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HomeMy WebLinkAboutInsurance Certificate: Straw, DonaldState Farm Insurance PO Box 2915 —Bloomington; IL 61702=2915 A StateFarm AT1 000621 1200 01 State Farm Fire and .Casualty Company CITY OF ASHLAND A stock'company'with home offices in Bloolningfon; Illincis 90 N MOUNTAIN AVE ASHLAND OR 97520-2014 0 �III��I��II�IIIIIIIIIII"IIIIII'II'IrIIIIII't11111I1'lll'II�IIIi' -. Amended Declarations' Policy number: 97-CP-D437-8 Effective date: February 28, 2024 . Policy period:12 months Expiration date: February 18,'2025. 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_ ` MortgageeiLienholder written notice in compliance with the policy provisions or as required by-law. NAMED INSURED DONALD STRAW ENTITY Sole Proprietorship=Individual 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 REASONS FOR. DECLARATIONS ' Your policy is amended effective .February 28,'2024 due to some recent policy changes you requested. Enclosed'is a copy;of your new endorsements, if any. Policy number: 97-CP-D437-8 Page 1 of 6 Prepared: February 29, 2024 © Copyright, State Farm Mutual Automobile_ Insurance Company, 2008 CMP Dec 3P ORA CMP.4000 1009482 2009 153090 209 09.01-2d23 n StateiFarm Coverage Limit of Insurance Glass Expenses -Included Increased Cost of Construction and Demolition Costs (applies only when buildings are insured on a - replacement cost basis) 10% g i? 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 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 Property) See., Schedule Signs See Schedule Valuable Papers and Records See Schedule Water Damage, Other Liquids, Powder or Molten Material Damage Included SECTION] — 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. Receive ble _• 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 Outdoor Property $5,000 . Property of Others (applies only to those premises provided Coverage B-Business Personal Property) $2,500 Policy number: 97-CP-D437-8 Page 3 of 6 Prepared: February 29, 2024 O Copyright,,State.Farm; Mutual Automobile Insurance Company, 2008 GMP-4000 I Qd State i Location Location of described premises , ,.. number 003 516 S FIR ST MEDFORD OR 97501-3616 o SECTION II - DEDUCTIBLES 0 Property Damage: $250 Other deductibles may apply - refer to policy. SECTION II - LIABILITY Coverage - Limit of:lnsurance. Coverage L - Business Liability Per Occurrence $1,000,000 Coverage M - Medical Expenses y $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 — Uabilityin 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-4237.2 Amendatory Endorsement (Oregon) CMP-4527 'Marijuana Exclusion CMP-4561.4 Policy Endorsement CMP4610.1 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 Policy number: 97-CP-D437-8 Page 5 of 6 Prepared; February 29, 2024 © Copyright,, state, Farm Mutual. Automobile Insurance Company, 20D8 CMP-4000 State Farm Insurance PO Box 2915 Qw)¢ Q �a Bloomington, IL 61702-2915 • SfateFar m° 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 o _ _ Inland Marine Attaching Declarations Policy number: 97-CP-D437-8 Effective date: February 28, 2024 Policy period: 12 months Expiration date: February 18, 2025 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 Mortg agee/Lien holder 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-6867 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 Pagel of 2 Prepared:'February 29, 2024 © Copyright, State Farm Mutual Automobile Insurance Company, 2008 CIM Att Dec 3P OR.1 FD-6007 10094B1 M02 153089 202 03-06-2021 .