The URL can be used to link to this page

Home My WebLink AboutTIMBERLINE CHURCH - INSURANCE CERTIFICATE (2)BROTHERHOOD MUTUAL, *Min istryFirst-'Commercial Multi -Peril Insurance Coverage Summary These are your policy's Declarations. Renewal of 05M5A0358236 TIMBERLINE CHURCH 2908 S Timberline Rd Fort Collins, CO 80525-2402 NAMED INSURED TIMBERLINE CHURCH POLICY NUMBER 05M5A0358236 POLICY PERIOD 07/27/2019 at 12:01 a.m. to 07/27/2020 at 12:01 a.m. Key Facts About Your Policy Policy Number 05MSA0358236 Brotherhood Mutual Insurance Company Print Date: June 18, 2019 Policy Period: 07/27/2019 at 12:01 a.m. to 07/27/2020 at 12:01 a.m. 866-215-7069 Borrett & Sons LLC 5551-001 PO Box 2225 Fort Collins, CO 80522-2225 Contact your agent with your customer service questions, including updating your policy or reporting a claim. www.brotherhoodmutual.com/payoniine For your convenience, you can make premium payments online. These Declarations replace your previous ones. Your policy's Declarations contain a summary of the coverage contained in the insurance policy. Your policy contains a full explanation of your coverage. AGREEMENT: In return for the payment of the premium and subject to all the terms of the policy, we agree to provide the insurance stated in the policy. TYPE OF ORGANIZATION: Church Institution FORM OF ORGANIZATION: Corporation *Policy Overview COVERAGE DESCRIPTION DETAILS COVERAGE DESCRIPTION Property Coverage Page 3 - 7 Terrorism Premium Inland Marine Coverage Page 8 - 9 Liability Coverage Page 10 -17 Excess Liability Coverage Page 18 -18 DETAILS $3,130 (See Notice Form BN6025A-D 3.1 for details) Policy Premium Overview This premium is subject to adjustment at each anniversary. This premium is subject to adjustment due to premium audit provision. ANNUAL PREMIUM: $77,281.00 PAYMENT SCHEDULE: See invoice. Common Policy Forms FORM FORM NAME BN2A 1.1 Notice to our'. CL3001.0 Amendatory Endorsement ._.__._._..............._...............,...............,..... _................. ... .... ... .... ....................................... ...... -- .....--.._.....................................- BCP100 4.0 Commercial Property Coverage Conditions .... ------....-_._......................-.............................................................................-......... -_.._.-._.._._ ... ........-.--...........-_... BCL3011.0 -- Form Number Reference — ..—..__._.._.._._._.....--..... —._............-...................................................... CLO182 0101 Amendatory Endorsement Colorado BCL1001.1 Additional Policy Conditions EX06061.0 Conditional Terrorism Exclusion .. .... .......... BN6025A-D 3.1 Notice Terrorism -Related Loss FORM FORM NAME CL1001.0 ............_-............--........ Common Policy Conditions — - - .._.._._._._........- ---- - . ..............._............_..---. _............._.......... _.._... _................................... _.................... GL1001.0 ............................--..........__.-...._.........--................................_...--.-..-_....................................,...................... Commercial Liability Coverage BN11A 1.2 Customer Notice: Value -Added Benefits . - ........__..__.... - .......... _.... ............._....................................._.Y BN1B 1.0 .......... No.Payment-RelatedCharges . ._... -_...._..... - ----- --- G13210 06 ..--.... ......._....__..............__..__....---.._...._........_...... Notice To Policyholders - --- _.... BN6EX1.0 Notice - Terrorism -Related Loss Brotherhood Mutual Insurance Company I www.brotherhoodmutual.com 1 800.333.3735 1 6400 Brotherhood Way, P.O. Box 2227, Fort Wayne, IN 46801-2227 ... .-.....I...-- ........... --._._.-........-...._..._......................_........._............._........-.........................._........_._............................-....._.....-........--.................._........._..............._...............................