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HomeMy WebLinkAbout128365 NATIONAL RESEARCH CENTER INC - INSURANCE CERTIFICATE (8)Statelarm STATE FARM FIRE AND CASUALTY COMPANY ASTOCK COMPANY WITH HOME OFFICES INSLOOMINGTON,ILLINOIS DECLARATIONS AMENDED SEP182014 Greele Pro 38 3&1 T-20.2388-FA65 F U 001060 3123 Addl Insured -Section II Only CITY OF FORT.COLLINS, CITY HALL WEST 300 LAPORTE AVE FORT COLLINS CO 80521-2719 Office Policy Policy Number 96-BU-3823-8 Policy Period Effective Date Ex !ration Date 12 Months NOV 16 2014 16 2015 The pall y period beg9ins and ends at12:01 am standard time att�ie premisesTocatlon. Named Insured NATIONAL RESEARCH CENTER INC 2955 VALMONT RD STE 300 BOULDER CO 80301-1360 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: Corporation Reason for Declarations: Your policy is amended SEP 18 2014 ADDITIONAL INSURED ADDED FORM CMP-4786 ADDED Other items shown are effective with the policy's 2014 renewal Endorsement Premium None Discounts Applied: Renewal Year Years in Business Sprinkler Claim Record Prepared OCT 22 2014 © Copyright State Farm Mutual Automobile Insurance Company, 2000 CMP-4000 Includes copyrighted materiel of Insurance Services Office, Inc., with its permission. 008906 290 Al Continued on Reverse Side of Page N Page 1 of 6 530 686 a 05 31,2011 10113231c1 DECLARATIONS (CONTINUED) Office Policy for CITY OF FORT COLLINS, Policy Number 96-SU-3823-8 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 2955 VALMONT RD STE 300 No Coverage $ 79,200 25% BOULDER CO 80301-1360 ` 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 1- INFLATION COVERAGE INDEWES) Cov A - Inflation Coverage Index: Cov B - Consumer Price Index: SECTION I -DEDUCTIBLES N/A 238.3 Basic Deductible $1,000 Special Deductibles: Money and Securities $250 Employee Dishonesty $250 Equipment Breakdown $1,000 Other deductibles may apply - refer to policy. Prepared OCT 22 2014 © Copyright State Farm'Mutual Automobile Insurance Company, 2008 CMP-4000 Includes copyrighted material of Insurance Services Office, Inc., with its permission. 008906 Continued on Next Page Page 2 of 6 Sratelamr a. DECLARATIONS (CONTINUED) Office Policy for CITY OF FORT COLLINS, Policy Number 96-BU-3823-8 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. LIMIT OF COVERAGE INSURANCE Accounts Receivable On Premises $50,000 Off Premises $15,000 Arson Reward $5,000 Back -Up Of Sewer Or Drain $15,000 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 $5,000 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) $5,000 Money And Securities (On Premises) $10,000 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 OCT 22 2014 © Copyright, State Farm Mutual Automobile Insurance Company, 2D08 CMP-4000 Includes copyrighted material of Insurance Services Office, Inc., with its permission. 008e07 290 Continued on Reverse Side of Page Page 3 of 6 N DECLARATIONS (CONTINUED) Office Policy for CITY OF FORT COLLINS, Policy Number 96-BU-3823-8 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) Sig Ins 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 $100,000 $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 OCT 22 2014 © Copyright State Farm Mutual Automobile Insurance Company, 2008 CMP-4000 Includes copyrighted material of Insurance Services Office, Inc., with its permission. 008907 Continued on Next Page Page 4 of 6 statem�n 411%- DECLARATIONS (CONTINUED) Office Policy for CITY OF FORT COLLINS, Policy Number 96-BU-3823-8 SECTION II - LIABILITY LIMIT OF COVERAGE INSURANCE Coverage L - Business Liability $1,000,000 Coverage M - Medical Expenses (Any One Person) $10,000 Damage To Premises Rented To You $300,000 LIMIT OF AGGREGATE LIMITS INSURANCE Products/Completed Operations Aggregate $2,000,000 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-4786 "Addl Insd Owners Lessee Schad CMP-4206.1 Amendatory Endorsement FE-6999.1 Terrorism Insurance Cov Notice CMP-4746 Hired Auto Liability CMP-4787 Waiver of Trans Rgt of Recov CMP-4713 Excl Testing Consulting E&O 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 Prepared OCT 22 2014 © Copyright State Farm Mutual Automobile Insurance Company, 2008 CMP-4000 Includes copyrighted material of Insurance Services Office, Inc., with its permission. 