Loading...
HomeMy WebLinkAboutAmended Insurance Certificate: Straw, DonaldState Farm Insurance L PO Box 2915 Bloomington, IL 61702-2915 AT1 000346 1200 01 CITY OF ASHLAND 90 N MOUNTAIN AVE ASHLAND OR 97520-2014 0 0 s� I�Ilrlllrlllll�l�l�lllllllrnllllrlll��lll�lllllrr�l�inllll,nll Amended Declarations .. StateFarm State Farm Fire and Casualty Company A stock company with home offices in Bloomington, Illinois Policy number: 97-CP-D437-8 Effective date: January 18, 2024 Policy period: 12 months Expiration date: February 18, 2024 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 Mortgagee/Lienholder 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. Increase in premium: $1.00 Discounts applied: Business Experience Rating Protective Devices Renewal Discount Years in Business REASONS FOR DECLARATIONS Your policy is amended effective January 18, 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 Prepared. January 31, 2024 CMP Dec 3P OR CMP-4000 © Copyright, State Farm Mutual Automobile Insurance Company, 2008 Page 1 of 6 1009482 2009 153090 209 09-01-2023 StateFarm SECTION I - PROPERTY SCHEDULE — BLANKET Limit of Insurance* Coverage A - Buildings: $1,093,200 Coverage B - Business Personal Property: $491,400 Seasonal Increase - Business Personal Property: 25% Location Location of described premises number 001 427 N RIVERSIDE AV MEDFORD OR 97501-4602 003 516 S FIR ST 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) Cov A - Inflation Coverage Index: 216.3 Cov B - Consumer Price Index: 298 SECTION I — DEDUCTIBLES BASIC DEDUCTIBLE $1,000 SPECIAL DEDUCTIBLES: Employee Dishonesty: $250 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 Arson Reward $5,000 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-OP-D437-8 Page 2 of 6 Prepared. January 31, 2024 © Copyright, State Farm Mutual Automobile Insurance Company, 2008 CMP-4000 4 StateFarm- 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% o a Money Orders and Counterfeit Money $1,000 N $ 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 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 D01 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 Outdoor Property $5,000 Property of Others (applies only to those premises provided Coverage B-Business Personal Property) $2,500 Policy number: 97-CP•0437-8 Page 3 of 6 Prepared: January 31, 2024 ©Copyright, State Farm Mutual Automobile Insurance Company, 20D8 CMP-4000 Location Coverage number StateFarm Limit of Insurance Signs $5,000 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 $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 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 Policy number: 97-CP-D437-8 Prepared: January 31, 2024 *Copyright, State Farm Mutual Automobile Insurance Company, 2008 CMP-4000 Page 4 of 6 El ^StateFarm- Location Location of described premises number 003 516 S FIR ST MEDFORD OR 97501-3616 $ SECTION II - DEDUCTIBLES 0 a o 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 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 ANDFNDORSEMFNTS 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 Policy number. 97-CP-D437-8 Prepared. January 31,2024 © Copyright. State Farm Mutual Automobile Insurance Company, 2008 Page 5 of 6 CMP-4000 Statefarw SCHEDULE OF ADDITIONAL INTEREST(S) Interest type: Owners, Lessees, or Contractors (Schedul Endorsement number: CMP-4684.1 Loan number: NIA CITY OF ASHLAND 90 N Mountain Ave Ashland OR 97520-2014 FULL NAMED INSURED 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 be signed by its President and Secretary at Bloomington, Illinois. �- rn . President Secretary Policy number: 97-CP-D437-8 Page 6 of 6 Prepared: January 31, 2024 © Copyright, State Farm Mutual Automobile Insurance Company, 2008 CMP-4000 State Farm Insurance J PO Box 2915 Bbomington, IL 61702-2915 CITY OF ASHLAND 90 N MOUNTAIN AVE ASHLAND OR 97520-2014 A& StateFarm State Farm Fire and Casualty Company A stock company with home offices in Bloomington, Illinois Inland Marine Attaching Declarations Policy number: 97-CP-D437-8 Effective date: January 18, 2024 Policy period: 12 months Expiration date: February 18, 2024 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: 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 FE4754 Inland Marine Dealers - Service Form Policy number: 97-CP-D437.8 Prepared. January 31, 2024 ©Copyright, State Farm Mutual Automobile Insurance Company, 2008 GM Att Dec 3P OR.1 FD-9007 Included $500 $374 Page 1 of 2 1009481 2002 153089 202 03-06-2021 l StateFarm 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 Prepared: January 31, 2024 FD-6007 © Copyright, State Farm Mutual Automobile Insurance Company, 2008 Page 2 of 2