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State Farm Fire and Casualty Company
PO Box 5000
Dupont, WA 98327-5000
1-15- 2134-F472 F U 3
CITY OF ASHLAND
20 E MAIN 51
ASHLAND OR 97520-1850
11.1..1...1.1.1...1.111......111..1..1.1.11...1.1..1.1...1.1.1
Insured: CASA OF JACKSON COUNTY
Location: 613 MARKET ST
MEDFORD OR
97504-6125
Mortgagee: STERLING HOLDINGS LLC
Add Ins-II: CITY OF ASHLAND
Forms, Options, and Endorsements
Special Form 3
Amendatory Endorsement
Tree Debris Removal
Business Policy Endorsement
Glass Deductible Deletion
Amendatory Endorsement
Fungus (Including Mold) Excl
Subcontractor Pd Exclusion
Terrorism Insurance Cov Notice
Policy Endorsement- Business
Building Ordinance or Law Cov
Back-Up SewerlDrain Coverage
Continued on next page
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FP-6103
FE-6237.1
FE-6451
FE-6464
FE-6538.1
FE-6551
FE-6566
FE-6598
FE-6999
FE-6610
FE-6620
FE-6603
RENEWAL CERTIFICATE
P&tiCY''iJt.lQeR ..............~~'TII:$~~~~~~~............................... .
Business- Office Policy
JUN 01 2006 to JUN 01 2007
Coverages and Limits
Section I
A Buildings
B Business Personal Property
C Loss of Income
Deductibles . Section I
Basic
Other deductibles may
apply - refer to policy
Section II
L Business Liability
M Medical Payments
Gen Aggregate (Other than PCO)
Products-Completed Operations
(PCO Aggregate)
Annual Premium
Forms, Opts, & Endrsmnt
Bus Liability - Cov L
Total Amount
Premium Reductions
Renewal Year Discount
Cov. A -Inflation Index:
Cov. B - Consumer Price:
189.2
199.2
$280,400
31 800
Actual Loss
500
$1,000,000
10,000
2,000,000
2,000,000
$688.00
54.00
128.00
$870.00
., 56 3669 3991
See reverse side for important information.
71uvrk P. ~it(l$~F"
6597 401 AI Agent RORY WOLD INSURANCE AGENCY IN
N Telephone (541) 773-1404 or (541) 773-1423
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REB
Prepared APR 07 2006
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PO Box 5000
Dupont, WA 98327-5000
1-15- 2134-F472 FU 3
CITY OF ASHLAND
20 E MAIN ST
ASHLAND OR 97520-1850
11.1..1...1.1.1...1.111......111..1..1.1.11...1.1..1.1...1.1.1
Forms, Options, and Endorsements
Additional Insured Endorsement
Ino Cost and Demolition COy
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6598
N
FE-6494
FE-6587
RENEWAL CERTIFICATE SUPPLEMENTAL PAGE II
POUC'tNLJ"*BER.. ..............Q1:~e$~$2~8ffi~m ........>....................m.m _
Business- Office Policy
JUN 01 2006 to JUN 01 2007
CONTINUED
401
AI
Agent RORY WOLD INSURANCE AGENCY IN
Telephone (541) 773-1404 or (541) 773-1423
--r-
REB
Prepared APR 07 2006