-........................................................,...............,......................................,..,.................,.................................................... M1 DEC 03/18 "Bear ye one another's burdens and so fulfill the law of Christ:' - Galatians 6:2 Page 1 of 18 NAMED INSURED TIMBERLINE CHURCH ;� �; BROTHERHOOD POLICY NUMBER 05M5A0358236 MUTUAL POLICY PERIOD 07/27/2019 at 12:01 a.m. to 07/27/2020 at 10 12:01 a.m. Liability Coverage Summary MinistryFirsC" commercial multi -peril policy Declarations continued... The Coverages listed here are provided according to the terms of the designated coverage form and any other applicable forms or endorsements. Only one liability coverage and one medical coverage will apply to an occurrence and any related loss. Any limit which is specifically stated within a coverage form or endorsement represents the most we will pay for the coverage to which such a limit applies. For application of limits, see Liability and Medical Coverage form (BGLT14.0). Key Liability Coverage Facts: Schedule of Limits GENERAL OCCURRENCE LIMIT $1,000,000 GENERAL AGGREGATE LIMIT $3,000,000 Principal Liability Coverages COVERAGE DESCRIPTIONS COVERAGE LIMIT Bodily Injury/Property Damage Liability (L) $1,000,0... ............... nAo.1',�i c�.,,..e�r� rnA) Vo noo*+ Supplemental Coverages COVERAGE DESCRIPTIONS COVERAGE LIMIT Incidental Contractual Liability $1,000,000' Additional Coverages COVERAGE AGGREGATE LIMIT FORM $3,000,000- GL1001.0 ...--_............... ......... _....----'- BGL9513.0 COVERAGE AGGREGATE LIMIT FORM $3,000,000' GL1001.0 $3,000,000' GL1001.0 ..........-- — - - COVERAGE DESCRIPTIONS COVERAGE LIMIT COVERAGE AGGREGATE LIMIT FORM Related Organizations/Operations The following entities are insured for designated related Coverages. Only a single limit applies to the loss. All coverage limits are subject to the general occurrence limit and all aggregate limits are subject to the general aggregate limit. +per person limit Brotherhood Mutual Insurance Company I www.brotherhoodmutual.com 1 800.333.3735 1 6400 Brotherhood Way, P.O. Box 2227, Fort Wayne, IN 46801-2227 ........ _.........__...... .... ....-...-._.-.._.....-...................-..._........_.-.. - —.� ._._-.-....-_.......................,...._...................,.....................................-_............................ ............. ---.....--....._ ........._.... -_....... - - - M1 DEC 03/18 'Bear ye one another's burdens and so fulfill the law of Christ"- Galatians 6:2 Page 10 of 18 BROTHERHOOD MUTUAL. NAMED INSURED TIMBERLINE CHURCH POLICY NUMBER 05105A0358236 POLICY PERIOD 07/27/2019 at 12:01 a.m. to 07/27/2020 at 12:01 a.m. *Liability Coverage Summary MinistryFirst" commercial multi -peril policy Declarations continued... The Coverages listed here are provided according to the terms of the designated coverage form and any other applicable forms or endorsements. Only one liability coverage and one medical coverage will apply to an occurrence and any related loss. Any limit which is specifically stated within a coverage form or endorsement represents the most we will pay for the coverage to which such a limit applies. For application of limits, see Liability and Medical Coverage form (BGL114.0). Details of Related Organization/Operations NAME Everyday Joe Additional Coverages ADDRESS MINISTRY TYPE FORMS 144 5 Mason St Fort Collins, CO 80524-2812 food/Clothing/Thrift BGL58R 4.0 Operation COVERAGE DESCRIPTIONS COVERAGE LIMIT COVERAGE AGGREGATE LIMIT FORM Defense Coverage • Applies in addition to the liability limit unless otherwise specifically stated in an applicable coverage form. Counseling Acts Professional Liability Coverage COVERAGE DESCRIPTIONS COVERAGE LIMIT COVERAGE AGGREGATE LIMIT FORM Counseling Acts Liability Coverage $1,000,000` $3,000,000' BGL63 4.1 Outside Counseling Reimbursement Coverage $5,000+ $3,000,000' BGL63 4.1 