HomeMy WebLinkAboutCasa of Jackson County
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State Farm Fire and Casualty Company
PO Box 5000
Dupont, WA 98327-5000
1-15- 2134-F472 F U 3
TO BE PAID BY INSURED
Coverages and Limits
Section I
A Buildings
B Business Personal Property
C Loss of Income
$302,300
32,600
Actual Loss
5144
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
Insured: CASA OF JACKSON COUNTY
Deductibles . Section I
Basic
Other deductibles may
apply - refer to policy
500
Location: 613 MARKET ST
MEDFORD OR
97504-6125
Section II
L Business Liability
M Medical Payments
Gen Aggregate (Other than PCO)
Products-Completed Operations
(PCO Aggregate)
$1,000,000
10,000
2,000,000
2,000,000
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 Sewer/Drain Coverage
Continued on next page
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
Annual Premium
Forms, Opts, & Endrsmnt
Bus Liability - Cov L
Total Amount
$587.00
45.00
106.00
$738.00
Premium Reductions
Renewal Year Discount
Claim Record Discount
COV. A - Inflation Index: 203.9
Cov. B - Consumer Price: 203.9
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5144 401 M Agent RORY WOLD INSURANCE AGENCY IN
N ___ __ __ Telephone (541) 773-1404 or (541) 773-1423
If you have moved, please contact your agent.
See reverse side for important information.
REB
Prepared MAR 30 2007
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State Farm Fire and Casualty Company
PO Box 5000
Dupont, WA 98327.5000
1-15- 2134-F472 FU 3
5145
CITY OF ASHLAND
20 E MAIN ST
ASHLAND OR 97520-1850
11.1..1.11111111.1111111.1.11111.111.1.1.11...1.1..1.1...1.1.1
Forms, Options, and Endorsements
Additional Insured Endorsement
Inc Cost and Demolition Cov
Dist Mat Violat Statues Excl
Policy Endorsement
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5145
N
FE-6494
FE-6587
FE-6655
FE-6656
RENEWAL CERTIFICATE
SUPPLEMENTAL PAGE
401
M
Agent RORY WOLD INSURANCE AGENCY IN
Telephone (541) 773-1404 or (541) 773-1423
RES
Prepared MAR 30 2007
II I
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