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HomeMy WebLinkAbout130469 THE BRENDLE GROUP INC - INSURANCE CERTIFICATE (2)DECLARATIONS AMENDED JUN 62014 StateFarm STATE FARM FIRE AND CASUALTY COMPANY A STOCK COMPANY WITH HOME OFFICES IN BLOOMINGTON, ILLINOIS Greeey �n8t1�38-0001 T-20-2359-FAF1 F U 001082 3123 Addl Insured -Section II Only Policy Number 96-CW-8447-1 Policy Period Effective Date Expiration Data 12 Months DEC 3 2013 DEC 3 2014 The pollGy period be?ins and ends at 12:01 am standard time attne premises ocation. CITY OF FORT COLLINS Named Insured 215 N MASON ST 2ND FLOOR THE BRENDLE GROUP INC PO BOX 580 212 W MULBERRY ST - FORT COLLINS CO 80522-0580 FORT COLLINS CO 80521-2814 13)OAQ`1 Office Policy Automatic Renewal - Ifthe policy period is shown as 12 months, this policywill 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/Lienholderwritten notice in compliance with the policy provisions or as required by law. Entity: Individual Reason for Declarations: Your policy is amended JUN 6 2014 ADDITIONAL INSURED ADDED. FORM CMP-4786 ADDED Endorsement Premium None Discounts Applied: Renewal Year Years in Business Enclosed Building Protective Devices Claim Record Prepared JUN 25 2014 -Copyright State Farm Mutual Autom ©obile Insurance Company,2008 -- CMP-4000 Includes copyrighted material of Insurance Services Office, Inc., with its permission. 009190 290 Al Continued on Reverse Side of Page Page 1 of 6 N 530 686 e.2 05-31-2011 1. H3231c1 11 2 0 5 4 3 z DECLARATIONS (CONTINUED) Office Policy for CITY OF FORT COLLINS Policy Number 96-CW-8447-1 SECTION I - PROPERTY 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 001 212 W MULBERRY No Coverage $ 212,700 25% FORT COLLINS CO 80521-2814 * 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 INDEX(ES) Cov A - Inflation Coverage Index: Cov B - Consumer Price Index: SECTION I - DEDUCTIBLES N/A 233.9 Basic Deductible $500 Special Deductibles: Money and Securities 250 Employee Dishonesty $250 Equipment Breakdown 1500 Other deductibles may apply - refer to policy. Prepared JUN 25 2014 © Copyright State Farm Mutual Automobile Insurance Company, 2008 CMP-4000 Includes copyrighted material of Insurance Services Office, Inc., with its permission. 009190 Continued on Next Page Page 2 of 6 staltafam. DECLARATIONS (CONTINUED) Office Policy for CITY OF FORT COLLINS Policy Number 96-CW-8447-1 SECTION I - EXTENSIONS OF COVERAGE - LIMIT OF INSURANCE - EACH DESCRIBED PREMISES 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, but has 'Included" indicated, please refer to that policy provision for an explanation of that coverage. COVERAGE Accounts Receivable On Premises Off Premises Arson Reward Back -Up Of Sewer Or Drain Collapse Damage To Non -Owned Buildings From Theft, Burglary On Robbery Debris Removal Equipment Breakdown Fire Department Service Charge Fire Extinguisher Systems Recharge Expense Forgery Or Alteration Glass Expenses ON Increased Cost Of Construction And Demolition Costs (applies only when buildings are insured on a replacement cost basis) Money And Securities (Off Premises) Money And Securities (On Premises) Money Orders And Counterfeit Money Newly Acquired Business Personal Property (applies only if this policy provides Coverage B - Business Personal Property) Newly Acquired Or Constructed Buildings (applies only if this policy provides Coverage A - Buildings) Prepared JUN 25 2014 CMP-4000 00e1e1 2e0 N © Copyright, State Farm Mutual Automobile Insurance Company, 2008 Includes copyrighted material of Insurance Services Office, Inc., with its permission. Continued on Reverse Side of Page LIMIT OF INSURANCE 50,000 15,000 $5,000 $15,000 Included Coverage B Limit 25% of covered loss Included $5,000 -$5,000 $10,000 Included 10% $5,000 $10,000 $1,000 $100,000 $250,000 Page 3 of 6 3 2 DECLARATIONS (CONTINUED) Office Policy for CITY OF FORT COLLINS Policy Number 96-CW-8447-1 Ordinance Or Law - Equipment Coverage Outdoor Property Personal Effects (applies only to those premises provided Coverage B - Business Personal Property) Personal Property Off Premises Pollutant Clean Up And Removal Preservation Of Property Property Of Others (applies only to those