policy.period If_this policy:is terminated, we will giveyou'.:and.the. __••-_ z, Mortgagee/Lienholder written notice in compliance with the policy provisions.or as required by law. NAMED INSURED STUDIO FUWAFUWA, LLC ENTITY , • Limited Liability Company • IMPORTANT MESSAGE(S) 4 • Notice - Information concerning;changes in your policylanguage is included.-Please:call your agent If you have any questions,,,,; POLICYPREMIUM :..:. 'This is note bill.If an amount is due, then a separate statement will be sent prior'to the due date;The preiniuni(s)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 Businessi Business in Residence Premises ' Policy Number:97-CP-D380-6 5 ' ' Pagel of 5 Prepared:December 7,2021 ©Copyright,State Farm Mutual Automobile Insurance Company,2008 CMP Dec 3P OR.1 1009482 2005 153090 205.0821-2021 CMP-4000 nroeAR • StateFarrt® • 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 $18,000,; , r 25% ,, MEDFORD OR 97501-2647 *As of the effective date of this policy, the Limit of Insuranceas 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: 274.3 SECTION I-DEDUCTIBLES BASIC DEDUCTIBLE $1,000 • SPECIAL DEDUCTIBLES: Employee Dishonesty: $250 . . • . • 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 has Included" indicated,'refer to that policy provision for an explanation of that coverage. Coverage • Limit of Insurance ' Accounts Receivable On Premises . . $50,000 Off Premises $15,000 : Arson Reward • Back-up of Sewer or Dr'aiii . _ $15,000 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 $5,000 .. a.' Fire Extinguisher Systems Recharge Expenset, . • • •, • ,.,, $5,000 Forgery or Alteration $10,000 ' Glass Expenses Included Policy Number:97-CP-D380-6 Page 2 of 5 Prepared:December 7,2021 ©Copyright,State Farm Mutual Automobile Insurance Company42008 • . ' CMP-400D . U o0 StateFarmm Coverage Limit of Insurance ' `` ' •''';a:..:-•;'t; i+ • ' 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 Money and Securities .. - - .. - . -- - 0 to 0 On Premises $10,000 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 Buildings"(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 j0'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 $1.5,000 ' • .' • 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. Coverage ;• riLimit 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 • Policy Number:97-CP-D380-6 .. • . Page 3 of 5 Prepared:December 7,2021 ©Copyright,State Farm Mutual Automobile''Insurance Company,2008 CMP-4000 Qb StateFarm..® 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 • ,,,. . • , $2,000,000, . 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 -$4,000,000:• . . 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, includingthose shown below as well as those issued subsequent to the issuance of this policy. V FORMS AND ENDORSEMENTS • . CMP4100 Businessowners,Coverage+Form, " • CMP-4237.1 Amendatory Endorsement(Oregon) CMP-4527 . Marijuana Exclusion . . . . CMP-4561.1 Policy Endorsement1( , • 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 • . • • " - -• CMP4706 Back-up of Sewer or Drain CMP-4709 Money and Securities CMP-4710 ..Employee Dishonesty , CMP-4819.1 ' Unauthorized'Business Card 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 V VV V • SCHEDULE OF ADDITIONAL INTEREST(S) ' • ' ; Interest type: Loss Payable-All Other. ' . ,,_ ; Endorsement number: CMP4875': • Loan number: ` • - NIA City of Ashland - _ . . 20 E Main St Ashland OR 97520-1814 Policy Number:97-CP-D380-6 ' ' Page 4 of 5 Prepared:December 7,2021 . ©.Copyright,State Farm Mutual Automobile Insurance Company,2008 , CMP-4000 . u 090 StateFarrno 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. President Secretary 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 average 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 informationyou provide about your structure. State Farm does not guarantee that any estimate will be the actual future cost to rebuild your structure. Higher limits are available at higher premiums. Lower limits are also available, as Iong.