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Home My WebLink AboutInsurance Certificate: The Jefferson Center State Farm Insurance PO Box 2915 t(ryJ`i ui� iw air e or minn pmW fu rc x Bloomington, IL 81702 2995 � III � atel y AT1 002159 1200 01 Mate Farm Fire and Casualty Company ASHLAND PARKS & RECREATION COM A stock company with home offices in Bloomington, Illinois 340 S PIONEER ST ASHLAND OR 97520-2729 $S Renewal ,��" IIIII'III'Illllllll'IIIIII'il"IIIrilllll'I'"IIIII"IIIIII"'dill Declarations .............- --------------- ......... Policy number:97-AA-E393-9 Effective date:September 19, 2025 Policy period: 12 months Expiration dater September 19, 2026 The policy period begins and ends at 12:01 am standard time at the premises location. 0t°I"] V PUI-MY 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 MortgageelLienholder written notice in compliance with the policy provisions or as required by law, I''1�P9"Plh';aC;�Nt�t.1Vl^tt�:':II:',1 THE JEFFERSON CENTER F7"'N"11'1['Y Nonprofit " df Y 11V EQY U This is not a bill.if an amount is due, then a separate statement will be sent prior to the due date, The premitm(s)shown below is the 12 months premium(s)for the characteristics of the policy as described in this Declarations, Premium: $203,00 Total Premium: $203.00 Discounts applied: Automatic Sprinkler Protection Business Experience Rating Renewal Discount Years in Business Notice - Information concerning changes in your policy language is included. Please call your agent if you have any questions. Policy number;97-AA-E393-9 Page 1 of 5 O Copyright, State Farm Mutual Automobile Insurance Company, 2008 GMP Deo 3P OR.1 CMP-4000 1009462 2014 153090 214 05-17-2025 Prepared:July 25,2025 SEG'P10N|-P[WPERT"Y SCHEDULE Location Location of described premises Limit of|mwrance Unit of|nsmonoe' Seasmm| |ncreaoo- numbmr Coverage A- Coverage B'Business Business Personal Property UuUd|nq* Personal Property 001 2D8 OAK GTGTE1V1 No Coverage $10.100 25% AGHLANDOR97520-107O «Aaofthe effective date of this policy, the Limit of IOsU[oOoo as shown iNclude,� any iDo[oamo in the limit due to Inflation Coverage, SEC1|,)N i—�WFLATM C0VE[`4AGE WDEX(�S), Gov A-Inflation Coverage Index: N/A Cov8'Consumer Price Index: 321.5 SE(`,110N|-0E0UCT|MLES BASIC DEDUCTIBLE $500 SPECIAL DEDUCTIBLES: Employee Dishonesty: $260 Equipment Breakdown: $500 Money and Securities: $250 Other deductibles may apply -refer Npolicy, �1, �1WN|—EX1 EN&IONS OFC()VEF?X3E' Lffifff OF: INSWRAW''�A(,,l1 DESCMiJ' PR[,`,`A(1l�ES The coverages and corresponding limits shown below apply separately to each described p[a0iGeu ghnN0 in [hnmm Declarations, UO|e8a indicated by "See schedule". |fa coverage does not have a corresponding limit shown bo|oN\ but has "|Dn|Uded" iVdioehad, refer to that policy provision for an explanation of that coverage, Coverage Limit n[Insurance Accounts Receivable On Premises $50.000 Off Premises o5.000 Arson Reward $5.000 ' Back-up o[Sewer nrDrain $15.000 Collapse Included ` Damage b Non-owned Buildings from Theft,Burglary or Robbery Coverage BLimit Debris Removal 2h96of covered|num Equipment Breakdown Included ' Fire Department Service Charge $5.000 Fire Ext|nguiaher Systems Recharge Expense $5.000 Forgery orAlteration $10.000 Glass Expenses Included Increased Cost of Construction and Demolition Costs(applies only when buiNin&m are insured uno 10Y6 replacement cost basis) Policy nvmLecgzAAE393'8 Page 3vr5 @ Copyright, State Farm Mutual Automobile Insurance Company, 2OOe ,fq iu�ti,' t Fin tir, Coverage Limit of Insurance Money Orders and Counterfeit Money $1,000 Money and Securities On Premises $10,000 Off Premises $5,000 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 $5,000 Personal Effects(applies only to those premises provided Coverage B-Business Personal Property) $5,000 Personal Property Off Premises $15,000 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 $2,500 Property) Signs $2,500 Unauthorized Business Card Use $5,000 Valuable Papers and Records On Premises $50,000 Off Premises $15,000 Water Damage, Other Liquids,Powder or Molten Material Damage Included f,.uVat '1 V 'ffif1 U-..IL.Dt t Ih.LiLfhttll'q OF t.'OV�lR.itAt,E- ILlMlI dI Of II II'9't,,wLJFtANCE-PER P01.aiC 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 Incorne $5,000 Employee Dishonesty $10,000 Loss of Income and Extra Expense 12 Months Actual Loss Sustained Utility Interruption-Loss of Income $10,000 Policy number 97-AA E399-9 Page 3 of 5 O Copyright, State Farm Mutual Automobile Insurance Company, 2008 CMP-4000 I Watel " ",,';EC I l("flNU ' LOCA"TON SCHEDUl E Location Location of described promises number 001 208 OAK 8T8TE 101 ASHLAND0RR7520'18TO SECTlONU-L|A[`,,|L|TY Coverage Limit nfInsurance Coverage L'Business Liability Per Occurrence $2.000.000 Coverage M Medical Expenses $5.00An One Person Damage h Premises Ranted toYou $300.000 Aggregate Limits Limit nfInsurance General Aggregate *4.000.000 Products/Completed Operations Aggregate $4.000.000 