Cyber Liability Coverage COVERAGE DESCRIPTIONS COVERAGE LIMIT COVERAGE AGGREGATE LIMIT FORM Injunctive) •' Only a single limit applies to the loss. All coverage limits are subject to the general occurrence limit and all aggregate limits are subject to the general aggregate limit. +per person limit Brotherhood Mutual Insurance Company I www.brotherhoodmutual.com 1 800.333.3735 1 6400 Brotherhood Way, P.O. Box 2227, Fort Wayne, IN 46801-2227 M1 DEC 03/18 'Bear ye one another's burdens and so fulfill the law of Christ." — Galatians 6:2 Page 11 of 18 BROTHERHOOD MUTUAL NAMED INSURED TIMBERLINE CHURCH POLICY NUMBER 05M5A0358236 POLICY PERIOD 07/27/2019 at 12:01 a.m. to 07/27/2020 at 12:01 a.m. Liability Coverage Summary MinistryFirstsm commercial multi -peril policy Declarations continued... The Coverages listed here are provided according to the terms of the designated coverage form and any other applicable forms or endorsements. Only one liability coverage and one medical coverage will apply to an occurrence and any related loss. Any limit which is specifically stated within a coverage form or endorsement represents the most we will pay for the coverage to which such a limit applies. For application of limits, see Liability and Medical Coverage form (BGL114.0). Defense Reimbursement Coverage COVERAGE DESCRIPTIONS COVERAGE LIMIT COVERAGE AGGREGATE LIMIT FORM Legal Liability Defense Reimbursement Coverage See Form BGL89 See Form BGL89 BGL89 4.1 .._.....-..._._ _ ..__. — .._... -.... Law Enforcement Inquiry See Form BGL89 See Form BGL89 BGL89 4.1 Directors and Officers Liability Coverage COVERAGE DESCRIPTIONS COVERAGE LIMIT COVERAGE AGGREGATE LIMIT FORM Directors and Officers (Leadership) Liability Coverage $1,000,000, $3,000,000' BGL81B 4.1 Benefits Administration Liability Coverage COVERAGE DESCRIPTIONS COVERAGE LIMIT COVERAGE AGGREGATE LIMIT FORM Employee Benefit Liability Coverage $1,000,000 $3 000 000 BGL83 4.0 (Medical Expense Limit) $100,000' $500000' BGL834.0 Employment Practices ("Employment Pract") Liability Coverage COVERAGE DESCRIPTIONS Employment -Related Liability Coverage COVERAGE LIMIT COVERAGE AGGREGATE LIMIT FORM $1,000,000" $3,000,000' BGL854.1 Fire Legal/Nonowned Property Damage Liability Coverage COVERAGE DESCRIPTIONS COVERAGE LIMIT COVERAGE AGGREGATE LIMIT FORM Nonowned Property Damage Liability. Coverage $1,000,000" $3,000,000' _ 8GL951 3.0 _ _ Additional Incidental Contractual Liability Coverage $1,000,000'� $3,000,000BGL951 3.0 Media Liability Coverage COVERAGE DESCRIPTIONS COVERAGE LIMIT COVERAGE AGGREGATE LIMIT FORM Personal Injury Liability Coverage (Media/Communications $1,000,000' $3,000,000- BGL411.0 Personal Injury Liability Coverage (Unauthorized Access/ $1,000,000- $3,000,000" Posting) Special Defense Coverage (Alleged Intentional Acts) $1,000,000- $3,000,000' BGL411.0 ' Only a single limit applies to the loss. All coverage limits are subject to the general occurrence limit and all aggregate limits are subject to the general aggregate limit. + per person limit Brotherhood Mutual Insurance Company I www.brotherhoodmutual.com 1800.333.3735 1 6400 Brotherhood Way, P.O. Box 2227, Fort Wayne, IN 46801-2227 _._....—._...._.— .... ._..... ._.. ------ ---- -- — — M1 DEC 03/18 'Bear ye one another's burdens and so fulfill the law of Christ" — Galatians 6:2 Page 12 of 18 a►� BROTHERHOOD IN MUTUAL. NAMED INSURED TIMBERLINE CHURCH POLICY NUMBER 05M5A0358236 POLICY PERIOD 07/27/2019 at 12:01 a.m. to 07/27/2020 at 12:01 a.m. *Liability Coverage Summary MinistryFirstsm commercial multi -peril policy Declarations continued... The Coverages listed here are provided according to the terms of the designated coverage form and any other applicable forms or endorsements. Only one liability coverage and one medical coverage will apply to an occurrence and any related loss. Any limit which is specifically stated within a coverage form or endorsement represents the most we will pay for the coverage to which such a limit applies. For application of limits, see Liability and Medical Coverage form (BGL114.0). 