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HomeMy WebLinkAboutSAINT THOMAS CHURCH - INSURANCE CERTIFICATESTATE FARM FIRE AND CASUALTY COMPANY A STOCK COMPANY WITH HOME OFFICES IN BLOOMINGTON, ILLINOIS DECLARATIONS AMENDED APR 9 2019 StateFarm • • • 33 Ravini pnvQ AtlantaA 30346-2117 Addl Insured -Section II Only M-20-1817-FAF1 F Y 002016 3123 CITY OF FORT COLLINS PO BOX 580 FORT COLLINS CO 80522-0580 II�IIIIIII�I���I�III�I��IIII�II'I��'Il'Il"..I"IIII��III�II����I Religious Organization Policy Policy Number 96-CL-M979-8 Policy Period Effective Date Expiration Date 12 Months DEC 22 2018 DEC 22 2019 The poly period begins and ends at 1201 am standard time at a premises ocatlon. Named Insured SAINT THOMAS CHURCH 421 S HOWES ST APT 607 FORT COLLINS CO 80521-2869 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. Entity: RELIGIOUS INSTITUTIONS Reason for Declarations: Your policy is amended APR 9 2019 ADDITIONAL INSURED ADDED BUSINESS PIERS PROP COVERAGE CHANGED OPERATIONS EXPOSURE CHANGED FORM CMP-4860 ADDED Endorsement Premium Increase Discounts Applied: Sprinkler Prepared JUN 07 2019 Copyright, State Farm Mutual Automobile Insurance Company, 2008 CMP-4000 Includes copyrighted material of Insurance Services Office, Inc., with its permission. 017886 290 Al Continued on Reverse Side of Page N Page 1 of 7 530-Mal 05 31 2011 l o l f32310 ATTACHING INLAND MARINE SCHEDULE PAGE ATTACHING INLAND MARINE ENDORSEMENT NUMBER COVERAGE FE-8743.1 Inland Marine Computer Prop Prepared J U N 07 2019 FD-6007 LIMIT OF INSURANCE 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 017890 530 685 a.2 05 31 2011 lott3233c'. StateFarm 96-CL-M979-8 017891 CMP-4860 Page 1 of 1 THIS ENDORSEMENT CHANGES THE POLICY PLEASE READ IT CAREFULLY srArr raaM ..r=cCMP-4860 ADDITIONAL INSURED — DESIGNATED PERSON OR ORGANIZATION D4 This endorsement modifies insurance provided under the following: BUSINESSOWNERS COVERAGE FORM SCHEDULE 8 Policy Number: 96-CL-M979-8 Named Insured. - SAINT THOMAS CHURCH 421 S HOWES ST APT 607 FORT COLLINS CO 80521-2869 Name And Address Of Additional Insured Person Or Organization: CITY OF FORT COLLINS PO BOX 580 FORT COLLINS CO 80522-0580 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 for "bodily injury", "property damage" or "personal and advertising injury" caused, in whole or in part, by: a. Premises And Ongoing Operations Your acts or omissions or the acts or omissions of those acting on your behalf: (1) In connection with your premises; or (2) In the performance of your ongoing operations; or b. Products -Completed Operations "Your work" performed for that additional insured and included in the "products -completed opera- tions hazard". 2. 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. 3. 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. There will be no refund of premium in the event this endorsement is cancelled. All other policy provisions apply. CM P-4860 ©, Copyright, State Farm Mutual Automobile Insurance Company, 2008 Includes copyrighted material of Insurance Services Office, Inc.. with its permission. 