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HomeMy WebLinkAboutAmended Insurance Certificate: Straw, Donald (05) State Farm Insurance U PO Box 2915 O'C State Farm® Bloomingtton,, IL 61702-2915 AT1 000450 1200 01 , : .. State Farm.Fireand Casualty Company CITY OF ASHLAND A stock company with home offices in Bloomington, Illinois 90 N MOUNTAIN AVE ASHLAND OR 97520-2014 •g Flulq1I1iuiiiIIIII"IIIiiI""11"1IiuiIl1199IIiililIlI" Amended Declarations : .; Policy number:97-CP-D437-8 Effective date:April 12,2022 . ' ' ; 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 succeeding policy period. If this policy is terminated, we will give you and'the Moritgagee/Lienholder written notice in compliance with the policy provisions oras required by law.. NAMED INSURED ri- ,,I=" -. DONALD STRAW .. . . ENTITY ' • Sole Proprietorship-Individual REASONS FOR DECLARATIONS .' . Your policy is amended effective April 12,2022 due to some recent policy changes you requested. Enclosed,is a copy'of your new endorsements, if any. POLICY PREMIUM This is not a bill.If an amount is due,thena 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:-$7.00 , Discounts applied: Business Experience-Rating Renewal Discount Protective Devices Years in Business Policy number:97-CP-D437-8 Page 1 of 6 Prepared:April 12,2022 ©Copyright, State'Farm Mutual Automobile:Insurance Company,2008 CMP Dec 3P OR.1 CMP-4000 1009482 2005 153090 205 08-21-2021 001772 • • . o o StateFarm® ' SECTION I-PROPERTY SCHEDULE=`BLANKET 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 FIRST 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. 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-referto,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 Deolarations,,' ' 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 ReceivableSee Schedule . . • Arson Reward • . $5,000 Back-up of Sewer or Drain ' See Schedule• , ' Collapse Included . Damage to Non-owned Buildings from Theft,Burglary or RobberyCoverage 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 . ' $10,000 Glass Expenses Included Policy number:97-CP-D437-8 . . Page 2 of 6 Prepared:April 12,2022 ©Copyright, State Farm Mutual'Automobile Insurance'Company, 2008 . CMP-4000 - . . u 090 State Farm® Coverage Limit of Insurance R • 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 See Schedule - 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 V 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 V 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 12,2022 ©.Copyright;.State Farm Mutual Automobile Insurance Company, 2008 „ - CMP-4000 001773 . 090 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 - $1.0,000. . . ' '. 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 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 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 0 - ' 001 427 N RIVERSIDE AV MEDFORD OR 97501-4602 • • • - . , 003 516 SFIRST - • MEDFORD OR 97501-3616 - • - Policy number:97-CP-D437-8 • Page 4 of 6 Prepared:April12,2022 ©Copyright, State Farm Mutual Automobile. Insurance Company; 2008 CMP-4000 u • • • o StateFarm® SECTION II-DEDUCTIBLES . FilProperty Damage: $250 Other deductibles may apply-refer to policy. ' ' SECTION II-LIABILITY • 8 Coverage ,.Limit of Insurance . • $ Coverage L-Business Liability Per-Occurrence , .. $1,000,000, , • 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 BUSINESSOWNERSCOVERAGE 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) 0 • 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 • . 0 .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: NIA CITY OF ASHLAND 0 90 N Mountain Ave . Ashland OR 97520-2014 . FULL NAMED INSURED Policy number:97-CP-D437-6 . Page 5 of 6 Prepared:April 12,2022 ©Copyright, State,Farm Mutual Automobile Insurance'Company;2008 • CMP-4000 001774 • oQ State Farm® 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 Incorporation, as amended. In Witness Whereof,.the State Farm'Fire and Casualty Company has caused this policy to besigned by it's Presidentand Secretary at Bloomington, Illinois. /f4e—Le4:77',Z7:k4,‘„) „ • President " Secretary • • • • • • • • Policy number:97-CP-D437-8 Page 6 of 6 Prepared:April 12,2022 ©Copyright, State'Farm.Mutual'Automobile insurance Company, 2008 ' CMP-4000 . State Farm Insurance U PO Box 2915 •"• Bloomington,'IL 61702-2915 UState Farm® State Farm Fire and Casualty Company CITY OF ASHLAND' A stock company with home offices in Bloomington, Illinois 90 N MOUNTAIN AVE •- - - • ' - i�'t- ASHLAND OR 97520-2014 6-1 - . Inland Marine AttachingDeclarations Policy number: 97-CP-D437-8 Effective date:April 12, 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 MortgageeiLienholder 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-6067 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:April 12 2022 ©Copyright, State Farm Mutual Automobile'Insurance Company, 2008 CIM Att Dec 3P OR.� FD-6007 1009481 2002 153089 202 03-06-2021 nm 77A . 69Q Statefarme Endorsement CoverageLimit 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 12,2022 ©Copyright; State Farm Mutual Automobile Insurance Company, 2008 FD-6007