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Home My WebLink AboutNEWSUMMIT LLC - INSURANCE CERTIFICATEStateFarm $7ATE FARM FIRE AND CASUALTY CQMPANY �• A STOCK COMPANY WlThf HQME OFFIC�S !N BLODMlNGTON, 1LLlNO1S DECLARATIONS AMENDED MAR 9 2023 P Box 2915 B�oomingfon !L 6i702-2915 Addi Insured-Section II Onfy M-20-215D-FB05 F N 002852 3123 CITY OF FORT COLLINS PUf2CHASING UIVi5I0N PO BOX 580 ��'�� FORT COLLIMS CO 80522-0580 :e`�!� 'I��I'I��II'��Ill��li��l�lllt'�l�I'I'lill�'�I'�lIII'I�I�'I'��'� � � �� o Office Policy Policy Number 96-C7-H511-0 i Policy Period �Hective Date Expiration DF 12 Monlhs SEP i8 2022 SEP 18 202 The pol�y period be�ins and ends at 12:01 am standa t�me at e premises ocaUon. l Named Insured NEWSUMMIT LLC Automatic Renewal � If the pollcy period is shown as 12 months , this policy will be renewed automatically subjectio the premiums, rules forms in e#fect for each succeedFng policy perrod lf tiiis policy is terminated, we will give you and the Mortgagee/Lienholder written nouc compliance with the policy provis�ans or as �equired by law. Entity: Lrmited LiabiliEy Company Reason for Declarations: Your policy is amended MAR 9 2023 AQQITIONAL INSURED ADDED PREMIUM ADJUSTMENT FORM CMP-4860 ADDED Endorsemenf Premium Discaunts Applied: Renewal Year Years in Business Sprinkler Claim Record None Prepared APR 10 2023 CMP-4000 a2is6i 2so Ai N �O Copyriqht, State Ferm Mutual Automobile Insarance Company, 2008 Inc4udes copyr ghted matenal af insurance Serwces Office, Ine„ with its permission. Continued on Reverse Side of Page Page 1 of tan FaF a � n�, ot tin t� DECLARA7'IQNS (CONTINUED} Office Policy ior CITY OF FORT COLLINS Policy Number 9fi-C7-H511-0 � '•• j� Y_� Location Location of Limit of Insurance' Limit of Insurance" Seasonai Number Described Increase- Premises Coverage A- Coverage B- Business Buildings Business Personal Personal Property Property 001 56i 0 WARD RD STE 3Q0 No Coverage $ 5,90Q 25°!0 ARVADA CO 80002-1309 , oi the effective date of this policy, the Limit af Insurance as shown includes any increase in the limit due to Inflation Coverage A; s � • � _�� r � Cov A� Inflation Coverage Index: N/A Cov B- Consumer Price Index: 292.3 SECTIpN ! - DEAUC716LES , , ,_,,,,,. �� , „ Basic Deductible Speciai �eductibles: Money and Securities Equipment Breakdown $�,oao $250 Employee Dishonesty $� ,oao $250 Other deductibies may apply - refer to policy. Prepared APR 10 2023 cM�-4oaa � Copyr ght, State farm Mutual Automobile Insurance Compeny, 2008 lncludes copynghted matenal of Insurence ServFces Offlce, Inc., with its permission. o��ss� Continued an Next Page Page 2 of 6 StateFarm � � � DECLARATIONS (CONTINUED) Oftice Policy for CITY OF FORT COLLINS Policy Number 96-C7-H511-0 � SECTION I- EXTENSIONS QF ��1fERAGE -IIMIT OF INSURANCE -��H DESC@{BED PREMi�S�S g The coverages and corresponding Omits shown befaw apply separately to each described premises shown in the; Deciarations, unless indicated by "See Schedu�e." If a coverage does not have a corresponding lirr�it shawn belo� � � but has "Included" indicated, please refer to that policy provisian for an explanatfon of that coverage. �o LIMIT OF COVERAGE INSURANCE Accaunts Receivable On Premises Off Premises Arson Reward Back-Up Of Sewer Or Drain