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HomeMy WebLinkAboutAmended Insurance Certificate: Rogue Boiler Works LLC (2) J1g6U1U1 Ill STATE FARM FIRE AND CASUALTY COMPANY Li O A STOCK COMPANY WITH HOME OFFICES IN BLOOMINGTON,.ILLINOIS DECLARATIONS AMENDED SEP 17 2021 O'O® Po Box 853926 Policy,Number, 9,7-CM-L796-1 Richardson, TX 75085-3925 u Addl Insured-Section II Only Policy Period Effective Date Expiration Date M-15-2275-FAE6 F E 1 Year JAN 2 2021 JAN 2 2022 001428 3123 The policy period begins and ends at 12:01 am standard THE CITY OF ASHLAND, OREGON time atthe premisesTocation. ITS OFFICERS, AGENTS AND ,r , EMPLOYEES Named Insured 90 N NDUORAIN AVE ROGUE BOILER WORKS LLC ASHLAND OR 9752.0-2014 . Illlllhdli'll.IIlIIludiu ulluhldl'.II Illidth4I•L'IIi C C Artisan.And Service Contractor Policy; ••4. . ; Automatic Renewal-`Ifthe'policyperiod is shown as 12 months,this policy will be renewed automatically subjectto the premiums,rules and . • forms in effectfor'each succeeding policy period.If this policy is terminated,we will give you and•the Mortgagee/Lienholdervuritten notice in compliance with the policy provisions or as required by law. • . , Entity: Limited Liability Company Reason for Declarations: Your•policy is amended SEP.17 2021 ' ADDITIONAL INSURED ADDED -, . . ,PREMIUM•ADJUSTMENT ,. • . . _• . . • ;.. . • FORM CMP-4684.1 ADDED • • Endorsement Premium None •• , ' , •. Audit Period:Annual Discounts Applied: : , Renewal Year Years in Business , • Claim Record ' • Prepared V., .., ' OCT 08 2021• n Co• pyright,State Farm Mutual Automobile Insurance Company,2008 • CMP-4000 OR Includes copyrighted material of Insurance Services Office,Inc.,with its.permission. • 010520 290 Al Continued ori Reverse Side of Page Page 1 of 6 DECLARATIONS(CONTINUED) Artisan And Service Contractor`Policy for THE CITY OF ASHLAND, OREGON - Policy Number 97-CM-L796-1 , . , r gi SECTION I- PROPERTY.SCHEDULE . . Location Location of Limit of Insurance* Limit of Insurance* Seasonal . Number DescribedIncrease- Premises Coverage•A i-;: -•- Coveragge.B, . Business Buildings "Business'Personal Personal �, Property Property - 001 2105 COREY-RD '• - - No•Cbverage ' - $ ' 75,000 -- = - • 25% CENTRAL POINT OR 97502-9405• *As of the effectivedate 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: N/A . Coy B-Consumer Price Index: 260.5 SECTION I- DEDUCTIBLES Basic Deductible $1,000 Special Deductibles: ; Equipment Breakdown $1,000 • Other deductibles,may apply- refer to policy. Prepared • OCT 08 2021 ©Copyright,.State Farm Muttual Automobile Insurance Company,2008 CMP-4000 OR Includes copyrighted material of Insurance Services Office,Inc.,with its permission, 010520 . . Continued on.Next Page \y Page 2 of 6 JIQLGI CII III 0 Go® DECLARATIONS(CONTINUED)" • . • Artisan And Service Contractor Policy'for'THE'CITY OF`ASHL'AiWOREGON. • Policy Number 97-CM-L796-1 .. .. �Y1 • • SECTION I- EXTENSIONS OF COVERAGE- LIMIT OF INSURANCE- EACH DESCRIBED PREMISES S 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, . N8, but has"Included" indicated, please refer-to that policy,provision for an explanation of that,coverage. ' LIMIT OF COVERAGE INSURANCE Accounts Receivable. • • On Premises $10,000 Off Premises _ $5,000 Arson,Reward $5,000 Collapse Included Damage To Non-Owned Buildings From Theft, Burglary Or Robbery Coverage B Limit Debris Removal ;25%0 of covered loss• Equipment BreakdownIncluded Fire Department Service Charge " $2 500 . • Fire Extinguisher Systems Recharge Expense $5,000 -Forgery Or Alteration • - - • , • • $'10,000' Glass Expenses Included Increased Cost Of Construction And Demolition Costs (applies only when buildings are, , . , _10% insured on a replacement cost basis) • MoneyOrders And Counterfeit Money ' ' ' ' '' ' ` :$1',000 Newly Acquired Business Personal Property(applies only if this policy provides $1'00,000 Coverage B- Business Personal Property) Newly'Acquired Or Constructed Buildings (applies only if this policy provides $250,000 Coverage A- Buildings) • • Ordinance Or Law- Equipment CoverageIncluded ' Outdoor Property $5,000 Prepared . ; OCT 08 2021 ©Copyright,State Farm Mutual AUtomobile'Ihsurerice Company,2008 . CMP-4000 OR Includes copyrighted meierial of Insur'ence'Services'bffice,Inc.,with its permission. 010521 290 - Continued oh Reverse Side of Page Page 3 of 6 DECLARATIONS:(CONTINUED). Artisan And Service Contractor Policy for,THE.CITY OF ASHLAND, OREGON . _ Policy Number 97-CM-L796-1 Personal Effects (applies only to those premises provided Coverage B- Business $2,500 Personal Property) Personal Property Off Premises $15,000 Pollutant Clean UpArid-Removal $10,000 PreservationsgProperty °. 