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HomeMy WebLinkAbout130469 THE BRENDLE GROUP - INSURANCE CERTIFICATEStateFarm STATE FARM FIRE AND CASUALTY COMPANY Q AggSTOCK �2t7COMPANY SsWITH HOME OFFICES IN SLOOMINGTON, ILLINOIS GreeleroCOn8U638-o1001 Addl Insured -Section II Only AT2 T-20-2359-FAF1 F U 001750 3$25 CITY OF FORT COLLINS 215 N MASON ST 2ND FLOOR PO BOX 580 FORT COLLINSLI CO 80522-0580 „ l�ll�hrll'I'�IIr1lr�lr�llllld'Il"I�III��I��I'I'I'�11'�'Ill�ll� Office Policy RENEWAL DECLARATIONS Policy Number 96-CW-8447.1 0 12 Months DEC 3 2014 DEC 3 2015 The poll v period begins and ends at12:01 am standard time at a premises location. Named Insured THE BRENDLE GROUP INC 212 W MULBERRY ST .FORT COLLINS CO. 80521-2814 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 effectfor 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. Entity: Individual NOTICE: Information concerning changes in your policy language is included. Please call your agent if you have any questions. POLICY PREMIUM $ 974.00 Discounts Applied: Renewal Year Years in Business Enclosed Building Protective Devices Claim Record Prepared OCT 10 2014 CM P-4000 010671 294 Al 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 Page 1 of 7 530-6e6 e.2 05 31 2011 1ot n231q RENEWAL 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 $ 216,800 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 INDEWES) Gov A - Inflation Coverage Index: Cov B - Consumer Price Index: SECTION I - DEDUCTIBLES N/A 238.3 Basic Deductible $500 Special Deductibles: Money and Securities $250 Employee Dishonesty $250 Equipment Breakdown $500 Other deductibles may apply - refer to policy. Prepared OCT 10 2014 © Copyright State Farm Mutual Automobile Insurance Company, 2008 CMP-4000 Includes copyrighted material of Insurance Services Office, Inc., with its permission. 010671 Continued on Next Page Page 2 of 7 StateFarm ❑ • w ® RENEWAL 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 Or Robbery Debris Removal Equipment Breakdown Fire Department Service Charge Fire Extinguisher Systems Recharge Expense Forgery Or Alteration Glass Expenses 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 OCT 10 2014 ® Copyright. State Farm Mutual Automobile Insurance Company, 2008 CMP-4000 Includes copyrighted mateiiel of Insurance Services Office, Inc., with its permission. 010672 294 Contiriued on Reverse Side of Page N 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 7 RENEWAL 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 1- 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,OO17 Actual Loss Sustained - 12 Months Prepared OCT 10 2014 © Copyright State Farm Mutual Automobile Insurance Company, 2008 CMP-4000 Includes copyrighted material of Insurance Services Office, Inc., with its permission. 010672 Continued on Next Page Page 4 of 7 StateFarm L ®s® RENEWAL DECLARATIONS (CONTINUED) Office Policy for CITY OF FORT COLLINS Policy Number 96-CW-8447-1 SECTION II - 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-4206.1 "Amendatory Endorsement FE-6999.1 `Terrorism Insurance Cov Notice CMP-4845 Excl Product Comp Operatn Liab CMP-4713 Excl Testing Consulting E&O CMP-4787 Waiver of Trans Rgt of Recov CMP-4819.1 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 CMP-4705 Loss of Income & Extra Expnse Prepared OCT 10 2014 © Copyright, State Farm Mutual Automobile Insurance Company, 2gg8 CMP-4000 Includes copyrighted material of Insurance Services Office, Inc., with its permission. Oio673 294' Continued on Reverse Side of Page Page 5 of 7 N RENEWAL DECLARATIONS (CONTINUED) Office Policy for CITY OF FORT COLLINS Policy Number 96-CW-8447-1 CMP-4746 Hired Auto Liability CMP-4786 Addl Insd Owners Lessee Schad CMP-4785 Addl Ins Owners Lessee Blkt CMP-4788 Addl Insd Mgrs Lessor of Prem FD-6007 Inland Marine Attach Dec * 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 �B,,lloQoomington,�Illiinois. "'"' 111 000 Secretary President Prepared OCT 10 2014 © Copyright, State Farm Mutual Automobile Insurance Company, 2008 CMP-4000 Includes copyrighted material of Insurance Services Office, Inc., with its permission. 010673 Continued on Next Page Page 6 of 7 StateFarm • • •, RENEWAL DECLARATIONS (CONTINUED) u Office Policy for CITY OF FORT COLLINS Policy Number 96-CW-8447-1 E NOTICE TO POLICYHOLDER: For a comprehensive description of coverages and forms, please refer to your policy. Policy changes requested before the "Date Prepared", which appear on this notice, are effective on the Renewal Date of this policy unless otherwise Indicated by a separate endorsement, binder, or amended declarations. Any coverage forms attached to this notice are also effective on the Renewal Date of this policy. Policy changes requested after the "Date Prepared" will be sent to you as an amended declarations or as an endorsement to your policy. Billing for any additional premium for such changes will be mailed at a later date. If, during the past year, you've acquired any valuable property items, made any improvements to insured property, or have any questions about your insurance coverage, contact your State Farm agent. Please keep this with your policy. Prepared OCT 10 2014 CMP-4000 © Copyright State Farm Mutual Automobile Insurance Company, 200a Includes copyrighted material of Insurance Services Office, Inc., with its permission. 010674 294 N Page 7 of 7 StateFarm STATE FARM FIRE AND CASUALTY COMPANY A STOCKCOMPANYWITH HOME OFFICES IN BLOOMING70N, ILLINOIS INLAND MARINE ATTACHING DECLARATIONS Greeley cS" &9fit Policy Number 96-CW-8447-1 T-20-2359-FAF1 F U Named Insured THE BRENDLE GROUP INC 212 W MULBERRY ST FORT COLLINS CO 80521-2814 0 9 Lh ATTACHING INLAND MARINE Policy Period Effective Date Expiration Date 12 Months DEC 3 2014 DEC 3 2015 The poll y period begins and ends at 12:01 am standard time att�ie premises Tocanon. Automatic Renewal - If the policy period is shown as 12 months, this policy will be renewed automatically subjectto 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 subsequentto 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 OCT 10 2014 © Copyright, State Farm Mutual Automobile Insurance Company, 2008 FD-6007 Includes copyrighted material of Insurance ServicesOffice, Inc., with its permission. 010675 530 886e.2 05 31 2011 101132320 96-CW-8447-1 ATTACHING INLAND MARINE SCHEDULE PAGE ATTACHING INLAND MARINE ENDORSEMENT LIMIT OF DEDUCTIBLE' NUMBER COVERAGE INSURANCE AMOUNT FE-8743 Inland Marine Computer Prop S 25,000 $ 500 Loss of Income and Extra Expense S 25,000 Prepared OCT 10 2014 FD-6007 010675 OTHER LIMITS AND EXCLUSIONS MAYAPPLY - 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 530 985 91 05.31.2011 1o1 Q2330