premises provided Coverage B - Business Personal Property) Signs ' Unauthorized Business Card Use Valuable Papers And Records On Premises Off Premises Water Damage, Other Liquids, Powder Or Molten Material Damage . SECTION I - EXTENSIONS OF COVERAGE - LIMIT OF INSURANCE - PER POLICY Included $5,000 $5,000 $15,000 $10,000 30 Days $2,500 $2,500 $5,000 $50,000 $15,000 Included The coverages and corresponding limits shown below are the most we will pay regardless of the number of described premises shown in these Declarations. COVERAGE Dependent Property - Loss Of Income Employee Dishonesty Utility Interruption - Loss Of Income Loss Of Income And Extra Expense LIMIT OF INSURANCE $5,000 $10,000 $10,000 Actual Loss Sustained - 12 Months Prepared JUN 25 2014 © Copyright State Farm Mutual Automobile Insurance Company, 2008 CMP-4000 Includes copyrighted material of Insurance Services Office, Inc., with its permission. 009191 Continued on Next Page Page 4 of 6 StateF" a. DECLARATIONS (CONTINUED) Office Policy for CITY OF FORT COLLINS Policy Number 96-CW-8447-1 SECTION 11 - LIABILITY COVERAGE Coverage L - Business Liability Coverage M - Medical Expenses (Any One Person) Damage To Premises Rented To You AGGREGATE LIMITS Products/Completed Operations Aggregate General Aggregate LIMIT OF INSURANCE $1,000,000 $5,000 $500,000 LIMIT OF INSURANCE Excluded $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-4786 'Addl Insd Owners Lessee Schad CMP-4787 'Waiver of Trans Rgt of Recov CMP-4206 Amendatory Endorsement CMP-4845 Excl Product Comp Operatn Liab FE-6999.1 Terrorism Insurance Cov Notice CMP-4713 Excl Testing Consulting E&O CMP4819.1 Unauthorized Business Card Use CMP-4706 Back -Up of Sewer or Drain CMP-4704 Dependent Prop Loss of Income CMP-4710 Employee Dishonesty CMP-4709 Money and Securities CMP-4703 Utility Interruption Loss Incm Prepared JUN 25 2014 © Copyright, StateFarmMutual Automobile Insurance Company, 2DD8 CMP-4000 Includes copyrighted materiel of Insurance Services Office, Inc., with its permission. 009192 290 Continued on Reverse Side of Page N Page 5 of 6 DECLARATIONS (CONTINUED) Office Policy for CITY OF FORT COLLINS Policy Number 96-CW-8447-1 CMP-4705 Loss of Income & Extra Expnse CMP-4746 Hired Auto Liability CMP-4785 Addl Ins Owners Lessee Blkt FD-6007 Inland Marine Attach Dec NOTICE: INFORMATION CONCERNING CHANGES IN YOUR POLICY LANGUAGE IS INCLUDED. PLEASE CALL YOUR AGENT IF YOU HAVE ANY QUESTIONS. * New Form Attached 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. rn3Rwa4.. Secretary President Prepared JUN 25 2014 CMP-4000 © Copyright State Farm Mutual Automobile Insurance Company, 2008 Includes copyrighted material of Insurance Services Office, Inc., with its permission. 009192 290 N Page 6 of 6 st3terarm STATE FARM FIRE AND CASUALTY COMPANY &- A STOCK COMPANY WITH HOME OFFICES IN BLOOMINGTON, ILLINOIS INLAND MARINE ATTACHING DECLARATIONS G�&y, 80635-0001 T-20-2359-FAFI F U Named Insured THE BRENDLE GROUP INC 212 W MULBERRY ST FORT COLLINS CO: 80521-2814 ATTACHING INLAND MARINE Policy Number 96-CW-8447-1 Policy Period Effective Date Expiration Date 12 Months DEC 3 2013 DEC 3 2014 The pollFy period begins and ends at 12:01 am standard time att a premises location. 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/Lienholderwritten 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 Inland Marine Computer Prop See Reverse for Schedule Page with Limits Prepared JUN 25 2014 © Copyright. State Farm Mutual Automobile Insurance Company, 2DDg FD-6007 Includes copyrighted materiel of Insurance Services Office, Inc., with its permission. 009193 530 685 e.2 0531.2011 101132320 96-CW-8447-1 ATTACHING INLAND MARINE SCHEDULE PAGE ATTACHING INLAND MARINE NUMBER COVERAGE FE-8743 Inland Marine Computer Prop Loss of Income and Extra Expense Prepared JUN 25 2014 FD-6007 LIMIT OF INSURANCE S 25,000 S 25,000 DEDUCTIBLE AMOUNT $ 500 OTHER LIMITS AND EXCLUSIONS MAY APPLY - REFER TO YOUR POLICY © Copyright State Farm Mutual Automobile Insurance Company, 2008 Includes copyrighted material of Insurance Services Office, Inc., with its permission. ANNUAL PREMIUM Included Included 009193 530 686 e.3 0531 2011 1o1 f3333c1