96-CL-M979-8 017891 DECLARATIONS (CONTINUED) Religious Organization Policy for CITY OF FORT COLLINS Policy Number 96-CL-M979-8 SECTION I - PROPERTY SCHEDULE Location Number Location of Described Premises Limit of Insurance* Coverage A - Buildings Limit of Insurance' Coverage B - Business Personal Property 001 2700 S LEMAY AVE No Coverage $ 2,900 FORT COLLINS CO 80525-2264 002 1200 RAINSTREE DR No Coverage $ 10,000 FORT COLLINS CO 80526-1831 003 307 W MAGNOLIA ST No Coverage $ 10,000 FORT COLLINS CO 80521-2804 As of the effective date of this policy, the Limit of Insurance as shown includes any increase in the limit due to Inflation Uoverage. SECTION I - INFLATION COVERAGE INDEX(ES) Cov A - Inflation Coverage Index: Cov B - Consumer Price Index: SECTION I - DEDUCTIBLES Basic Deductible $500 N/A 252.4 Prepared JUN 07 2019 C Copyright, State Farm Mutual Automobile Insurance Company, 2008 CMP-4000 Includes copyrighted material of Insurance Services Office, Inc., with its permission. 017PPc ContirntQd on Noxt Pagn rago 2 of 7 StateFarm • • • , DECLARATIONS (CONTINUED) Religious Organization Policy for CITY OF FORT COLLINS Policy Number 96-CL-M979-8 Special Deductibles: Money and Securities $100 Equipment Breakdown $500 Other deductibles may apply - refer to policy. 0 0 N N Employee Dishonesty $250 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. COVERAGE Accounts Receivable On Premises Off Premises Arson Reward Back -Up Of Sewer Or Drain Collapse Damage To Non -Owned Buildings From Theft, Burglary Or Robbery Debris Removal Equipment Breakdown Fire Department Service Charge Fire Extinguisher Systems Recharge Expense Forgery Or Alteration Glass Expenses Increased Cost Of Construction And Demolition Costs (applies only when buildings are insured on a replacement cost basis) Money And Securities Prepared JUN 07 2019 Copyright, State Farm Mutual Automobile Insurance Company, 2008 CMP-4000 Includes copyrighted material of Insurance Services Office, Inc., with its permission. 017887 290 Continued on Reverse Side of Page N LIMIT OF INSURANCE See Schedule See Schedule $5,000 See Schedule Included Coverage B Limit 25% of covered loss Included $5,000 $5,000 $10,000 Included 10% $5,000 Page 3 of 7 DECLARATIONS (CONTINUED) Religious Organization Policy for CITY OF FORT COLLINS Policy Number 96-CL-M979-8 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 See Schedule Personal Property Off Premises $15,000 Pollutant Clean Up And Removal $10,000 Preservation Of Property 30 Days Valuable Papers And Records On Premises See Schedule Off Premises See Schedule Water Damage, Other Liquids, Powder Or Molten Material Damage Included SECTION I - EXTENSIONS OF COVERAGE - LIMIT OF INSURANCE - SCHEDULE The coverages and corresponding limits shown below apply only to the described premises as shown. LOCATION COVERAGE 0001 Back -Up Of Sewer Or Drain Accounts Receivable (On Premises) Accounts Receivable (Off Premises) Outdoor Property Valuable Papers and Records (On Premises Valuable Papers and Records (Off Premises 0002 Accounts Receivable (On Premises) Accounts Receivable (Off Premises) Back -Up Of Sewer Or Drain Outdoor Property Valuable Papers and Records (On Premises) Valuable Papers and Records (Off Premises) 0003 Accounts Receivable (On Premises) Accounts Receivable (Off Premises) Prepared ,1 UN 02019 O Copyright, State Farm Mutual Automobile Insurance Company, 2008 CMP-4000 Includes copyrighted material of Insurance Services Office, Inc.,with its permission. 