Collapse Damage To Non-Owned Buildings From Theit, Burglary Or Robbery Debris Remov�l Equipment Breakdown Fire Department Service Charge Fire Extinguisher Systems Recharge Expense Forgery Or Alteration Glass Expenses increased CasE Of Construction And Demolition Costs {applies only when buildings are insured on a replacement co5# basis} Money And Securities (Off Premises) Money And Securities (On Premises) Money Qrders And Counterleit Money Newly Acquired Business Personal Property (applies anly ii this policy provides Coverage B- Business Personal P►aperty) Newly Acquired Or Constructsd Buildings (applies only if this policy provides Coverage A - Buildings) Prepared APR 10 2023 CMP-4000 021862 290 N � Copynght, State Farm Mutual Automob le insurance Compeny, 2008 Includes copynghted mater al of Insurance Serv+ees Office, Inc , wiih its perm�ssion. Continued on Reverse Side of Page $50,000 $15,000 $5,00a $15,000 Included Coverage B Limit 25% o# covered loss lncluded $5,00a $�,00a $10,000 I ncluded 10% $5,OOQ $10,040 $� ,040 $�oo,00a $250,OOQ Page 3 of DECLARATIONS (CON7INUED} Office Policy ior CITY OF FORT COLLINS Palicy Number 9fi-C7-H511-0 Ordinance Or Law - Equipment Coverage Outdoor Property Personal Eifects (applies only to those premises provided Coverage B- Business Parsonal Properly) Personal Prbperty 4ff Premises Poliutant Clean Up And Removal Preservation Of Property Property Of Others (applies only to those premises provided Coverage B- Business Personal F'roperty) Signs Unauthorized Business Card Use Valuable Papers And Records On Premise5 Off Premises Water Damage, Uther L+quids, Powder Or Molten Material Damage Included $5,000 �s,aao $15,000 $1 d,000 30 Days $2,500 $2,500 $5,000 $50,000 $15,000 Included SECTION I- exr�rv��QN� Fj� COYERAGE - LIMIT OF iNSURANCE - P�R POLtCY The coverages and corresponding limits shown below are the most we wllt pay regardless oi the number af described premises shown in these Declarations. COVERAGE Dependent Property - Loss Of income Employee Dishonesty Utifity Interruption - Loss Of Income Loss Of Income And Extra Expense LIMIT OF INSURANCE $�,aoo $1 d,d00 $� o,oao Actual Loss Sustained - 12 Months Prepared APR 10 2023 m Copyripht, State Farm MuWal Automobile Ensurence Company, 2008 CMP-a0Q0 (ncludes copynphted materiel of Insurance Services Ofiice, Inc, with rts perrrussion p21g62 Gontinued on Next Page Page 4 of 6 Siafefarm • •• DECLARATIQNS (CONTINUED) Office Policy far CITY OF F�RT COLLINS Policy fVumbe� 96-C7-ii511-0 . :�� 0 N O •� COVERAGE Coverage L - Business Liability Goverage M- Medical Expenses (Any One Person) Damage To Premtses Rented To You AGGRFGATE LiMITS Products/Completed Operations Aggregate General Aggregate LIMIi OF INSURANCE $1,0OO,OQO $5,000 $300,aaa LlMIT OF iNSURANCE $2,000,0�0 $2,000,oao Each paid cEaim for Liabil�ty Coverage reduces the amouni 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 BUSINESSOWNERS COVERAGE FORM 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. �iIIr� • r _ ii�Z�I��u.L�� CMP-4100 CMP-4$6Q CMP-4787 CMP-4819.1 FE-6999.3 CMP-4206.1 FE-3650 CMP-4561.1 CMP-4705.2 CMP-4710 CMP-4709 CMP-4706 CMP-4704.1 Prepared APR 10 2023 CMP-4000 Businessowners Coverage Form 'AI Design Person Org 'Waiver of Trans Rgt of Recov