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HomeMy WebLinkAboutLLOYDS BARBER SHOP LLC - INSURANCE CERTIFICATEStateFarm • • STATE FARM FIRE AND CASUALTY COMPANY A STOCK COMPANY WITH HOME OFFICES IN BLOOMINGTON, ILLINOIS DECLARATIONS 3 Ra o Dr3 ntta !�0346-2117 Atla M-20-2644-FAF1 F Z 003696 3123 Addl Insured -Section II Only CITY OF FORT COLLINS PO BOX 580 FORT COLLINS CO 80522-0580 Policy Number 96-B8-K105-4 Policy Period Effective Date Expiration Date 12 Months JAN 12 2019 JAN 122020 The policy period begins and ends at 12:01 am standard time at the premisesTocation. Named Insured LLOYDS BARBER SHOP LLC 226 S COLLEGE AVE FORT COLLINS CO 80524-2811 Hair Salon, Day Spa and Barber Policy 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/Lienholder written notice in compliance with the policy provisions or as required by law. Entity: Limited Liability Company NOTICE: Information concerning changes in your policy language is included. Please call your agent if you have any questions. POLICY PREMIUM Minimum Premium Discounts Applied: Renewal Year Years in Business Claim Record $ 475.00 Prepared OCT 01 2018 © Copyright, State Farm Mutual Automobile Insurance Company, 2008 CMP-4000 Includes copyrighted material of Insurance Services Office, Inc., with its permission. 038205 290 Al Continued on Reverse Side of Page Page 1 of 7 N DECLARATIONS (CONTINUED) Hair Salon, Day Spa and Barber Policy for CITY OF FORT COLLINS Policy Number 96-B8-K105-4 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 001 226 S COLLEGE AVE No Coverage $ 24,600 25% FORT COLLINS CO 80524-2811 . As of the effective date of this policy, the Limit Ot Insurance as snown incluaes any increase in ine emit aue to innanon uuveiayu. SECTION I - INFLATION CQVERAGE INDEXES) Cov A - Inflation Coverage Index: Cov B - Consumer Price Index: SECTION I - DEDUCTIBLES N/A 252.1 Basic Deductible $500 Special Deductibles: Money and Securities $250 Employee Dishonesty $250 Equipment Breakdown $500 Other deductibles may apply - refer to policy. Prepared OO OCT re 2018 Copyright, State Farm Mutual Automobile Insurance Company, 2008 CMP-4000 Includes copyrighted material of Insurance Services Office, Inc., with its permission. 038205 Continued on Next Page Page 2 of 7 DECLARATIONS (CONTINUED) Hair Salon, Day Spa and Barber Policy for CITY OF FORT COLLINS Policy Number 96-88-K105-4 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) Ordinance Or Law - Equipment Coverage Included Outdoor Property $5,000 Personal Effects (applies only to those premises provided Coverage B - Business $2,500 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 Valuable Papers And Records On Premises $10,000 Off Premises $5,000 Water Damage, Other Liquids, Powder Or Molten Material Damage Included Prepared OCT re 2018 © Copyright, State Farm Mutual Automobile Insurance Company, 2008 CMP-4000 Includes copyrighted material of Insurance Services Office, Inc., with its permission. 038206 Continued on Next Page Page 4 of 7 StateFarm • • • DECLARATIONS (CONTINUED) Hair Salon, Day Spa and Barber Policy for CITY OF FORT COLLINS Policy Number 96-B8-K105-4 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 SECTION 11- LIABILITY LIMIT OF COVERAGE INSURANCE Coverage L - Business Liability $1,000,000 Coverage M - Medical Expenses (Any One Person) $5,000 Barber And Cosmetologist Professional Liability $1,000,000 Damage To Premises Rented To You $300,000 LIMIT OF AGGREGATE LIMITS INSURANCE Products/Completed Operations Aggregate Excluded General Aggregate $27000,000 Professional Aggregate $1,000,000 Prepared OCT 01 2018 © Copyright, State Farm Mutual Automobile Insurance Company, 2008 CMP-4000 Includes copyrighted material of Insurance Services Office, Inc., with its permission. 