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HomeMy WebLinkAboutAntoinette Smith Photo LLC - Insurance Certificate 2024 StateFarm STATE FARM FIRE AND CASUALTY COMPANY A STOCK COMPANY WITH HOME OFFICES IN BLOOMINGTON, ILLINOIS DECLARATIONS AMENDED JAN 29 2024 P BoX 2915 Policy Number 96-EF-C708-3 Boommgton IL 6 1 702-29 15 y Addl Insured-Section 11 Only Policy Period Effective Date Expiration Date M-20-2695-FA65 F Z 12 Months FEB 3 2024 FEB 3 2025 002146 3123 The poll y period beggins and ends at 12:01 am standard CITY OF FORT COLLINS time at a premisesTocation. PO BOX 580 ti FORT COLLINS CO 80522-0580 Named Insured ANTOINETTE SMITH PHOTO LLC '�I'��'�111111�1"�1�11�11��1111�1111111��11�11111'lll�'�11�1111� s 0 0 a U)o Businessowners Policy Automatic Renewal-If the policy period is shown as 12 months,this policy will be renewed automatically subjectto the premiums,rules and forms in effectfor each succeeding policy period.If this policy is terminated,we will give you and the Mortgagee/Lien holder written notice in compliance with the policy provisions or as required by law. Entity: Limited Liability Company Reason for Declarations: Your policy is amended JAN 29 2024 ADDITIONAL INSURED ADDED PREMIUM ADJUSTMENT FORM CMP-4860 ADDED Other items shown are effective with the policy's 2024 renewal Endorsement Premium None Discounts Applied: Renewal Year Claim Record Prepared MAR 01 2024 ©Copyright,State Farm Mutual Automobile Insurance Company,200E CMP-4000 Includes copyrighted material of Insurance Services Office,Inc.,with its permission. 015369 290 Al Continued on Reverse Side of Page Page 1 of 6 N 530-666a 05-31- 011 W93 1 1 DECLARATIONS(CONTINUED) Businessowners Policy for CITY OF FORT COLLINS Policy Number 96-EF-C708-3 SECTIQN I - PROPE.RTY SCHEDULE Location Location of Limit of Insurance* Limit of Insurance* Seasonal Number Described Increase- Premises Coverage A- Coverage B- Business Buildings Business Personal Personal Property Property 001 642 ZUNI CIR No Coverage $ 15,700 25% FORT COLLINS CO 80526-2738 * 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 INDEXES) Cov A- Inflation Coverage Index: N/A Cov B - Consumer Price Index: 307.8 SECTION I- DEDUCTIBLES Basic Deductible $500 Special Deductibles: Money and Securities $250 Equipment Breakdown $500 Other deductibles may apply- refer to policy. Prepared MAR 01 2024 ©Copyright,State Farm Mutual Automobile Insurance Company,2008 CMP-4000 Includes copyrighted material of Insurance Services Office,Inc.,with its permission. 015369 Continued on Next Page Page 2 of 6 StateFarm ••'_ DECLARATIONS (CONTINUED) Businessowners Policy for CITY OF FORT COLLINS Policy Number 96-EF-C708-3 1" 1 y SECTION I- EXTENSIONS OF COVERAGE- LIMIT OF INSURANCE- EACH DESCRIBED PREMISES 8 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, �o but has "Included" indicated, please refer to that policy provision for an explanation of that coverage. LIMIT OF COVERAGE 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 10% insured on a replacement cost basis) Money And Securities (Off Premises) $2,000 Money And Securities (On Premises) $5,000 Money Orders And Counterfeit Money $1,000 Newly Acquired Business Personal Property (applies only if this policy provides $100,000 Coverage B - Business Personal Property) Newly Acquired Or Constructed Buildings (applies only if this policy provides $250,000 Coverage A- Buildings) Prepared MAR 01 2024 ©Copyright,State Farm Mutual Automobile Insurance Company,2008 CMP-4000 Includes copyrighted material of Insurance Services Office,Inc.,with its permission. 