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HomeMy WebLinkAboutInsurance Certificate: Rogue Boiler Works LLCStateFarm so. STATE FARM FIRE AND CASUALTY COMPANY 0 A STOCK COMPANY WITH HOME OFFICES IN BLOOMINGTON, ILLINOIS DECLARATIONS AMENDED FEB 29 2024 P Box 2915 Bloomington IL 61702-2915 Addl Insured -Section II Only M-15-2275-FAE6 F E 001140 3123 THE CITY OF ASHLAND, OREGON ITS OFFICERS, AGENTS AND MEEMPLOYEES 90 N MOUNTAIN AVE ASHLAND OR 97520-2014 s 0 a NO I�llll�llll�ll��lnll�lllllllllll��lll��llnlll�l����llnlll�lll� Artisan And Service Contractor Policy Policy Number 97-CP-Y154-1 Policy Period Effective Date Expiration Date 1 Year JAN 2 2024 JAN 22025 The poll y period beg9ins and ends at 12:01 am standard time ate premises focation. Named Insured ROGUE BOILER WORKS LLC Automatic Renewal - If the policy period 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/Lien holder written notice in compliance with the policy provisions or as required by law. Entity: Limited Liability Company Reason for Declarations: Your policy is amended FEB 29 2024 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 MAY 08 2024 © Copyright, State Farm Mutual Automobile Insurance Company, 2008 CMP-4000 OR Includes copyrighted material of Insurance Services Office, Inc., with its permission. 008427 290 Al Continued on Reverse Side of Page N Page 1 of 6 DECLARATIONS (CONTINUED) Artisan And Service Contractor Policy for THE CITY OF ASHLAND, OREGON Policy Number 97-CP-Y154-1 SECTION I - PROPERTY SCHEDULE Location Location of Limit of Insurance* Limit of Insurance* Seasonal Number Described Increase - Premises Coverage A - Coverage B - Business Buildings Business Personal Personal Property Property 001 615 ROGUE AIR DR No Coverage $ 88,700 25% SHADY COVE OR 97539-9822 ` 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 CQVERAGE INDEXES) Cov A - Inflation Coverage Index: Cov B - Consumer Price Index: SECTION I - DEDUCTIBLES Basic Deductible $1,000 Special Deductibles: Equipment Breakdown $1,000 Other deductibles may apply - refer to policy. N/A 307.8 Prepared MAY 08 2024 © Copyright, State Farm Mutual Automobile Insurance Company, 2008 CMP-4000 OR Includes copyrighted material of Insurance Services Office, Inc., with its permission. 008427 Continued on Next Page Page 2 of 6 StateFarm DECLARATIONS (CONTINUED) Artisan And Service Contractor Policy for THE CITY OF ASHLAND, OREGON Policy Number 97-CP-Y154-1 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, please refer to that policy provision for an explanation of that coverage. COVERAGE Accounts Receivable On Premises Off Premises Arson Reward Collapse Damage To Non -Owned Buildings From Theft, Burglary Or Robbery Debris Removal Equipment Breakdown Fire Department Service Charge Fire Extinguisher Systems Recharge Expense Forgery Or Alteration Glass Expenses Increased Cost Of Construction And Demolition Costs (applies only when buildings are insured on a replacement cost basis) Money Orders And Counterfeit Money Newly Acquired Business Personal Property (applies only if this policy provides Coverage B - Business Personal Property) Newly Acquired Or Constructed Buildings (applies only if this policy provides Coverage A - Buildings) Ordinance Or Law - Equipment Coverage Outdoor Property Prepared MAY 08 2024 CMP-4000 OR 008428 290 N © Copyright, State Farm Mutual Automobile Insurance Company, 2008 Includes copyrighted material of Insurance Services Office, Inc., with its permission. Continued on Reverse Side of Page LIMIT OF INSURANCE $10,000 $5,000 $5,000 Included Coverage B Limit 25% of covered loss Included $2,500 $5,000 $10,000 Included 10% $1,000 $100,000 $250,000 Included $5,000 Page 3 of 6 DECLARATIONS (CONTINUED) Artisan And Service Contractor Policy for THE CITY OF ASHLAND, OREGON Policy Number 97-CP-Y154-1 Personal Effects (applies only to those premises provided Coverage B - Business Personal Property) Personal Property Off Premises Pollutant Clean Up And Removal Preservation Of