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-CP-D380-6 Page 5 of 5 Prepared:December 7,2021, 0 Copyright,State Farm Mutual Automobile Insurance Company,2008 CMP-4000 11419421.7 • U State Farm at City,Line PO Box 853925 Richardson, TX 75085-3925 090 0 State Farm • State Farm Fire and Casualty Company P" CITY OF ASHLAND A stock company with home offices in Bloomington, Illinois „4 20 E MAIN ST —:-' ASHLAND OR 97520-1814 O • • O Inland Marine Attaching Declarations Policy number: 97-CP-D380-6 Effective date: February 14, 2022 Policy period: 12 months Expiration date: February 14, 2023 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 aswell 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:December 7,2021 ©Copyright,State Farm Mutual Automobile Insurance Company,2008 CIM AttDec3P OR.1 1009481 2002 153089 202 03-06-2021 FD-6007 U CMP-4875 Page 1 of 2 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. I LOSS PAYABLE This endorsement modifies insurance provided under the following:' • • BUSINESSOWNERS COVERAGE FORM ,• - 61, SCHEDULE , • Policy Number:97-CP-D380-6.; '• . • Named Insured: • STUDIO FUWAFUWA, LLC PO BOX 103 . . MEDFORD OR 97501-0007 Name And Address Of Loss Payee: , City of Ashland 20 E Main St Ashland OR 97520-1814 • Interest/Description Of Property: A 1 additional insured ' Loan Number: Nothing in-this endorsement increases the applicable Limit Of Insurance, We will not pay any.Loss Payee more than their financial interest in the Covered Property, and we will not pay more'than the applicable Limit Of.Insurance on the Covered Property.,,. The following is added,to the,Loss Payment condition under SECTION I,— CONDITIONS,,,as shown.by an°A",'B" or "C" as the Interest shown in the Schedule above: A. Loss Payable For Covered Property in which both you and the Loss Payee shown in the Schedule have an insurable interest, w9 will: 1. Adjust losses with you; and 2. ..Pay.:any'claim for:loss jointly to you and the:Loss Payee, as interests may;appear, • B. Lender's Loss Payable 1. The Loss Payee•shown'in the Schedule is'a creditor, including a mortgageholder or•trustee, whose interest in that Covered. Property is established by such written contracts as: a. Warehouse receipts; b. A contract for deed; c. Bills of lading; d. Financing statements; or e. Mortgages, deeds of trust, or security agreements. CMP-4875 ' . 151391 05.06-2017 ©;.Copyright;•State,Farm Mutual Automobile Insurance Company, 20Q8 Includes copyrighted material of Insurance Services Office; Inc.,withits permission.' ' flflOAAO • CMP-4875 , Page 2 of 2 2. For Covered]Property in which:both you and,a Loss•Payee have an insurable interest: • a. We will pay for covered loss to each Loss Payee in their order of precedence, as interests may appear. b. The Loss Payee has the right to receive loss payment even if the Loss Payee has started foreclosure or similar action on : the Covered Property. a, , •c. If we'deny your claim because of your acts or because you have failed to comply.with the-terms.of this policy, the Loss Payee will stillhave the right to receive loss payment if the Loss Payee: . (1) Pays any premium due under this policy at our request.if you have failed to do so; (2) Submits a signed, sworn proof of loss within 60 days after receiving notice from us of your failure to do so;.and (3) Has notified us of any change in ownership, occupancy.or.substantial change in'risk known to.the-Loss Payee. All of the terms of this policy will then apply directly to the Loss Payee. • d. If we pay the Loss Payee for any loss and deny payment to you because of your acts or because you have failed to comply'with the terms of this policy: • (1) The Loss Payee's rights will be transferredto us to the extent of the amount we pay; and (2) The Loss Payee's right to recover the full amount of the Loss Payee's clairri'will not be impaired. ' • • At our option, we may pay to the Loss Payee the whole principal on the debt plus any accrued interest, In,this event, . •your will pay your remaining debt to us. . 3. If we cancel this policy, we will give written notice to the Loss Payee at least: . a. 10 days before the effective date of cancellation If we cancel for your nonpayment of premium; or b. 30 days before the effective'date of cancellation if we cancel for any other reason. 4. If we elect not to renew this policy, we will.give written notice to the Loss Payee at least 10 days before the expiration date of - this policy. • • C. Contract Of-Sale • ' • 1'. The Loss Payee shown'in'the Schedule`is a person'or organization you have entered'a contract with for'.the sale.of Covered, Property. 2. For Covered!Property in which both you and the Loss Payee have an insurable interest, we will: - ` a. ' Adjust losses with you;and ' • ' b. Pay any claim for loss jointly to you and the Loss Payee, as interests may appear. • 3. The following' is added to the Other Insurance`condition under SECTION 1 AND 'SECTION' If COMMON POLICY CONDITIONS: . ,For Covered]Property that is the subject of a contract of sale, the,word."you" includes.the Loss,Payee. • ' • . All other policy provisions apply. '• CMP-4875 • 151391 08-06-2017 ©, Copyright, State Farm'Mutual Automobile Insurance Company;2008 Includes copyrighted.material'of Insurarice'Services"Office;Inc.,with its permission.