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Home My WebLink About385923 PENNY FLATS CONDOMINIUM ASSOCIATION INC - INSURANCE CERTIFICATE (2)359 05XN142401 07 000 SRT019 AMERICAN FAMILY MUTUAL INSURANCE COMPANY MADISON, WISCONSIN 53783-0001 BUSINESSOWNERS POLICY DECLARATIONS POLICY NUMBER CUSTOMER BILLING ACCOUNT 05XN142401 015-433-556 44 NAMED PENNY FLATS CONDOMINIUM ASSOCIATION INC INSURED MAILING C/O MOUNTAIN—N—PLAINS INC ADDRESS 375 E HORSETOOTH RD BLDG 3100 FORT COLLINS, CO 80525-3197 POLICY PERIOD FROM 10-23-2014 TO 10-23-2015 12:01 A.M. Standard Time at your mailing address shown above. FORM OF BUSINESS CORPORATION In return for the payment of the premium, and subject to all the terms of this policy, we agree with you to provide the insurance as stated in this policy. SECTION I PROPERTY COVERAGE PROVIDED INSURANCE AT THE FOLLOWING DESCRIBED PREMISES ONLY FOR COVERAGES FOR WHICH A LIMIT OF INSURANCE IS SHOWN UNLESS COVERAGE IS PROVIDED BY AN ENDORSEMENT. DESCRIPTION OF PREMISES PREMISES NO. 0001 BUILDING NO. 001 LOCATION 204 MAPLE ST FORT COLLINS, CO 80521-2076 BUILDING INTEREST LEASED TO OTHERS PREDOMINANT OCCUPANCY CONDOMINIUM ASSOCIATION — RESIDENTIAL WITH MERCANTILE NUMBER OF UNITS 30 CONSTRUCTION FRAME YEAR BUILT 2008 COMMERCIAL BUILDING CONSTRUCTION COST INDEX LEVEL 326 PROPERTY DEDUCTIBLE $10,000 OTHER PROPERTY DEDUCTIBLE(S) OPTIONAL COVERAGE/GLASS DEDUCTIBLE COVERAGE BUILDING REPLACEMENT COST ADDITIONAL COVERAGE BUSINESS INCOME $500 LIMIT OF INSURANCE PREMIUM $5,574,398 $14,526.00 LIMIT OF INSURANCE PREMIUM ACTUAL LOSS SUSTAINED INCLUDED AGENT 017-309 PHONE PAGE 0001 DANIEL B RICHMOND AGENCY, INC. 970-484-2881 BRANCH SRT019 RENW 923 E PROSPECT RD ENTRY DATE 09-02-2014 FORT COLLINS, CO .80525-1110 BP AF 01 07 09 MEMORANDUM Stock No. 15141 Includes copyrighted material of Insurance Services Office, Inc , with its Permission 359 05XN142401 07 000 SRT019 AMERICAN FAMILY MUTUAL INSURANCE COMPANY MADISON, WISCONSIN 53783-0001 BUSINESSOWNERS POLICY POLICY NUMBER DECLARATIONS CUSTOMER BILLING ACCOUNT 05XN142401 015-433-556 44 Property forms and endorsements applying to this premises and made part of this policy at time of issue: Any endorsement followed by a state abbreviation will only apply to coverages within this state. BP 04 30 01 06 BP 12 03 01 06 BP 84 11 07 98 BP 85 11 12 08 APPLICABLE PROPERTY ENDORSEMENT CHARGES $58.00 TOTAL ADVANCE PROPERTY PREMIUM $14,584.00 Property forms and endorsements applying to all premises and made part of this policy at time of issue: Any endorsement followed by a state abbreviation will only apply to coverages within this state. BP 06 01 01 07 BP 83 01 07 98 BP 83 02 01 07 SECTION II LIABILITY AND MEDICAL EXPENSES Each paid claim for the following coverages reduces the amount of insurance we provide during the applicable annual period. Please refer to Section II Liability in the BUSINESSOWNERS COVERAGE FORM and any attached endorsements. COVERAGE AGGREGATE LIMIT (OTHER THAN PRODUCTS COMPLETED OPERATIONS) PRODUCTS -COMPLETED OPERATIONS AGGREGATE LIMIT DAMAGE TO PREMISES RENTED TO YOU LIABILITY AND MEDICAL EXPENSES PREM 0001 BLDG 001 LOCATION MEDICAL EXPENSES - ANY ONE PERSON PREMISES NO. 0001 BUILDING NO. 001 PREMIUM BASIS 30 UNITS TOTAL ADVANCE BUSINESS LIABILITY PREMIUM LIMIT OF INSURANCE $4,000,000 $4,000,000 $50,000 $2,000,000 $5,000 RATE ADVANCE PREMIUM $207.00 $207.00 Liability forms and endorsements applying to all premises and made part of this policy at time of issue: Any endorsement followed by a state abbreviation will only apply to coverages within this state. BP 04 17 07 02 BP 04 39 07 02 BP 04 48 01 06 BP 04 54 01 06 BP 04 93 01 06 BP 05 17 01 06 BP 05 77 01 06 BP 10 05 07 02 BP 14 60 06 10 BP 84 24 01 07 BP 85 04 07 10 BP 85 05 07 98CO BP 85 10 07 98 BP 85 12 01 06 IL 75 26 12 05 TOTAL ADVANCE BUSINESS PREMIUM $14,791.00 This premium may be subject to adjustment. Forms and endorsements applying to property and liability at all premises and made part of this policy at time of issue: Any endorsement followed by a state abbreviation will only apply to coverages within this state. BP IN 01 01 06 BP 00 03 01 06 BP 01 81 07 02 BP 05 01 07 02 BP 05 15 01 08 BP 05 24 01 08 BP 05 41 06 08 BP 05 64 01 07 BP 05 71 01 07 BP 80 01 01 07 BP 87 01 08 10 BP 87 90 08 10 AGENT 017-309 PHONE PAGE 0002 DANIEL B RICHMOND AGENCY, INC. 970-484-2881 BRANCH SRT019 RENW 923 E PROSPECT RD ENTRY DATE 09-02-2014 FORT COLLINS, CO 80525-1110 BP AF 01 07 09 MEMORANDUM Stock No. 15141 Includes coovriahted material of Insurance Services Office. Inc . with its oermission 359 POLICY NUMBER 05XN142401 AUTHORIZED REPRESENTATIVE 05XN142401 07 000 SRT019 AMERICAN FAMILY MUTUAL INSURANCE COMPANY MADISON, WISCONSIN 53783-0001 BUSINESSOWNERS POLICY DECLARATIONS CUSTOMER BILLING ACCOUNT 015-433-556 44 W z — 6/ j yK C �l— COUNTERSIGNED Xpresident J I cSecretary LICENSED RESIDENT AGENT AGENT 017-309 PHONE PAGE 0003 DANIEL B RICHMOND AGENCY, INC. 970-484-2881 BRANCH SRT019 RENW 923 E PROSPECT RD ENTRY DATE 09-02-2014 FORT COLLINS, CO 80525-1110 BP AF 01 07 09 MEMORANDUM Stock No. 15141 Includes cooyriohted material of Insurance Services Office. Inc.. with its nermiesinn