00e908 290 Continued on Reverse Side of Page N Page 5 of 6 DECLARATIONS (CONTINUED) Office Policy for CITY OF FORT COLLINS, Policy Number 96-BU-3823-8 CMP-4705 Loss of Income & Extra Expnse CMP-4788 Addl Insd Mgrs Lessor of Prem CMP-4785 Addl Ins Owners Lessee Blkt 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 Bloomington, Illinois. Secretary President Prepared OCT 22 2014 CMP-4000 © Copyright State Farm Mutual Automobile Insurance Company, 2008 Includes copyrighted material of Insurance Services Office, Inc., with its permission. 008908 290 N Page 6 of 6 Statefarm STATE FARM FIRE AND CASUALTY COMPANY A STOCK COMPANY WITH HOME OFFICES IN BLOOMINGTON, ILLINOIS INLAND MARINE ATTACHING DECLARATIONS Gr5e5W, GVnB(xi38.0001 T-20-2388-FA65 F U Named Insured NATIONAL RESEARCH CENTER INC 2955 VALMONT RD STE 300 BOULDER CO 80301-1360 ATTACHING INLAND MARINE Policy Number 96-BU-3823-8 Policy Period Effective Date Exppiration Date 12 Months NOV 16 2014 NOV 16 2015 The policy period begins and ends at 12:01 am standard time aM premises location. Automatic Renewal - lithe 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. Ifthis policy is terminated, we will give you and the Mortgagee/Lienholder written notice in compliance with the policy provisions or as required bylaw. 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-8743 Inland Marine Computer Prop FE-8739 Inland Marine Conditions See Reverse for Schedule Page with Limits Prepared OCT 22 2014 ® Copyright State Farm Mutual Automobile Insurance Company, 2008 FD-6007 Includes copyrighted material of Insurance Services Office, Inc., with its permission. 008909 530 666a2 05 31 2011 (032320 96-BU-3823-8 ATTACHING INLAND MARINE SCHEDULE PAGE ATTACHING INLAND MARINE ENDORSEMENT NUMBER FE-8743 Prepared OCT 22 2014 FD-6007 COVERAGE Inland Marine Computer Prop Loss of Income and Extra Expense LIMIT OF INSURANCE 6 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 materiel of Insurance Services Office, Inc., with its permission. ANNUAL PREMIUM Included Included 008909 530 6e6 eR 05 31.2011 10113233c) �z 90 9 stateimm 96-BU-3823-8 008910 CMP-4786 �. Page 1 of 1 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. .. CMP-4786 ADDITIONAL INSURED — OWNERS, LESSEES, OR CONTRACTORS . (Scheduled) This endorsement modifies insurance provided under the following: BUSINESSOWNERS COVERAGE FORM 1 SCHEDULE Policy Number: 96-BU-3823-8 Named Insured: NATIONAL RESEARCH CENTER INC 2955 VALMONT RD STE 300 BOULDER CO 80301-1360 Name And Address Of Additional Insured Person Or Organization: CITY OF FORT COLLINS, CITY HALL WEST 300 LAPORTE AVE FORT COLLINS CO 80521.2719 SECTION II — WHO IS AN INSURED of SECTION II — LIABILITY is amended to in- clude, as an additional insured, any person or organization shown in the Schedule, but only with respect to liability for "bodily in- jury", "property damage", or "personal and advertising injury" caused, in whole or in part, by: a. Ongoing Operations (1) Your acts or omissions; or (2) The acts or omissions of those acting on your behalf; in the performance of your ongoing opera- tions for that additional insured; or b. Products -Completed Operations "Your work" performed for that additional insured and included in the "products - completed operations hazard". 2. Any insurance provided to the additional in- sured shall only apply with respect to a claim made or a "suit' brought for damages for which you are provided coverage. 3. Primary Insurance. The insurance afforded the additional insured shall be primary insur- ance. Any insurance carried by the additional insured shall be noncontributory with respect to coverage provided by you. There will be no refund of premium in the event this endorsement is cancelled. All other policy provisions apply. CMP-4786 ®, Copyright, State Farm Mutual Automobile Insurance Company, 2008 Includes copyrighted material of Insurance Services Office, Inc., with its permission.