Unauthorized Business Card Use Terrorism Insurance Cov Notice Amendatory Endorsement Actual Cash Value Endorsement Policy Endorsement Loss of Income & Extra Expnse Emp�oyee Qishonesty Money and Securities Back-Up of Sewer or Drain Dependent Prop Loss of Income C Copynght, State Ferm Mutual Autvmob�le Insurance Company, 2008 Includes copyrighted material of Insurance Serwces Offwe, Ine , with its permission o�isss 2so Continued on Reverse Side of Page Page 5 of N DECLARATIONS (C�NTINUED� Ottice Policy for CI7Y OF FORT COLLINS Policy Number 96-C7-H511-0 CMP-4703.1 Utility Interruption Loss Incm CMP-4713.1 Excl Testing Consufting �&O FD-6007 Inland Marine Attach Dec NOTICE: INFORMATION CONCERNING CI-tANGES IN YOUR POLICY LANGUAGE IS INCLUDED. PLEASE CALL YOUR AGENT IF YOU HAVE ANY GIUESTIONS. ` New Form Attached This policy is issued by the State Farm Fire and Casualry Company. Participating Policy You are entitied to participate in a distribution of the earnings of the company as deterrrt{ned by aur Board of Directors in accordance with the Gompany's Articles af lncorporation, as amended. In Witness Whereof, the State Farm Fire and Casualty Company has csused this policy to be signed by its President and Secretary at Bloomingion, Illinois. ��rn��- ��-�-� Secretary President Prepared APR 10 2023 � Copynght, 5tate Farm Mutuaf Automobile Insurance Compeny, 20D6 CMP-4000 Inc{udes copynghted material of Insurance Services Office, Inc., wath its parmission. 021863 290 Page 6 of 8 N Statefarm STATE FARM FIRE ANd GASUALTY COMPANY •, A STOCK COMPANY iN17N HOME QFFICE5 IN BLOOMlIVGTON, ILLlNOJS IMLAND MARINE ATTACHING qECLARATI0N5 Po Box 2$15 Bloomingron !L 67702-29t5 Named Insured NEWSUMMIT LLC � �� ATTACHING INLAND MARINE Pollcy Period Etfective Date Ex iratian Da M-20-215D-F605 F N 12 Months SEP 18 2022 S�P 18 242, The poli y period begins and ends at 12:01 am standar tlme at�e premises TocaUon, AuUomatic Renewal - If the pol}cy pprfod is shown as 12 months , this policy will be renewed automa6caliy subjectto the premiums, rules forms in effectfor each succeeding policy period. If this policy is terminated, we will give you and the MortgageelLienholder written notic compliance wit#� the policy provisions or as required by law. Annua! Policy Premium Included The above Premium Amauntis included in the Policy Premium shown on the Declaratians. Your policy consists of these Oeclarations, the INLAND MARINE CON�7ITIOIVS shown below, and any other forms and endorsements that apply, including those shown below as well as those issued subsequentto the issuance of tt�is pol�cy. Fo�ms, Options, and Endorseme�ts FE-8739 Inland Marine Conditians FE-8743.1 lnland Marine Camputer Prap See Reverse tor Schedule Page wath Limits Prepared APR 10 2023 FD-6007 Policy IVumber 96-C7-H511-0 C�1 Copyr�ght, State Farm Mutual Automobde Insurance Compsny, 2008 Inelaides copynghted metenal of Insurance Services Oftice, Inc., with 4s permission. 