015370 290 Continued on Reverse Side of Page Page 3 of 6 N DECLARATIONS(CONTINUED) Businessowners Policy for CITY OF FORT COLLINS Policy Number 96-EE-C708-3 Ordinance Or Law- Equipment Coverage Included Outdoor Property $5,000 Personal Effects (applies only to those premises provided Coverage B , pusiness $2,500 Personal Property) 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 S - Business $2,500 Personal 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- LIMIT OF INSURANCE-.EEO 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. LIMIT OF COVERAGE INSURANCE Loss Of Income And Extra Expense Actual Loss Sustained - 12 Months SECTION 11 - LIABILITY ^�„ LIMIT OF COVERAGE INSURANCE Coverage L - Business Liability $1,000,000 Prepared MAR 01 2024 0)Copyright,State Farm Mutual Automobile Insurance Company,2008 CMP-4000 Includes copyrighted material of Insurance Services Offlrg,Inc.,with its permission. 015370 Continued on Next Page Page 4 of 6 StateFarm • ••. DECLARATIONS(CONTINUED) Businessowners Policy for CITY OF FORT COLLINS Policy Number 96-EF-C708-3 Coverage M - Medical Expenses (Any One Person) $10,000 Damage To Premises Rented To You $300,000 LIMIT OF AGGREGATE LIMITS INSURANCE g Products/Completed Operations Aggregate $2,000,000 a General Aggregate $2,000,000 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 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. FORMS AND ENDORSEMENTS CMP-4100 Businessowners Coverage Form CMP-4860 "AI Design Person Org FE-6999.3 Terrorism Insurance Cov Notice CMP-4206.2 Amendatory Endorsement FE-3650 Actual Cash Value Endorsement CMP-4561.4 Policy Endorsement CMP-4705.2 Loss of Income & Extra Expnse CMP-4709 Money and Securities FD-6007 Inland Marine Attach Dec New Form Attached Prepared MAR 01 2024 ©Copyright,State Farm Mutual Automobile Insurance Company,2008 CMP-4000 Includes copyrighted material of Insurance Services Office,Inc.,with its permission. 015371 290 Continued on Reverse Side of Page Page 5 of 6 N DECLARATIONS(CONTINUED) Businessowners Policy for CITY OF FORT COLLINS Policy Number 96-EF-C708-3 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, In Witness Whereof, the State Farm Fire and Casualty Company has caused this policy to be signed by its President and Secretary at Bloomington, Illinois. Secretary President Prepared MAR 01 2024 ©Copyright,State Farm Mutual Automobile Insurance Company,2008 CMP-4000 Includes copyrighted material of Insurance Services Office,Inc.,with its permission. 015371 290 Page 6 of 6 N StateFarm STATE FARM FIRE AND CASUALTY COMPANY U • A STOCK COMPANY WITH HOME OFFICES IN BLOOMINGTON, ILLINOIS INLAND MARINE ATTACHING DECLARATIONS P Boy2915 Policy Number 96-EF-C708-3 B�oomrngton IL 6 1 702-29 15 y Named Insured Policy Period Effective Date Expiration Date M-20-2695-FA65 F Z 12 Months FEB 3 2024 FEB 3 2025 The poll y period beggins and ends at 12:01 am standard ANTOINETTE SMITH PHOTO LLC time at a premises location. g 0 0 ATTACHING INLAND MARINE 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 succeeding policy period. If this policy is terminated,we will give you and the Mortgagee/Lienholder 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-8739 Inland Marine Conditions FE-8743.1 Inland Marine Computer Prop See Reverse for Schedule Page with Limits Prepared MAR 01 2024 ©Copyright,State Farm Mutual Automobile Insurance Company,2008 FD-6007 Includes copyrighted material of Insurance Services Office,Inc.,with its permission. 015372 530-686 a.2 05-31-2011 WN2320 98-EF-C708-3 ATTACHING INLAND MARINE SCHEDULE PAGE ATTACHING INLAND MARINE ENDORSEMENT LIMI1 OF DEDUCTIBLE ANNUAL NUMBER COVERAGE INSURANCE AMOUNT PREMIUM FE-8743.1 Inland Marine Computer Prop S 2 5 p 0 0 0 S 500 Included Loss of Income and Extra Expense 5 2 Ej , 000 Included - OTHER LIMITS AND EXCLUSIONS MAY APPLY-REFER TO YOUR POLICY Prepared MAR 01 2024 0)Copyright,State Farm Mutual Automobile Intu!jgce Company,2008 FD-6007 Includes copyrighted material of Insurance Services Off iee,Inc.,with its permission. 015372 530-666a.2 05-31-2011(03233cl