HomeMy WebLinkAboutInsurance Certificate: Dancing People Co Policy Number DECLARATIONS PAGE COVERAGE SUMMARY
97-BB-W571-2 I DEC 2 2011 O
STATE FARM FIRE AND CASUALTY COMPANY s
PO BOX 5000, DUPONT WA 98327-5000
A STOCK COMPANY WITH HOME OFFICES IN BLOOMINGTON,ILLINOIS
Named Insured and Mailing Address
15-9A13-F4731
STIEHM, ROBIN
DBA DANCING PEOPLE CO
310 OAK ST STE 5
ASHLAND OR 97520-1877
Cov A - Inflation Coverage Index: N/A
BUSINESS POLICY - SPECIAL FORM 3-. Cov_S -.Consumer Price Index: 226.0
AUTOMATIC RENEWAL - If the POLICY PERIOD is shown as 12 MONTHS, this policy will be renewed automatically
subject to the premiums, rules and forms in effect for each succeedinp policy period. If this policy is terminated, we will
give you and the Mortgagee/Lienholder written notice in compliance wllh the policy provisions or as required by law.
Policy Period: 12 Months The policy period begins and ends at 12:01 am standard time at the
Effective Date: SEP 25 2011 premises location.
Expiration Date: SEP 25 2012
Named Insured: NON-PROFIT Requested By: Policyholder
Location of Covered Premises:
310 OAK ST
ASHLAND OR 97520-1876
Coverages & Property Limits of Insurance
Section
A Buildings Excluded
B Business Personal Property $ 6 200
C Loss of Income - 12 Months $ Actual foss
Section II Deductibles -Section I
L Business Liability 1,000 000
M Medical Payments 5,000 $ 500 Basic
Products-Completed Operations $ 2,000,000
(PCO)Aggregate
General Aggregate (Other $ 2,000,000
Than PCO) In case of loss under this policy, the deductible will be
applied to each occurrence and will be deducted from the
amount of the loss. Other deductibles may apply - refer to
policy.
Policy Premium $ 375.00
Forms, Options, and Endorsements Minimum Premium
Special Form 3 FP-6103
Policy Endorsement -Business FE-6851 Discounts Applied:
Amendatory Collapse FE-6573.1 Renewal Year
Fungus (Including Mold) Excl FE-6566 Years in Business
Teachers Liability Endorsement FE-6359 Enclosed Building
Policy Endorsement-Business FE-6610 Protective Devices
Policy Endorsement FE-6656 Claim Record
Continued on Reverse Side of Page
Prepared OTHER LIMITS AND EXCLUSIONS MAY APPLY- ER TO YOUR POLICY
DEC 02 2011 Count s n d
FP-8030.2C CGET By ent
06/1993 JON SN VDEN
Your policy consists of this page,any endorsements (541)462 461
and the DOlicv form.PLEASE KEEP THESE TOGETHER.
FE-6494
(5/91)
ADDITIONAL INSURED ENDORSEMENT
Managers or Lessors of Premises
Policy No.: 97-BB-W571-2
Named Insured:
STIEHM, ROBIN
DBA DANCING PEOPLE CO
310 OAK ST STE 5
ASHLAND OR 97520-1877
Name of Person or Organization:
CITY OFASHLAND
ITS OFFICERS AND EMPLOYEES
20 E MAIN ST
ASHLAND OR 97520-1850
Designation of Premises:
CITY OF ASHLAND,OREGON
WHO IS AN INSURED, under SECTION II This insurance does not apply to:
DESIGNATION OF INSURED, is amended to include 1. any occurrence which takes place after you cease to
as an insured the person or organization shown above, be a tenant in that premises; or
but only with respect to their liability arising out of the
ownership, maintenance or use of the premises leased to 2. structural alterations, new construction or demolition
you and designated above. operations performed by or on behalf of the person
or organization shown above.
FE-6494
(5/91)