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HomeMy WebLinkAboutAmended Insurance Certificate: Straw, Donald State Farm Insurance PO Box 29,15 0 Sta{#6eFarn ® Bloomington, It: 0170.2-2915 09ff� AT1 000597 1200 01 :State Farm•Fire,and.Casualty;Company CITY OF ASHLAND A stock company with-home offices in Bloomington, Illinois • 90 N MOUNTAIN AVE ASHLAND OR 97520-2014 z o - O IIIliilililn1rlli1I11III1II1IIIIniilliIIIuiilrllirillnllll,ll, _. . (0s Amended , Declarations ' • Policy number:97-CP-D437-8 Effective date:April 5, 2022 Policy period: 12 months Expiration date:February 18,2023 The policy period begins and ends at 12:01 am standard time at the premises location. ; ; HOME PRODUCT SALES POLICY 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 succeedingpolicy 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., . , NAMED INSURED c ."„ _1R.. I: . ;iE "..J ,: • 1 ,,.., ,-�.. . , �..t • t3. DONALD STRAW ENTITY • Sole Proprietorship-Individual REASONS FOR DECLARATIONS Your policy is amended effective.April:5, 2022.due to some recent policy changes you requested. Enclosed is a dopy'of your new endorsements, if any. 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. • - Change in premium: none " - , - Discounts applied: Business Experience Rating ,' Renewal Discount Protective Devices _Years in Business . ' . • Policy number:97-CP-D437-8 Page 1 of 6 Prepared:April 5,2022 ©.Copyright;State Farm Mutual:,Automobile Insurance.Company,.2008 CMP Dec 3P OR.1 CMP-4000 1009482 2005 153090 205 08-21-2021 _ , 090 State Farm& . _ , . .•_ . SECTION I;PROPERTY SCHEDULE—BLANKET . I ' , • I , . Limit of Insurance* Coverage A-Buildings: $1,029,500 . , , . Coverage B-Business Personal Property: $456,000 Location Location of described premises Seasonal Increase- number Business Personal Property , 001 427 N RIVERSIDE AV , 25% . • . • . • MEDFORD OR 97501-4602 003 516 S FIR ST • •25% • MEDFORD OR 97501-3616 • .. , *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: . 203.7 • . . , , .4 Coy B-Consumer Price Index: 2743 SECTION I—DEDUCTIBLES , .. . . "-- '' • - , ' • ' • BASIC DEDUCTIBLE $1,000 , • . • , . SPECIAL DEDUCTIBLES: ,J:1: .....-• ': i ..,._ •.), Employee Dishonesty: $250 • . .. . , . . . , • Equipment Breakdown: $1,000 , . Money and Securities:' ' ` .$250 ' , ' , Other deductibles may apply-refer to'policy. t -.'• . SECTION I—EXTENSIONS OF COVERAGE-LIMIT OF INSURANCE'-EACH DESCRIBED PREMISES V '•',, ._ .,,:'• • 0, The coverages and corresponding limits shown below apply separately to each described premises shovvn.in these Declarations, unless indicated by"See schedule". If a coverage does not have a corresponding limit shown below, but has'Included" indicatedorefer to that policy provision for an explanation of that coverage. Coverage . . Limit of Insurance Accounts Receivable V V , See Schedule Arson Reward $5,000 • . - , . , • • Back-up of Sewer or Drain See Schedule ;•::Irv: :;•, ! • -, v, , „ Collapse • ' ,. •., ., , - V . ' • Included ' • V V • • 4. . - • 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 Alteration . $10,000 ' Glass Expenses Included • • Policy number:97-CP-D437-8 Page 2 of 6 Prepared:April 5,2022 ©Copyright, State.Farm Mutual Automobile Insurance Company, 2008 CMP-4000 . , • . V V V , . . , U ao State Farm. Coverage ; , Limit of Insurance •. , 'Increased Cost of Construction and Demolition Costs(applies only when buildings are insured on a .• 10% • • •- - • -.• • - `rr& replacement cost basis) • Money Orders and Counterfeit Money $1,000 8 Money and Securities See Schedule-, • ' o Newly Acquired Business Personal Property(applies only if this policy provides Coverage B-Business $100,000 • - co 0 • 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, OtherLiquids,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 - • • - • • . e . • . . . 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,b00 ' ' . 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:April 5,2022 ©.Copyright, State Farm Mutual Automobile Insurance Company, 2008 CMP-4000 690 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.PremisesLimit . , $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 _ Valuable Papers and Records .. . . . On PremisesLimit . . • $10,000 . . _ . . .. Off Premises Limit. _ . ._ $5,000 __ ' _ SECTION I—EXTENSIONS OF COVERAGE-LIMIT OF INSURANCE-PER POLICY - The coverages and corresponding limits ihown'below e the'most we will pay rregar•dless Of the number of described premises shown 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 OR 97501-4602 • • . 003 516 S FIRST . MEDFORD OR 97501-3616 • - - • Policy number:97-CP-D437-8 . • Page 4 of 6 Prepared:April 5,2022 ©.Copyright;State.Farm.Mutual Automobile Insurance Company, 2008 CMP-4000 u as StateFarm® • SECTION II-DEDUCTIBLES • • Property Damage: $250 Other deductibles may apply-refer to policy. SECTION II-LIABILITY Coverage Limit of Insurance ,- • • Coverage.L-Business Liability Per•Occurrence , $1,000,000 o Coverage M-Medical Expenses $10,000 Any One Person - • Damage to Premises Rented to You $300,000 --• Hired Auto Liability Included in Coverage L, • , .. • Aggregate Limits Limit of Insurance • General Aggregate • $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 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 • FULL NAMED INSURED Policy number:97-CP-D437-8 " Page 5 of 6 Prepared:April 5,2022 ©Copyright, State.Farm,Mutual Automobile Insurance Company, 2008 CMP-4000 o&StateFarm® 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 the earnings of the company as determined by our Board of Directors in accordance with the Company's Articles of Incorp`oration,'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. Wiete.4--Q117.144,-%D TY1 'youlat, President Secretary • , I • • • • Policy number:97-CP-D437-8 Page 6 of 6 Prepared:April 5,2022. ©,Copyright;State.Farm Mutual Automobile Insurance Company,'•2008 CMP-4000 LI State Farm Insurance • PO Box 2915 • . Bloomingfon, IL.61702-2915 09 State Farm& State Farm Fire and Casualty Company CITY OF ASHLAND A stock company with home offices iii Bloomington, Illinois ..; 90 N MOUNTAIN AVE - , 'NZ' ASHLAND OR '97520-2014 g . • • Inland Marine Attaching Declarations Policy nuniber: 97-CP-D437-8 Effective date:April 5,2022 . Policy period: 12 months • Expiration date: February 18, 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 MortgageelLienholder 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 form's 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-8139 Inland Marine Conditions • FE-8143.1 Inland Marine Computer Property Form FE-8154 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:April 5,2022 ©Copyright, State Farm Mutual Automobile Insurance'Company,2006 CIM Att Dec 3P OR.1 FD-6007 1009481 2002 153089 202 03-06-2021 a a State Farm® 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, • • • • • • . • • Policy number,97-CP-D437-8 ' Page 2 of 2 Prepared.April 5,2022 ©Copyright, State Farm Mutual Automobile.Insurance Company,.2008 FD-6007 '