02i864 530 666 a.2 OS 31 2011 96-C7-H51 i -0 ATTACHING INLAND MARlNE SCHEDULE PAGE ATTACHING INLAND MARENE EiVDORSEMEI�T NUMBER �E-8743.1 COVERA6E Inland Marine Computer Prop $ Loss of Income and Extra Expense $ LIMIT OF fNSURANCE 25,000 25,000 DTHER LIMITS ANQ EXCLlJSIONS MAY APPLY - REFER TQ YOUR POLfCY Prepared APR 1 Q 2023 C� Copyright, State Ferm Mutuel Automobile Ensarance Company, 2�D6 F D-6007 Inclades copyr�phtad matenal of Insurence Servicss Office, Inc„ with its permission. DEDUCTIBLE AMOUN7 500 ANNUAL PREMIUM Included Included oziasa 530 6E5 e.Y 05 31 �01I Io113273� StaieFarm g6-C7-H51i-0 021865 • • • TH1S ENDORS�MENT CHANGES THE POLICY PLEASE READ IT CAREFULLY. ;•►:.�. � �� o CMP-486d Page 1 oi 1 snrc ra�r ��, CMP-4860 ADDITfONA� INSURED — DESIGNATED PERSON OR ORGANIZATION This endorsement modifies insurance provided under the foUowing: BUSINESSOWNERS COVERAG� FORM Policy Number: �s-C7-ii5il-o Named Insured: SCHEDULE NEWSUMMIT LLC Name And Address �f Additional Insured Persan Or Organization: CITY OF FORT COLLINS PURCWASING DIVISI(JN PO BOX SBQ FORT COLLtNS CO 80522-0580 1. SECTION II — WHO IS AN INSURED af SECTION II --- LIABILITY is amended to include, as an additional insured, any person or organization shown in the Schedule, but only with respect ta liability for "badily injury", "property darrzage" or "personal and advertising injury" caused, in whole or in part, by: a. Prernises And Ongoing Operations Your acts or omissions or the acts or omissions of those acting on your behalf: (1) In connection with your premises; or (2) In #he performance of your ongoing operations; or b. Products-Completed Operations "Your work" performed for that additional insured and included in the "products�compfeted opera- tions hazard". 2. Any insurance provided ta the additional insured shall only apply with respect to a claim made o� a "suit" brought for damages for which you are provided coverage. 3. Primary I�surance. The insurance afforded the additional insured shall be primary insurance. Any insurance carried by the addi#ional insured shall be noncontributory with respect to coverage provid- ed by you. The�e will be na refund of premium in the event this endorsement is cancelled. All other policy provisions appiy_ CM P-4860 m, Copyright, State Farm Mutual Automobile Insurance Company, 2008 Includes copyrghted material ai Insurance Services �ffice, Inc., with its permission StateFarm g6-C7-H511-0 021866 CMP-4i87 �, Page 1 of 1 THIS ENDORSEMENT CHANGES THE POLICY PLEASE READ IT CAREFULLY. CMP-4787 WAlVER OF TRANSFER OF RIGHTS OF RECOVERYAGAlNST OTHERS TO US � This endorsement modifies insurance provided under the following: BUSINESS4WNERS COVERAGE FORM � Palicy Number: 96-C7-Hsi�-o �� Named Ittsured: SCHEDULE NEWSUMMIT LLC Name And Address Of Person Ur Urganization: CITY OF FORT C�L�INS PURCHASING DIVfSION PO BOX 580 FORT COLLINS CO 8Q522-0580 The following is added to Paragraph 10.b. of SECTION I AND SECTION II — COMMON POLICY C�NDITIONS: We waive any right of recovery we may have against the person or organization shown in the Schedule because of payments we make for injury or damage arising out of: a. Your ongoing operations; or b. "Your work" done under contract with that persan or organization and included in the "products- completed operatians hazard". This waiver applies only to the person or organization shown in the Schedule. All other policy provisions apply. CMP-4787 �, Copyright, 5tate Farm Mutual Automobile Insurance Gompany, 2008 Includes copyrighted material of Insurance Services Office, Inc., with its permission