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HomeMy WebLinkAboutFORT COLLINS CHILDREN'S THEATRE INC - INSURANCE CERTIFICATEStateFarm STATE FARM FIRE AND CASUALTY COMPANY A A STOCK COMPANY WITH HOME OFFICES IN BLOOMINGTON, ILLINOIS DECLARATIONS AMENDED OCT 153018 3 Ravrni8 pave Atlanta vA 30346-2117 M-20-2359-FAF1 F N 002423 3123 Addl Insured -Section II Only THE CITY OF FORT COLLINS PO BOX 580 FORT COLLINS CO 80522-0580 Businessowners Policy Policy Number 96-BO-8754-5 Policy Period Effective Date Expiration Date 12 Months JUN 20 2018 JUN 202019 The poll y period begins and ends at 12:01 am standard time ate premises Tocation. Named Insured FORT COLLINS CHILDREN'S THEATRE INC PO BOX 442 FORT COLLINS CO 80522-0442 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. Endorsement Premium None Discounts Applied: Renewal Year Years in Business Protective Devices Claim Record Prepared NOV 14 2018 © Copyright, State Farm Mutual Automobile Insurance Company, 2008 CMP-4000 Includes copyrighted material of Insurance Services Office, Inc., with its permission. 023260 290 Al Continued on Reverse Side of Page Page 1 of 6 N DECLARATIONS (CONTINUED) Businessowners Policy for THE CITY OF FORT COLLINS Policy Number 96-BQ-8754-5 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 001 725 E VINE DR No Coverage $ 45,200 25% FORT COLLINS CO 80524 * 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 INDEXES) Cov A - Inflation Coverage Index: Cov B - Consumer Price Index: SECTION I - DEDUCTIBLES N/A 249.0 Basic Deductible $500 Special Deductibles: Money and Securities $250 Equipment Breakdown $500 Other deductibles may apply - refer to policy. Prepared NOV 14 2018 © Copyright, State Farm Mutual Automobile Insurance Company, 2DD8 CMP-4000 Includes copyrighted material of Insurance Services Office, Inc., with its permission. 023260 Continued on Next Page Page 2 of 6 StateFarm � �DECLARATIONS (CONTINUED) Businessowners Policy for THE CITY OF FORT COLLINS Policy Number 96-BO-8754-5 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 $10,000 Off Premises $5,000 Arson Reward $5,000 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 $2,500 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) $2,000 Money And Securities (On Premises) $5,000 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 NOV 14 2018 © Copyright, State Farm Mutual Automobile Insurance Company, 2008 CMP-4000 Includes copyrighted material of Insurance Services Office, Inc., with its permission. 023261 290 Continued on Reverse Side of Page Page 3 of 6 N DECLARATIONS (CONTINUED) Businessowners Policy for THE CITY OF FORT COLLINS Policy Number 96-BCC-8754-5 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 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 Loss Of Income And Extra Expense LIMIT OF INSURANCE Actual Loss Sustained - 12 Months SECTION II - LIABILITY LIMIT OF COVERAGE INSURANCE Coverage L - Business Liability $1,000,000 Prepared NOV 14 2018 © Copyright, State Farm Mutual Automobile Insurance Company, 2008 CMP-4000 Includes copyrighted material of Insurance Services Office, Inc., with its permission. 023261 Continued on Next Page Page 4 of 6 StateFarm • •• DECLARATIONS (CONTINUED) Businessowners Policy for THE CITY OF FORT COLLINS Policy Number 96-BO-8754-5 Coverage M - Medical Expenses (Any One Person) Damage To Premises Rented To You AGGREGATE LIMITS Products/Completed Operations Aggregate General Aggregate $5,000 $300,000 LIMIT OF INSURANCE $2,000,000 $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-4788 'Addl Insd Mgrs Lessor of Prem CMP-4206.1 Amendatory Endorsement CMP-4766 Theft Deletion (Cov B Only) FE-6999.2 Terrorism Insurance Cov Notice CMP-4709 Money and Securities CMP-4705.2 Loss of Income & Extra Expnse CMP-4860 Al Design Person Org FE-3650 Actual Cash Value Endorsement CMP-4561.1 Policy Endorsement FD-6007 Inland Marine Attach Dec New Form Attached Prepared NOV 14 2018 © Copyright, State Farm Mutual Automobile Insurance Company, 2008 CMP-4000 Includes copyrighted material of Insurance Services Office, Inc., with its permission. 