30 Days Propertybf Others (applies'only to those premises pr`ovided'Coverage B Business "'' $2,500 Personal Property) • Signs $2,500 Valuable Papers And Records On Premises $10,000 Off Premises $5,000 Water Damage, Other Liquids, Powder Or Molten Material Damage Included SECTION'II DEDUCTIBLES . . '. : ., Business Liability- Property Damage. ' $500 • , Other deductibles may apply- refer to policy. , SECTION II- LIABILITY . . • LIMIT.OF COVERAGE ' INSURANCE Coverage L- Business Liability $2,000,000 Coverage M - Medical Expenses (Any One Person) ., „$10,000 Damage•To Premises Rented To You $100,000 LIMIT OF AGGREGATE LIMITS • . ,INSURANCE Products/Completed Operations Aggregate $4,000,000 l Prepared • OCT 08 2021 ©Copyright,State Farm Mutual Automobile Insurance Company,2008 CMP-4000 OR ' ' Includes copyrighted material of Insurance Services Office,Inc.,with its permission. 010521 Continued on Next Page Page 4 of 6 areirrd1w • U O 0 DECLARATIONS'(CONTINUED)" • Artisan And Service Contractor Policy for THE CITY-OF ASHLAND,OREGON Policy Number 97-CM-L796-1 • • General Aggregate $4,000,000 r• 1' 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. • ,o • 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-4684.1 *Addl Insd Owners Lessee Sched CMP-4600 Artisan and Service Contractor FE-6999.3 Terrorism Insurance Coy Notice • CMP-4237.1 Amendatory Endorsement FE-3650 Actual Cash Value Endorsement CMP-4561.1 Policy Endorsement ' • CMP-4683.1 Addl Ins Owners Lessee Blkt CMP-4787 Waiver of Trans Rgt of Recov CMP-4527 Exci Ctrl Substances • CMP-4875 Loss Payable FD-6007 Inland Marine Attach Dec * New Form Attached • • Prepared , OCT 08 2021 n Copyright,'State Farm Mutual Automobile Insurance Company,2008 • CMP-4000 OR • , Includes copyrighted'material of Insurance Services Office,Inc.,with its permission. • 010522 290 Continued on Reverse Side of Page Page 5 of 6 DECLARATIONS(CONTINUED) .• Artisan And Service Contractor Policy,fdr THE CIT,Y OF ASHLAND, OREGON ••• • , - • Policy Number 97-CM-L796-1 ' - • • • , • 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 cornp'any 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: .• , • • • • • „ . /frter-A-4-4,7- • Secretary President • .• • Prepared ; • OCT 08 2021 ,©Copyright,State Farm Mutual Automobile Insurance Company,2008 CMP-4000 OR Includes copyrighted material of Insurance Seryices,Office,Inc.,with its permission. 010522 290 Page 6 of 6 agaccrauu STATE FARM FIRE AND CASUALTY COMPANY • . " - ' . LJ O A STOCK COMPANY WITH HOME OFFICES IN BLOOMINGTON,ILLINOIS; INLAND MARINE ATTACHING DECLARATIONS O'O® Rloha°rdson9TX5.75085-3925 • Policy Number 97-CM-L796-1 • Named Insured Policy Period Effective Date Expiration Date M-15-2275-FAE6 F E 1 'Year • JAN 2 2021 JAN 2 2022 The policy period begins and ends at 12:01 am standard ROGUE BOILER WORKS LLC time attfle premises-Location. - . • .. .- _... .. .. .-.. .. . . . _ . - • $ - 0 • y o • , i° ATTACHING INLAND MARINE {1; ' . Automatic Renewal-If the policy period is shown as 12 months,this policy will be renewed automatically subjectto 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 $ 100.00 ' • The above Premium Amountis included in the Policy Premium shown on the Declarations. • Your policy consists of these.Declarations,the INLAND MARINECONDITIONS 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-8739 Inland Marine Conditions . FE-6867 Amend of Inland Marine Condtns " FE-8743.1 Inland Marine Computer Prop FE-8756.1 Installation Endorsement FE-8760 Mobile Equipment Form See Reverse for Schedule Page with Limits ,;Ir Prepared OCT 08'2021 ' • ©Copyright,'State Farm Mutual Automobile'Insfirance Company,2008 • FD-6007 Includes copyrighted'material of Insurance Services Office,Inc.,with its permission. 010523 , " • 5311-fiflfl a.7 05-31.71111 1n1f3737r • ATTACHING INLAND MARINE SCHEDULE PAGE • • ATTACHING INLAND MARINE ENDORSEMENT • LIMIT OF DEDUCTIBLE ANNUAL NUMBER COVERAGE INSURANCE AMOUNT PREMIUM • FE-8743.1. Inland Marine Computer Prop $ 25,000 $ 500 Included , FE-8760 Mobile Equipment Form $ 20 ,000 $ 500 $ 100 . 00 FE-8756.1 Installation Endorsement $ 5,000 . $, 500 . . Included Property in Transit $ 5,000 Number of Job-Sites: 1 .. - t • • • • • OTHER LIMITS AND EXCLUSIONS MAY APPLY-REFER TO YOUR POLICY• Prepared OCT 08 2021 ©Copyright,State Farm Mutual Automobile Insurance Company,2008 FD-6007 'Includes copyrighted material.of Insurance Services Office,Inc.,with its permission. 010523 , 536.666 0.2 05-31.2011 1o1f3233c1