038207 290 Continued on Reverse Side of Page Page 5 of 7 N DECLARATIONS (CONTINUED) Hair Salon, Day Spa and Barber Policy for CITY OF FORT COLLINS Policy Number 96-138-1<105-4 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. FORMS AND ENDORSEMENTS CMP-4100 Businessowners Coverage Form CMP-4561.1 *Policy Endorsement CMP-4705.2 'Loss of Income & Extra Expnse CMP-4704.1 'Dependent Prop Loss of Income CMP-4703.1 "Utility Interruption Loss Incm FE-6999.2 "Terrorism Insurance Cov Notice CMP-4826 Employee Equipment Coverage CMP-4825 Brands and Labels CMP-4206.1 Amendatory Endorsement CMP-4710 Employee Dishonesty CMP-4709 Money and Securities CMP-4706 Back -Up of Sewer or Drain CMP-4793 AI State Political Perm Prem CMP-4402 Barber Cosmetologist Prof Liab CMP-4845 Excl Product Comp Operatn Liab CMP-4787 Waiver of Trans Rgt of Recov CMP-4788 Addl Insd Mgrs Lessor of Prem FE-3650 Actual Cash Value Endorsement FD-6007 Inland Marine Attach Dec New Form Attached Prepared OCT 01 2018 © Copyright, State Farm Mutual Automobile Insurance Company, 2008 CMP-4000 Includes copyrighted material of Insurance Services Office, Inc., with its permission. 038207 Continued on Next Page Page 6 of 7 StateFarm • ••. DECLARATIONS (CONTINUED) Hair Salon, Day Spa and Barber Policy for CITY OF FORT COLLINS Policy Number 96-68-1<105-4 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 01 2018 CMP-4000 © Copyright, State Farm Mutual Automobile Insurance Company, 2008 Includes copyrighted material of Insurance Services Office, Inc., with its permission. 038208 290 N Page 7 of 7 StateFarm • • • STATE FARM FIRE AND CASUALTY COMPANY A STOCK COMPANY WITH HOME OFFICES IN BLOOMINGTON, ILLINOIS INLAND MARINE ATTACHING DECLARATIONS Atlanta 8, f13S46-2117 M-20-2644-FAF1 F Z Named Insured LLOYDS BARBER SHOP LLC 226 S COLLEGE AVE FORT COLLINS CO 80524-2811 ATTACHING INLAND MARINE Policy Number 96-B8-KI OS-4 Policy Period Effective Date Expiration Date 12 Months JAN 12 2019 JAN 122020 The poll y period beggins and ends at 12:01 am standard time ate premises Tocation. 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/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-8743.1 'Inland Marine Computer Prop FE-8739 Inland Marine Conditions "New Form Attached See Reverse for Schedule Page with Limits Prepared OCT 01 2018 © Copyright, State Farm Mutual Automobile Insurance Company, 2008 FD-6007 Includes copyrighted material of Insurance Services Office, Inc., with its permission. 038209 ATTACHING INLAND MARINE SCHEDULE PAGE ATTACHING INLAND MARINE ENDORSEMENT NUMBER COVERAGE FE-8743.1 Inland Marine Computer Prop Loss of Income and Extra Expense Prepared OCT 01 2018 FD-6007 LIMIT OF INSURANCE 25,000 25,000 DEDUCTIBLE AMOUNT OTHER LIMITS AND EXCLUSIONS MAY APPLY - REFER TO YOUR POLICY © Copyright, State Farm Mutual Automobile Insurance Company, 2008 Includes copyrighted material of Insurance Services Office, Inc., with its permission. 500 ANNUAL PREMIUM Included Included 038209 530 686 a.2 Ob 31 2011 IoIf32330