Loading...
HomeMy WebLinkAbout128365 NATIONAL RESEARCH CENTER INC - INSURANCE CERTIFICATE (10)DECLARATIONS AMENDED AN 262015 stare"- STATE FARM FIRE AND CASUALTY COMPANY a�. A STOCK COMPANY WITH HOME OFFICES IN BLOOMINGTON, ILLINOIB BII Bar°o°,�i-'Ost�ia°i8001 T-20-2388-FA65 F U r11127 also Achill Insured -Section II Only CITY OF FORT COLLINS, CITY HALL WEST 300 LAPORTE AVE FORT COLLINS CO 80521-2719 Policy Number 96-BU-3823.8 Policy Period Effective Dab Expiration Date 12 Months NOV 16 2014 NOV 16 2015 The pall y period be ins and ends at 12:01 am standard time atticie premises�ocation. Named Insured NATIONAL RESEARCH CENTER INC 2955 VALMDNT RD STE 500 BOULDER CO 80301-1360 Office Policy Automatic Renewal - lithe policy period is shown as 12moMhs, 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 wrben notice in Entity: Corporation Reason for Declarations: Your policy is amended JAN 26 2015 ADDITIONAL INSURED ADDED FORM CMP-4786 ADDED Endorsement Premium None Discounts Applied: Renewal Year Years in Business Sprinkler Claim Record Prepared FEB 042015 0Copyright State Form Mutual Automobile Insurance Company,2ma CMP-4000 Includes copyrighted material of Insurance Services Office, Inc., with its permission. 009916 290 At Continued on Reverse Side of Pepe N Page 1 of 6 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 W 80301-1360 As of the effective data of this policy, the Limit of Insurance as shown includes any increase in the limit due to Inflation Coverage. SECTION I •INFLATION COVERAGE INDEX(ES7 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 04 2015 m Copyright Sue Form Mumal Automobile Insurance Company, 2= CM P-4000 Includes copyrighted material of Insurance Surnsus Office, Inc., with i%permission. 00N1e Continued on Next Page Page 2 of 6 DECLARATIONS (CONTINUED) Office Policy for CITY OF FORT COLLINS, Policy Number 96-SU-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 lose 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 pmvides $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 042015 0Copyright Stet, Form Mutual Automobile Insurance Company, 20OO CMP-4000 Includes copyrighted material of Insurance Services Office, Inc, with its persimmon. 009917 290 Continued on Reveres 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 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 Preservation 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 $100,000 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 042015 ©Copyright State Form Mutual Automobile Insurance Company,200E CMP-4000 Includes Copyri0hted materiel of Insurance Somcas DIAcs, Inc., with is permission. 0ON17 Continued on Next Page Page 4 of 6 DECLARATIONS (CONTINUED) Office Policy for CITY OF FORT COLLINS, Policy Number 96-BU-3823-8 CTION 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 11 - 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. CMP4100 Businessowners Coverage Form OMP4786 *Add( Insd Owners Lessee Schad OMP4787 *Waiver of Trans Rgt of Recov CMP4206.1 Amendatory Endorsement FE-6999.1 Terrorism Insurance Cov Notice CMP-4746 Hired Auto Liability CMP-4713 Excl Testing Consulting E&O CMP4819.1 Unauthorized Business Card Use CMP4706 Back -Up of Sewer or Drain CMP4704 Dependent Prop Loss of Income CMP-4710 Employee Dishonesty CMP4709 Money and Securities CMP-4703 Utility Interruption Loss Incm Prepared FEB 042015 O CulNnghp State Form Mutual Automobile Insurance Company,20011 CMP4000 Includes copyrighted materiel of Insurance Services Office, Inc., whh its permission. 009918 290 Continued on Reverse Side of Page Page 5 of 6 N DECLARATIONS (CONTINUED) Office Policy for CITY OF FORT COLLINS, Policy Number 96-BU-3823.8 CMP-4705 Loss of Income & Extra Expnse CMP-4786 Addl Insd Mgrs Lessor of Pram CMP4785 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 enthled 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 FEB 04 2015 ® Copyright, State Form Mutual Automobile Insurance Company, 2006 CMP-4000 Includes copyrighted materiel of Insurance services office, Inc, with his permission. 009818 290 Page 6 of 6 N 51a1ernmi A S K CM FIRE AND H HOME O COMPANY A9RJCK COMPANY WITH HOME OFFICES IN BLOOMINGTON, ILLINO/S INLAND MARINE ATTACHING DECLARATIONS 21nNand Gmve Policy Number 98-BU-3823.E Ir Inglon, IL 6r f Policy Period Effective Dab Ex ImBon Data T-20-2388-FA65 F U 12 Months NOV 16 2014 NOV 16 2015 The poll y period be ins and ends at 12:01 am standard Named Insured time atm premisesQocation. NATIONAL RESEARCH CENTER INC 2955 VALMONT RD STE 300 BOULDER CO 80301-1360 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/Lienholdor written notice in compliance with the policy provisions or as required bylaw. 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 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 FEB 042015 O Comduht State Form Mutual Automobile Insurance Company, 2000 FD6007 Includes copyrighted materiel of Insurance Services Office, Inc., with its permission 009919 530 on 0 a31 "n lolmalal 96-BU-3823-8 ATTACHING INLAND MARINE SCHEDULE PAGE ATTACHING INLAND MARINE ENDORSEMENT LIMIT OF DEDUCTIBLE NUMBER COVERAGE INSURANCE AMOUNT FE-8743 Inland Marine Computer Prop B 25,000 6 500 Loss of Income and Extra Expense 6 25,000 Prepared FEB 04 2015 FD-6007 009919 OTHER LIMITS AND EXCLUSIONS MAY APPLY - REFER TO YOUR POLIC m Copyright, State Farm Mutual Automobile Insurance Company, 2003 Includes copyrighted materiel of Insurance Services Office, Inc., with its permission. ANNUAL PREMIUM Included Included I.I..c asHm 011111330