0 Medical Coverage COVERAGE DESCRIPTIONS COVERAGE LIMIT COVERAGE AGGREGATE LIMIT FORM Student/Day Care Medical $5,000'+ $3,000,000` _ BGL93A4.0 _-....-- - -- -- - . -. ......_ .....__. Religious Athletic Medical Coverage $10,000"+- ----- $3,000,000' - BGL914.0 Nonowned Vehicle Coverage COVERAGE DESCRIPTIONS COVERAGE LIMIT COVERAGE AGGREGATE LIMIT FORM _ _ deductible Nonowned Vehicle Medical Payments Extension $10,000'+ $150,000' BGL778 4.0 Nurse Liability Coverage COVERAGE DESCRIPTIONS COVERAGE LIMIT COVERAGE AGGREGATE LIMIT FORM Nurses' Professional Liability Coverage $1,000,000' $3,000,000' BGL234 4.1 Other Liability Coverage COVERAGE DESCRIPTIONS COVERAGE LIMIT COVERAGE AGGREGATE LIMIT FORM Terrorism Liability Coverage $1,000,000 $3,000,000 BGL0250 3.1 Relief Activity Additional Coverages COVERAGE DESCRIPTIONS COVERAGE LIMIT COVERAGE AGGREGATE LIMIT FORM Emotional Injury and Financial Damage Liability $1,000,000" $3,000,000` BGL9941.0 -_. . Additional Medical Expense Coverage - - $50,000+,$250,000 per $3,000,000 BGL9941.0 occurrrence _—. &oadened Wage Loss Reimbursement Coverage _ $10,000+, $50,000 per ._...... ------....... .................... _........... ......... ........... ......... ,...... $3,000,000 ........ .__.._ ..... - -- BGL9941.0 occurrence Damage to Relief Worker's Tools and Equipment Coverage $2,500+, $10,000 per $3,000,000 BGL9941.0 occurrence -- —.—...... ----............_ Primary Liability Coverage for Relief Workers ................. _--.-.......................... ....._.............._........._.._..........-_..__......_....................__..... $1,000,000' - ...... - -- $3,000,000' -- BGL9941.0 •' Only a single limit applies to the loss. All coverage limits are subject to the general occurrence limit and all aggregate limits are subject to the general aggregate limit + per person limit Brotherhood Mutual Insurance Company I www.brotherhoodmutual.com 1 800.333.3735 1 6400 Brotherhood Way, P.O. Box 2227, Fort Wayne, IN 46801-2227 -_._._..._.__...--......_........ -- - - ._._......-..-........................................................................ ....................-_.............................................. ..__.---._....—..._.-..- ._._._.._...-._.__._...... _....... _....... ...._---. M1 DEC 03/18 'Bear ye one another's burdens and so fulfill the law of Christ." - Galatians 6:2 Page 13 of 18 P- BROTHERHOOD MUTUAL. NAMED INSURED TIMBERLINE CHURCH POLICY NUMBER OSM5AO358236 POLICY PERIOD 07/27/2019 at 12:01 a.m. to 07/27/2020 at 12:01 a.m. Liability Coverage Summary MinistryFirst' commercial multi -peril policy Declarations continued... The Coverages listed here are provided according to the terms of the designated coverage form and any other applicable forms or endorsements. Only one liability coverage and one medical coverage will apply to an occurrence and any related loss. Any limit which is specifically stated within a coverage form or endorsement represents the most we will pay for the coverage to which such a limit applies. For application of limits, see Liability and Medical Coverage form (BGL114.0). Religious Freedom Protection Coverage COVERAGE DESCRIPTIONS COVERAGE LIMIT COVERAGE AGGREGATE LIMIT FORM Security Operations Coverage COVERAGE DESCRIPTIONS COVERAGE LIMIT COVERAGE AGGREGATE LIMIT FORM Additional Medical Expense Coverage $50,000'+ $50,000' _ BG1_993 4.0. Broadened Wage Loss Reimbursement Coverage (Emotional — $10,000'+ $50,000` BGL993 4.0 Operations Sexual Acts Liability Coverage COVERAGE DESCRIPTIONS COVERAGE LIMIT COVERAGE AGGREGATE LIMIT FORM Sexual Acts Liability Coverage With Screening _ $1,000,000' $1,000,000` BGL614.1 __.x_u_—....._._...........-------....-----.._-------....................................................................................---_......._..