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HomeMy WebLinkAboutAmended Insurance Certificate: Straw, Donald dba Fashion Floors State Farm at CityLine 'J PO Bbx 853925 -*•• Richardson, TX 75085-3925 • 090 StateFarms • AT1 000423 1200 01 State Farm Fire and Casualty Company ,. CITY OF ASHLAND A stock company with home offices in'Bloomington Illinbis 90 N MO ASHLAND ORUNTAIN 97520AVE-2014 ' 00 . cog 111111'111111"11111"1111111111111111111111111111"111111114111 .. • Amended Declarations . , . ,.. . . . . . . , ,,,s,, ,,,,,.,. , "-, , ,„ i: ,.:._.,,, .., ,:,, ,.,:. Policy number: 97-CP-D437-8 Effective date: March 4, 2021 ' ' Policy period: 12 months Expiration date: February 18, 2022 • 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 forme in.effect.for;each succeeding,policyperiod..,If this,policy is terminated, we will give you and the • Mortgagee/Lienholder written notice in compliance with the policy provisions or as"regi iced by1avv. NAMED INSURED ' . STRAW, DONALD E DBA FASHION.FL .- ." '..",; ..1t' ,,, ;3:'''i'-- .A ; ."71":-' :;,_:-, . _ : ` . . 427 N RIVERSIDE AVE , , , . ,, ,• , MEDFORD OR 97501-4602 • . . , ENTITY ' ,, • . Sole Proprietorship-Individual , . , , , - REASONS FOR DECLARATIONS • •• Your policy is amended-effective March 4,.2021 due to somerecent policy changes you requested. Enclosed isa copy of your new endorsements, if any. POLICY PREMIUM - • _ - 0 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 is the 12 months premium(s)for the characteristics of(he'policy as described in this Declarations. • ' • ` Total Premium: $3,926.00' , : Discounts applied: _ Business Experience Rating Renewal Discount . ., . Protective Devices. .- - . Years in Business - • .. Policy Number:97-CP-D437-8 ' Page 1 of 6 Prepared:,March 17,2021 . . ©Copyright;State Fatn Mutual Automobile Insurance Company,2008 CMP Dec 3P OR.1 1008482 2003 153090 203 03.06-2021 CMP-4000 001662 . • • • oQ StateFtarm® • • SECTION I-PROPERTY SCHEDULE-BLANKET • Limit of insurance* . Coverage A-Buildings: $961,200 Coverage B-Business Personal Property: $432,800 Location Location of described premises , Seasonal increase- numberBusiness Personal Property . ; ,•••t : ' 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: 190.2 ., . Coy B-Consumer Price Index: 260.4 ' SECTION I—DEDUCTIBLES BASIC DEDUCTIBLE $1,000 : SPECIAL DEDUCTIBLES: • .. ,f; ; • ' • . . . Employee Dishonesty: - $250 .. i' .. . 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 ' See Schedule .-..-1, . s. ; • -,f,,c,•:. - :' Arson Reward ' •' .' ' -' •' • • : ' 2 . .. . : . $5;000 ' S.. , '• - Back-up of Sewer or Drain See Schedule. 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 • $10,000 • Policy Number:97-CP-D437-8 Page 2 of 6 Prepared:March 17,2021, 0 Copyright,State Farm Mutual Automobile Insurance Company,2008 CMP-4000 . u & State.Fart i Coverage Limit of Insurance ,,' 1 Glass Expenses- - ' • • Included - . Increased Cost of Construction and Demolition•Costs(applies;only when buildings are insured on a 10% - • ' - •- ' . replacement cost basis) § • Money Orders and Counterfeit Money $1,000 . • CD$ 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 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 • 0 30 days Property of Others(applies only to those premises provided Coverage B-Business Personal Property) See'Schedule Signs . . See Schedule., ' Valuable Papers and Records See Schedule • Water Damage, Other Liquids,Powder or Molten Material Damage• Included SECTION I-EXTENSIONS 00 COVERAGE-LIMIT OF INSURANCE'-SCHEDULE''' " ` - ' The coverages and corresponding limits'shown'beloW apply-only to the described premises as'sho'wn • • 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 0 . , .$5,000 . .. ., Outdoor Property •• $5,000 - Property of Others(applies only to those premises provided Coverage B-Business $2,500 - Personal Property) Signs • $5,000 • ' : 'Policy Number:97-CP-D437-8 Page 3 of 6 Prepared:March 17,2021 ' ©Copyright,State.Farm Mutual Automobile Insurance Company,2008 • CMP-4000 • 001663 ' • • . o90 State Faring' • • • • 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•, , • . • ;310,000,, 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 B-Business $2,500 . 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 ' ' 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:March 17,2021 • • ©Copyright,State Farm Mutual Automobile Insurance.Company,2008 CMP-4000 • ..• •_ : • 090StateFarm SECTION II-LIABILITY . • ;P Coverage Limit of Insurance Coverage L-Business Liability Per Occurrence - $1,000,000 Coverage M-Medical Expenses . . . , •. $5;000.Any One Person. • a Damage to Premises Rented to You - • $300;000 a' Hired Auto Liability •Included in Coverage L Aggregate Limits Limit of Insuranbe - ' - ' Products/Completed Operations Aggregate . . $2;000,000 General 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 .Poiicy 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 • FULL NAMED INSURED Named Insured: STRAW, DONALD E DBA FASHION FLOORS • ' Policy Number:97-CP-D437-8 • •• Page 5 of 6 Prepared:March 17,2021 : 0 Copyright,State Farm Mutual Automobile Insurance Company,2008 CMP-4000 , 001664 po StateFarme 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 • • • • Policy Number:97-CP-D437-8 . Page 6 of 6 Prepared:March 17,2021 ©.Copyright,State Farm Mutual.Automobile Insurance Company,2008 CMP-4000 State Farm at CityLine u PO Box 853925 • Richardson,.TX 75085-3925 • '090 StateFarm' • 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 , �,1 • • - • 8 5 . - Co' g Inland Marine .Attaching .Decla rations ,. . • . . . Policy number: 97-CP-D437-8 . Effective date: March 4, 2021 Policy period: 12 months . Expiration date: February 18, 2022 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: STRAW, DONALD E DBATASHION 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 ENQ.QRSEMENTS. • . FE-6867 Inland Marine 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 Policy Number:97-CP-D437-8 - .Page 1 of 2 Prepared:March 17,2021 ©Copyright,State Farm Mutual Automobile Insurance Company,2008 • CIM Att Dec 3P DR.1 1009481 2002 153089 202 03.06-2021 FD-6007 nniP K _. StaiteFarm® 'Endorsement ' Coverage Limit of insurance Deductible amount Annual premium • number • " .. FE-8754 Inland Marine Dealers-Service Form . . $500 , • $374 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, , ' • • ..• -1:. ,• . '. . ., , ' ,t -21 Policy Number:97-CP-D437-8 Page 2 of 2. Prepared:March 17,2021 • ©Copyright,State Farm Mutual Automobile Insurance Company,2008 ' . , FD-6007 •