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HomeMy WebLinkAbout548846 CAROLINE BRADFORD - INSURANCE CERTIFICATE (2)DECLARATIONS AMENDED NOV 262014 srurev.,n STATE FARM FIRE AND CASUALTY COMPANY App STOCK COMPANY WITH HOME OFFICES IN BLOOMINGMN, ILLINOIS BlomInghsa fL-MMoof T-20-1676-FAD1 F U W0871 3123 Addl Insured -Section II Only CITY OF FORT COLLINS PO BOX 580 FORT COLLINS CO 80522-0580 eC'jjf!] in Entity: Individual Reason for Declarations: Your policy is amended NOV 26 2014 ADDITIONAL INSURED ADDED FORM OMP-4786 ADDED Endorsement Premium Prepared FEB 03 2015 CMP4000 008D11 290 Al N None Policy Number 96-136-0139.6 Policy Period Effective Date Expiration Dab 12 Months AUG 19 2014 AUG 19 2015 The Pali y period be ins and ends at 12:01 am standard time atlFie premises castor. Named Insured BRADFORD, CAROLINE PO BOX 930 EAGLE CO 81631-0930 will be renewed we will give you m Copyright, State Farm Mutual Automobile Insurance Company, 20M Includes copyrighted mneriat of Insurance Services Office, Inc., with ns permission. Continued on Reverse Side of Page and t in Page 1 of 6 DECLARATIONS (CONTINUED) Office Policy for CITY OF FORT COLLINS Policy Number 96-B6-G139.6 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 49 HOCKETT ST No Coverage $ 11000 25% EAGLE CO 81631 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 INDEX(FS) Cov A - Inflation Coverage Index: N/A Cov B - Consumer Price Index: 238.3 SECTION I - DEDUCTIBLES 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 FEB 03 2015 m Copyright Smte Farm Mutual Automobile Insurance Company, M GMF 4000 Includes copyrighted marsdal of Insurance Services Office, Inc., with as permission. 008011 Continued on Next Page Page 2 of 6 DECLARATIONS (CONTINUED) Office Policy for CITY OF FORT COLLINS Policy Number 96-136-G139-6 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 FEB 03 2015 ® Com ieht Stes Farm Motel Aummohlle Insurance Company, 28B CMP4000 Includes copyrii materiel of Insurance Services Office, Inc., with in permission. OON12 280 Continued on Reverse Side of Page Page 3 of 6 N DECLARATIONS (CONTINUED) Office Policy for CITY OF FORT COLLINS Policy Number 96-B6-G139-6 Ordinance Or Law - Equipment Coverage Included Outdoor Property $5,000 Personal Effects (applies only to those premises provided Coverage B - Business $5,000 Personal Property) Personal Property Off Premises $15,000 Pollutant Clean Up And Removal $10,000 Presentation Of Property 30 Days Property Of Others (applies only to those premises provided Coverage B - Business $2,500 Personal Property) Signs $2,500 Unauthorized Business Card Use $5,000 Valuable Papers And Records On Premises 0,000 Off Premises 15,000 Water Damage, Other Liquids, Powder Or Molten Material Damage Included SECTION I - EXTENSIONS OF COVERAGE - LIMIT OF INSURANCE - PER 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. 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 FEB 03 2015 O Copyright, State Farm showed Automobile Insurance Company, pale CMP4000 Includes copyrighted material of Insurance Services Ci ice. Inc., won its permission. MM12 Continued on Next Page Page 4 of 6 In DECLARATIONS (CONTINUED) Office Polio y for CITY OF FORT COLLINS Policy Number 96-B6-G139-6 SECTION II - LIMIT OF COVERAGE INSURANCE Coverage L - Business Liability $1,000,000 Coverage M - Medical Expenses (Any One Person) $5,000 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 Please to Section II - Liability in the Coverage Form and any attached endorsements. annual period. refer 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 Businessownere Coverage Form OMP4786 'Addl Insd Owners Lessee Schad CMP4819.1 Unauthorized Business Card Use FE-6999A Terrorism Insurance Coy Notice CMP-4206.1 Amendatory Endorsement CMP4705 Lose of Income & Extra Expnee CMP-4710 Employee Dishonesty CMP-4709 Money and Securities CMP4706 Beck -Up of Sewer or Drain CMP4704 Dependent Prop Loss of Income CMP-4703 Utility Interruption Loss Incm FD-6007 Inland Marine Attach Dec New Form Attached Prepared FES 03 2015 m Copyright, State Farm Mutual Automobile Insurance Company, 200E CMP4000 Includes copyrighted materiel of Insurance Services O6ice, Inc., with ifs permission. 008013 290 Continued on Reverse Side of Page Page 5 of 6 N DECLARATIONS (CONTINUED) Office Policy for CITY OF FORT COLLINS Policy Number 96-136-G139-6 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 FES 032015 0Copyright, some Farm Mutuml Automobile Insurance Company, 200E CMP-4000 Includes copyrighted material of Insurance services Office, Inc, with ite permission. 009013 29e Page 6 of 6 N srarertrm STATE FARM FIRE AND CASUALTY COMPANY A STOCK COMPANY WITN HOME OFFICES IN BLOOMINGTON, ILLINOIS INLAND MARINE ATTACHING DECLARATIONS FOR Ireland (�'m;jxgoar Policy Number 96-BS-G139.6 Policy Period Effective Date Expiration Data T-20-1676-FADI F U 12 Months AUG 19 2014 AUG 19 2015 The pollGy period be ins and ends at 12:01 am standard Named Insured tme at01e premisesyocation. BRADFORD, CAROLINE PO BOX 930 EAGLE CO 81631-0930 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 Amountis 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. Former Options, and Endorsements FE-8739 Inland Marine Conditions FE-8743 Inland Marine Computer Prop See Reverse for Schedule Page with Limits Prepared FEB 03 2015 0 Copyright State Form Mutual Automobile Insurance Company, 2mE FD-6007 Includes copyrighted materiel of Insurance services Office, Inc„ with its permission. 008014 96-B6-G139-6 ATTACHING INLAND MARINE SCHEDULE PAGE ATTACHING INLAND MARINE ENDORSEMENT LIMIT OF DEDUCTIBLE ANNUAL NUMBER COVERAGE INSURANCE AMOUNT PREMIUM FE-8743 Inland Marine Computer Prop a 25,000 6 500 Included Leas of Income and Extra Expense $ 25,000 Included Prepared FEB 03 2015 FD-6007 00e014 OTHER LIMITS AND EXCLUSIONS MAY APPLY - REFER TO YOUR POLICY © CopydOht Stab Farm Mutual Automobile Insurance Company, 300E Includes copyrighted meurial of Insurance Services Office, Inc, with as permission, 531486.2 us 312011 lollamel 5�� 11"ll-G139.6 006015 CMP4766 �- Page 1 of 1 THIS ENDORSEMENT CHANGES THE POLICY PLEASE READ IT CAREFULLY. OCMP-4786 ADDITIONAL INSURED — OWNERS, LESSEES, OR CONTRACTORS (Scheduled) This endorsement modifies insurance provided under the following: BUSINESSOWNERS COVERAGE FORM SCHEDULE Policy Number: 96-se-G139.6 Named Insured: BRADFORD, CAROLINE PO BOX 930 EAGLE CO 81631.0930 Name And Address Of Additional Insured Person Or Organization: CITY OF FORT COLLINS PO BOX 580 FORT COLLINS CO 80522-0580 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 CMP4786 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. 0, Copyright, State Farm Mutual Automobile Insurance Company, 2005 Includes copynghted material of Insurance Semoes Once, Inc., with its permission.