017887 Continued on Next Page LIMIT OF INSURANCE $15,000 $10,000 $5,000 $5,000 $10,000 $5,000 $10,000 $5,000 $15,000 $5,000 $10,000 $5,000 $10,000 $5,000 Page 4 of 7 StateFarm • • • DECLARATIONS (CONTINUED) Religious Organization Policy for CITY OF FORT COLLINS Policy Number 96-CL-M979-8 . , Back -Up Of Sewer Or Drain $15,000 Outdoor Property $5,000 Valuable Papers and Records (On Premises) $10,000 Valuable Papers and Records (Off Premises) $5,000 0 �m SECTION I - EXTENSIONS OF -COVERAGE - LIMIT OF INSURANCE - PER POLICY �o The coverages and corresponding limits shown below are the most we will pay regardless of the number of described premises shown in these Declarations. LIMIT OF COVERAGE INSURANCE Employee Dishonesty $25,000 Property Of Others (applies only to those premises provided Coverage B - Business $2,500 Personal Property) SECTION II - LIABILITY LIMIT OF COVERAGE INSURANCE Coverage L - Business Liability Coverage M - Medical Expenses (Any One Person) Counseling Professional Liability PASTOR Damage To Premises Rented To You Directors And Officers Liability AGGREGATE LIMITS Products/Completed Operations Aggregate Prepared JUN 07 2019 t Copyright, State Farm Mutual Automobile Insurance Company, 2008 CMP-4000 Includes copyrighted material of Insurance Services Office, Inc., with its permission 017888 290 Continued on Reverse Side of Page N $1,000,000 $10,000 $300,000 $300,000 $300,000 LIMIT OF INSURANCE $2,000,000 Page 5 of 7 DECLARATIONS (CONTINUED) Religious Organization Policy for CITY OF FORT COLLINS Policy Number 96-CL-M979-8 General Aggregate Professional Aggregate Directors and Officers Aggregate 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. $2,000,000 $300,000 $300,000 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-4860 'AI Design Person Org CMP-4650 Religious Organization FE-6999.2 Terrorism Insurance Cov Notice CMP-4206.1 Amendatory Endorsement FE-3650 Actual Cash Value Endorsement CMP-4815 Directors/Officers Endorsement CMP-4654 Money and Securities CMP-4708 Counseling Prof Liab CMP-4655 Employee Dishonesty CMP-4706 Back -Up of Sewer or Drain CMP-4788 Addl Insd Mgrs Lessor of Prem CMP-4561.1 Policy Endorsement FD-6007 Inland Marine Attach Dec * New Form Attached Prepared JUN 07 2019 Cc Copyright, State Farm Mutual Automobile Insurance Company, 2008 CMP-4000 Includes copyrighted material of Insurance Services Office, Inc., with its permission. 017888 Continued on Next Page Page 6 of 7 StateFarm • • • DECLARATIONS (CONTINUED) Religious Organization Policy for CITY OF FORT COLLINS Policy Number 96-CL-M979-8 This policy is issued by the State Farm Fire and Casualty Company. Com an . Participating Policy 0 0 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 JUN 07 2019 CMP-4000 CD Copyright. State Farm Mutual Automobile Insurance Company, 2008 Includes copyrighted material of Insurance Services Office, Inc., with its permission. 017889 290 N Page 7 of 7 96-CL-M979-8 017889 STATE FARM FIRE AND CASUALTY COMPANY A STOCK COMPANY WITH HOME OFFICES IN BLOOMINGTON, ILLINOIS INLAND MARINE ATTACHING DECLARATIONS StateFarm • • • ., Atlanta �i r3I 346-2117 Named Insured M-20-1817-FAF1 F Y SAINT THOMAS CHURCH 421 S HOWES ST APT 607 FORT COLLINS CO 80521-2869 8 a 0 �9 ATTACHING INLAND MARINE Policy Number 96-CL-M979-8 Policy Period Effective Date Expiration Date 12 Months DEC 22 2018 DEC 22 2019 The poly period begins and ends at 12:01 am standard time at a premises location. Automatic Renewal - If the policy period is shown as 12 months, this policywill 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-8739 Inland Marine Conditions FE-8743.1 Inland Marine Computer Prop See Reverse for Schedule Page with Limits Prepared JUN 07 2019 C Copyright, State Farm Mutual Automobile Insurance Company, 2008 FD-6007 Includes copyrighted material of Insurance Services Office, Inc., with its permission. 017890 530-585a.2 05 31 2911 1oIt3232c) I