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HomeMy WebLinkAboutInsurance Certificate: Wild Rivers Surveying, LLC State Farm Insurance ❑ PO Box 2915 Bloomington, IL 61702-2915 tateFarm^ AT1 002797 1200 01 State Farm Fire and Casualty Company THE CITY OF ASHLAND A stock company with home offices in Bloomington, Illinois 20 E MAIN ST ASHLAND OR 97520-1814 r � Illlliillll�llllllirl�"'III��II�II�I'�I��I��I�'��Ir111r111illll J1012 Renewal Declarations Policy number:97-CN-X256-3 Effective date:January 24, 2026 Policy period: 12 months Expiration date:January 24,2027 The policy period begins and ends at 12:01 am standard time at the premises location. BUSINESSOWNERS 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 Mortg agee/Lien holder written notice in compliance with the policy provisions or as required by law. NAMED INSURED WILD RIVERS SURVEYING, LLC ENTITY Limited Liability Company 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 is the 12 months premium(s)for the characteristics of the policy as described in this Declarations. Premium: $542.00 Total Premium: $542.00 Discounts applied: Business Experience Rating Renewal Discount Years in Business Business in Residence Premises IMPORTANT MESSAGE(S) Notice - Information concerning changes in your policy language is included. Please call your agent if you have any questions. Policy number:97-CN-X256-3 Page 1 of 5 ©Copyright, State Farm Mutual Automobile Insurance Company, 2008 CMP Dec 3P OR.1 CMP-4000 1009482 2014 153090 214 05.17-2025 Prepared:December 1,2025 cStateFarm° SECTION I-PROPERTY SCHEDULE Location Location of described premises Limit of Insurance" Limit of Insurance* Seasonal Increase- number Coverage A- Coverage B-Business Business Personal Property Buildings Personal Property 001 3339 GREEN ACRES DR No Coverage $34,000 25% CENTRAL POINT OR 97502-1413 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: WA Cov B-Consumer Price Index: 324.8 SECTION I—DEDUCTIBLES BASIC DEDUCTIBLE $500 SPECIAL DEDUCTIBLES: Employee Dishonesty: $250 Equipment Breakdown: $500 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 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%of covered loss Equipment Breakdown Included 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 insured on a 10% replacement cost basis) Policy number 97-CN-X2563 Page 2 of 5 ©Copyright, State Farm Mutual Automobile Insurance Company, 2008 CMP-4000 71 StateFarm, Coverage Limit of Insurance { Money Orders and Counterfeit Money $1.000 Money and Securities On Premises $5,000 Off Premises $2,000 00 NewlyAcquired Business Personal Property(applies only If this policy provides Coverage B-Business $100,000 q PrfY( PP Y P YP 9 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) $2,500 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 Valuable Papers and Records On Premises $10,000 Off Premises $5,000 Water Damage, Other Liquids,Powder or Molten Material Damage Included SECTION I—EXTENSIONS OF COVERAGE-LIMITOF 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 Employee Dishonesty $5,000 Loss of Income and Extra Expense 12 Months Actual Loss Sustained SECTION 11 -LOCATION SCHEDULE Location Location of described premises number 001 3339 GREEN ACRES DR CENTRAL POINT OR 97502-1413 Policy number.97-CN-X256-3 Page 3 of 5 ©Copyright, State Farm Mutual Automobile Insurance Company, 2008 CMP-4000 State Farw SECTION II-LIABILITY Coverage Limit of Insurance Coverage L-Business Liability Per Occurrence $2,000,000 Coverage M-Medical Expenses $10,000 Any One Person Damage to Premises Rented to You $300,000 Aggregate Limits Limit of Insurance General Aggregate $5,000,000 Products/Completed Operations Aggregate $5,000,000 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 BUSINESSOWNERSCOVERAGE FORM shown below,and any other forms and endorsements the 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-4529 Policy Endorsement CMP-4532 Exclusion-Cyber Incident CMP-4543 Additional Insured-Designated Person or Organization * CMP-4587 Exclusion-Silica or Silica-Related Dust CMP-4683.1 Additional Insured-Owners,Lessees or Contractors(Blanket) CMP-4684.1 Additional Insured-Owners,Lessees or Contractors(Scheduled) CMP-4705.2 Loss of Income and Extra Expense CMP-4709 Money and Securities CMP-4710 Employee Dishonesty CMP-4787 Waiver of Transfer of Rights of Recovery Against Others To Us CMP-4788 Additional Insured-Managers or Lessors of Premises FD-6007 Inland Marine Attaching Declarations FE-3650 Actual Cash Value Endorsement FE-6999.3 Policyholder Disclosure Notice of Terrorism Insurance Coverage *New Form Attached SCHEDULE OF ADDITIONAL INTERESTS) Interest type: Owners,Lessees, or Contractors(Schedul Endorsement number: CMP-4684.1 Loan number: NIA The City of Ashland 20 E Main St Ashland OR 97520-1814 Policy number:97-CN-X256-3 Page 4 of 5 ©Copyright, State Farm Mutual Automobile Insurance Company, 2008 CMP-4000 StateFarm 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. gg In Witness Whereof, the State Farm Fire and Casualty Company has caused this policy to be signed by its President and Secretary at N$ Bloomington, Illinois, President Secretary OTHER MESSAGES) 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-CN-X256-3 Page 5 of 5 ©Copyright, State Farm Mutual Automobile Insurance Company, 2008 CMP-4000 ' .. _ _ _ �, r x y.` i _e' .� `r i . � i %. �i �, � _ ., '� _� _ `' _ _ � 1 �' 1 . � « r.^ �..' i �' t ".r - :, -� _ . � `, _- �. _ { .. � .- _ t `; � �: �� ; � �., _. .. .. _ :� _ .: .. � ` �, � 1 ��. State Farm Insurance PO Box 2915 Bloomington, IL 61702-2915 cStateFarm- State Farm Fire and Casualty Company THE CITY OF ASHLAND A stock company with home offices in Bloomington, Illinois 20 E MAIN ST ASHLAND OR 97520-1814 N 8 4� Inland Marine Attaching Declarations Policy number: 97-CN-X256-3 Effective date: January 24, 2026 Policy period: 12 months Expiration date: January 24, 2027 The policy period begins and ends at 12:01 am standard time at the premises location. ATTACHING INLAND MARINE Automatic renewal -If the State FarmO 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: 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,OPTIONS AND ENDORSEMENTS 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 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 Other limits and exclusions may apply - refer to your policy. Policy number:97-CN-X256-3 Page 1 of 1 CIM AC Dec 3P OR.1 ©Copyright, State Farm Mutual Automobile Insurance Company, 2008 FD-6007 1009481 2002 153089 202 03-06-2021