023262 290 Continued on Reverse Side of Page Page 5 of 6 N DECLARATIONS (CONTINUED) Businessowners Policy for THE CITY OF FORT COLLINS Policy Number 96-BCC-8754-5 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 NOV 14 2018 © Copyright, State Farm Mutual Automobile Insurance Company, 2008 CMP-4000 Includes copyrighted material of Insurance Services Office, Inc., with its permission. 023262 290 Page 6 of 6 N StateFarm STATE FARM FIRE AND CASUALTY COMPANY A STOCK COMPANY WITH HOME OFFICES IN BLOOMINGTON, ILLINOIS INLAND MARINE ATTACHING DECLARATIONS Atlanta �A 30346 2f 17 Named Insured FORT COLLINS THEATRE INC PO BOX 442 FORT COLLINS M-20-2359-FAF1 F N CHILDREN'S CO 80522-0442 ATTACHING INLAND MARINE Policy Number 96-BQ-8754-5 Policy Period Effective Date Expiration Date 12 Months JUN 20 2018 JUN 202019 The policy period begins and ends at 12:01 am standard time atthe premises location. 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-8743.1 Inland Marine Computer Prop See Reverse for Schedule Page with Limits Prepared NOV 14 2018 © Copyright, State Farm Mutual Automobile Insurance Company, 2008 FD-6007 Includes copyrighted material of Insurance Services Office, Inc., with its permission. 023263 96-BQ-8754-5 ATTACHING INLAND MARINE SCHEDULE PAGE ATTACHING INLAND MARINE ENDORSEMENT LIMIT OF DEDUCTIBLE ANNUAL NUMBER COVERAGE INSURANCE AMOUNT PREMIUM FE-8743.1 Inland Marine Computer Prop $ 25,000 $ 500 Included Loss of Income and Extra Expense S 25,000 Included Prepared NOV 14 2018 FD-6007 023263 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. 530-606 a.2 05. 31 2011 1o1 F3233c1 StateFarm 96-BQ-8754-5 023264 CMP-4788 i • Page 1 of 1 THIS ENDORSEMENT CHANGES THE POLICY PLEASE READ IT CAREFULLY CMP-4788 ADDITIONAL INSURED — MANAGERS OR LESSORS OF PREMISES This endorsement modifies insurance provided under the following: BUSINESSOWNERS COVERAGE FORM SCHEDULE Policy Number: 96-BQ-8754-5 Named Insured: FORT COLLINS CHILDREN'S THEATREINC PO BOX 442 FORT COLLINS CO 80522-0442 Name And Address Of Additional Insured Person Or Organization: THE CITY OF FORT COLLINS PO BOX 580 FORT COLLINS CO 80522-0580 Location Of Premises (Part Leased To You): 1. SECTION II — WHO IS AN INSURED of SECTION II — LIABILITY is amended to include, as an additional insured, any person or organization shown in the Schedule, but only with respect to liability arising out of the ownership, maintenance or use of that part of the premises leased to you and shown in the Schedule. 2. With respect to the insurance afforded the additional insured, this insurance does not apply to: a. Any "occurrence" or offense which takes place after you cease to be a tenant in the premises shown in the Schedule. b. Structural alterations, new construction or demolition operations performed by or for that addi- tional insured. 3. Any insurance provided to the additional insured shall only apply with respect to a claim made or a "suit" brought for damages for which you are provided coverage. 4. Primary Insurance. The insurance afforded the additional insured shall be primary insurance. Any insurance carried by the additional insured shall be noncontributory with respect to coverage provid- ed by you. All other policy provisions apply. CMP-4788 @, Copyright, State Farm Mutual Automobile Insurance Company, 2008 Includes copyrighted material of Insurance Services Office, Inc., with its permission.