Property Property Of Others (applies only to those premises provided Coverage B - Business Personal Property) Signs Valuable Papers And Records On Premises Off Premises Water Damage, Other Liquids, Powder Or Molten Material Damage SECTION II - DEDUCTIBLES Business Liability - Property Damage $500 Other deductibles may apply - refer to policy. $2,500 $15,000 $10,000 30 Days $2,500 $2,500 $10,000 $5, 000 Included SECTION 11- LIABILITY LIMIT OF COVERAGE INSURANCE Coverage L - Business Liability Coverage M - Medical Expenses (Any One Person) Damage To Premises Rented To You AGGREGATE LIMITS Products/Completed Operations Aggregate Prepared MAY 08 2024 © Copyright, State Farm Mutual Automobile Insurance Company, 2008 CMP-4000 OR Includes copyrighted material of Insurance Services Office, Inc., with its permission. 008428 Continued on Next Page $2,000,000 $10,000 $100,000 LIMIT OF INSURANCE $4,000,000 Page 4 of 6 Statefarm A DECLARATIONS (CONTINUED) Artisan And Service Contractor Policy for THE CITY OF ASHLAND, OREGON Policy Number 97-CP-Y154-1 General Aggregate 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. $4,000,000 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 Cov Notice CMP-4237.2 Amendatory Endorsement FE-3650 Actual Cash Value Endorsement CMP-4561.4 Policy Endorsement CMP-4683.1 Addl Ins Owners Lessee Blkt CMP-4787 Waiver of Trans Rgt of Recov CMP-4527 Excl Ctrl Substances CMP-4875 Loss Payable FD-6007 Inland Marine Attach Dec * New Form Attached Prepared MAY 08 2024 © Copyright, State Farm Mutual Automobile Insurance Company, 2008 CMP-4000 OR Includes copyrighted material of Insurance Services Office, Inc., with its permission. 008429 290 Continued on Reverse Side of Page Page 5 of 6 N DECLARATIONS (CONTINUED) Artisan And Service Contractor Policy for THE CITY OF ASHLAND, OREGON Policy Number 97-CP-Y154-1 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 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. Secretary President Prepared MAY 08 2024 CMP-4000 OR © Copyright, State Farm Mutual Automobile Insurance Company, 2008 Includes copyrighted material of Insurance Services Office, Inc., with its permission. 008429 290 N Page 6 of 6 StateFarm A. STATE FARM FIRE AND CASUALTY COMPANY El A STOCK COMPANY WITH HOME OFFICES IN BLOOMINGTON, ILLINOIS INLAND MARINE ATTACHING DECLARATIONS Po Box 2915 Bloomington IL 61702-2915 Named Insured M-15-2275-FAE6 F E ROGUE BOILER WORKS LLC ATTACHING INLAND MARINE Policy Number 97-CP-Y154-1 Policy Period Effective Date Expiration Date 1 Year JAN 2 2024 JAN 22025 The poll y period begins and ends at 12:01 am standard time at a premises location. 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/Lien holder written notice in compliance with the policy provisions or as required by law. Annual Policy Premium $ 100.00 The above Premium Amount is included in the Policy Premium shown on the Declarations. 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 subsequentto the issuance of this policy. Forms, Options, and Endorsements FE-8739 Inland Marine Conditions FE-6867.1 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 Prepared MAY 08 2024 © Copyright, State Farm Mutual Automobile Insurance Company, 2008 FD-6007 Includes copyrighted material of Insurance Services Office, Inc., with its permission. 008430 530-686 a.2 05-31-2011 W932320 97-CP-Y154-1 ATTACHING INLAND MARINE SCHEDULE PAGE ATTACHING INLAND MARINE ENDORSEMENT LIMIT OF NUMBER COVERAGE INSURANCE FE-8743.1 Inland Marine Computer Prop S 25,000 FE-8760 Mobile Equipment Form S 20,000 FE-8756.1 Installation Endorsement S 51000 Property in Transit 5 5,000 Number of Job -Sites: 1 DEDUCTIBLE ANNUAL AMOUNT PREMIUM $ 500 Included $ 500 $ 100.03 $ 500 Included OTHER LIMITS AND EXCLUSIONS MAY APPLY - REFER TO YOUR POLICY Prepared MAY 08 2024 © Copyright, State Farm Mutual Automobile Insurance Company, 2008 FD-6007 Includes copyrighted material of Insurance Services Office, Inc., with its permission. 008430 530-586a.2 05-31All (o113233c