Each paid clairn for Liability Coverage reduces the amount of insurance we provide during the applicable annual period. Please refer io Section||— Liability in the Coverage Form and any attached endorsements. Your policy consists of these Declarations, the BUSINESSOWNERS COVERAGE FORM shown helow, and any other forms and endorsernents that apply, including those shown below as well as those issued subsequent to the issuance of this policy, FORMS AND ENDORSEMENT'S CMP'4100 Buoinoaemvnero Coverage Form CMP'4237.2 Amendatory Endorsement(Dmgnn) CMP'407 Marijuana Exclusion ° CMP'4529 Policy Endorsement ^ CMP4532 Exo|uoinn-Cyber|noidont CMP'4543 Additional Insured'Designated Person mOrganization CMP-4/03.1 Utility Interruption-Loss ofIncome CMp'47041 Dependent P 'Lnoe of Income CMP'4705.2 Loss v[Income and Extra Expense CMP'470$ Back-up of Sewer orDrain CMP'4709 Money and Securities CMP'4710 Employee Dishonesty QNP4780 Additional Insured Managers Lessor's o4Premises CMP'48181 Unauthorized Business Card Use FO'8007 Inland Marine Attaching Dyc|mmUnno FE'3650 Actual Cash Value Endorsement FE'89983 Policyholder Disclosure Notice oY Terrorism Insurance Coverage 'Now Form Attached SCHEDULE OFAWTMAL��E�� Interest type: Designated Person orOrganization Endorsement number: CMP4043 Loan number: NIA AGHLAND PARKS&RECREATION COMMISSION 340 8 Pioneer G( Ashland OR 97520-2728 �� wdicynumboc97-AxE390-9 Page 4ofS @ Copyright, State Farm Mutual Automobile Insurance Compavy. 2oon oMp-^00w This policy is issued by the State Farm Fire and Casualty Company, Krurcli)ATING P01 W 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, '8 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 OTIERIlA SAG E(S) NOTICE TO POLICYHOLDER: For a comprehensive description of coverage and forms, please refer to Your Policy. Policy changes requested before the"Date Prepared", which appear on this notice, are effective on the Renewal Date of this policy unless otherwise indicated by a separate endorsement, binder, or amended declarations, Any coverage forms attached to this notice are also effective on the Renewal Date of this policy. Policy changes requested after the "Date Prepared"will be sent to you as an amended declarations or as an endorsement to your policy, Billing for any additional premium for such changes will be mailed at a later date. If, during the past year, you've acquired any valuable property items, made any improvements to insured property, or have any questions about your insurance coverage, contact your State Farm agent, Please keep this with your policy, Your coverage amount.... It is up to you to choose the coverage and limits that meet your needs, We recommend that you purchase a coverage limit equal to the estimated replacement cost of your structure. Replacement cost estimates are available from building contractors and replacement cost appraisers, or, your agent can provide an estimate from Xactware, Inc. using information you provide about your structure, State Farm does not guarantee that any estimate will be the actual future cost to rebuild your structure, Higher limits are available at higher premiums, Lower limits are also available, as long as the amount of coverage meets our underwriting requirements. We encourage you to periodically review your coverages and limits with your agent and to notify us of any changes or additions to your structure. ----—----------------- ......... ------- Policy number:97-AA-E393-9 Page 5 of 5 Copyright, State Farm Mutual Automobile Insurance Company, 2008 CMP-4000 State Farm Insurance PO Box 2915 Bloomington, IL. 61702-2915 �,96 ff State Farm hire and Casualty Company � , 1 ASHLAND PARKS & RECREATION COM A stock company with home offices in Bloomington, Illinois 340 S PIONEER ST ASHLAND OR 97520-2729 p O O O O O N in Inland MM ing Declarati Policy number: 97-AA-E393-9 Effective date: September 19, 2025 Policy period: 12 months Expiration date: September 19,2026 The policy period begins and ends at 12:01 am standard time at the premises location, "4"1=4aV G Q4 8.IM0 MAIi 14E 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: Included 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 subsequent to the issuance of this policy. FORMS,OP'7.046 AND * FE-1403 Exclusion-Cyber Incident FE-6867 Amendment of Inland Marine Conditions FE-8739 Inland Marine Conditions FE-8743.1 Inland Marine Computer Property Form *New Form Attached See below for schedule page with limits XYTAQt 1U3 0�114LAh4V4.;t MAFU`-'-' W li.,N`411V.4,.PAGE Endorsement Coverage Limit of insurance Deductible arnount Annual premium number FE-8743.1 Inland Marine Computer Property Form $25,000 $500 Included Loss of Income and Extra Expense $25,000 Included Other limits and exclusions may apply - refer to your policy, .._....... _ _..-,. --------------------- Policy number 9/-AA-E393-9 Pale 1 of 1 O Copyright, State Farm Mutual Automobile Insurance Company, 2008 CIM Att Dec V M1 FD-6007 1009481 2002 153089 202 03-G6-2021