___00,00 ...._............-_.......-._............-....................-.-._.... ....._.... — GL614_ Sexual Harassment Liability Coverage (other than your $1,000,000' $1,000,000` BGL614.1 Only a single limit applies to the loss. All coverage limits are subject to the general occurrence limit and all aggregate limits are subject to the general aggregate limit. +per person limit Brotherhood Mutual Insurance Company I www,brotherhoodmutual.com 1 800.333.3735 1 6400 Brotherhood Way, P.O. Box 2227, Fort Wayne, IN 46801-2227 M1 DEC 03/18 "Sear ye one another's burdens and so fulfill the law of Christ." — Galatians 6:2 Page 14 of 18 �"A BROTHERHOOD 01 MUTUAL. NAMED INSURED TIMBERLINE CHURCH POLICY NUMBER 05MSA0358236 POLICY PERIOD 07/27/2019 at 12:01 a.m. to 07/27/2020 at 12:01 a.m. !Liability Coverage Summary MinistryFirstsm commercial multi -peril policy Declarations continued... The Coverages listed here are provided according to the terms of the designated coverage form and any other applicable forms or endorsements. Only one liability coverage and one medical coverage will apply to an occurrence and any related loss. Any limit which is specifically stated within a coverage form or endorsement represents the most we will pay for the coverage to which such a limit applies. For application of limits, see Liability and Medical Coverage form (BGL114.0). Traumatic Incident Response Coverage COVERAGE DESCRIPTIONS COVERAGE LIMIT COVERAGE AGGREGATE LIMIT FORM Additional Medical Expense Coverage $50,000'+ $1,000,000' BGL991D 4.1 ........— — - ..._..---....---- Broadened Wage Loss Reimbursement Coverage (Including See form $1,000,000' BGL991D 4.1 Emotional Injury) . _............_............. .........._.............__._.........__........._.............._..................................................................................... .... .... ... ... .... .... ._... ... .... .... ... ... ... ... ..... .... ... _... .... .... .... ... ... ............... _...................... ............ .............. ._... ... .... ... ... ... .... ... .... ............ _..... .......................... .................................... ........._...... Wage Reimbursement Coverage COVERAGE DESCRIPTIONS Wage Loss Reimbursement Coverage Worldwide Liability Extension Coverage is COVERAGE DESCRIPTIONS Limited Worldwide Kidnap and Extortion Expense Reimbursement Coverage Expanded Medical Coverage for Short -Term Foreign Trip Participants Schedule of Liability Exposures $500,000' $1,000,000' BGL991D 4.1 COVERAGE LIMIT COVERAGE AGGREGATE LIMIT FORM $3,500+ $35,000 per occurrence BGL99 4.0 COVERAGE LIMIT COVERAGE AGGREGATE LIMIT FORM See form See form BGL111T 1.3 See form See form BGL111T 1.3 In issuing this policy, we have relied on material information provided to us by the Named Insured. The following schedule discloses all of the insured's insurable exposures (as conveyed by the Named Insured) known to exist at the policy inception date. Declared premises must be owned, occupied, or rented by you or your scheduled related organizations. EXPOSURE DESCRIPTIONS Offices - NOC ----......---- ._.._....-_........ _.... ..-...... -.. ._..... Food & Clothing Pantry Book/Magazines/Stationery Stores - Small Retail ...... .... ......... _._....... ......... _......... ----....... ......... __....--_...._... ......... Thrift Shop Thrift Shop _ Coffee Shop ...,... .--.... ............ ........... _...... .. --- ....__........ - - ........ After School Ministry Medical Including Students _ Church ADDRESS / BUILDING DESCRIPTION CODE Location 4 Building 1 Office _..._...............---._..._._......._.._...-... 04504 - Location 1 Building 1 Church --..................._.......___........_......,.._..............__..__......___...._.._.._._....__._................_ 05813 ------- - Location 1 Building 1 Church 05813 Location 1 Building 1 Church -................_.. -.......... -...._........-......_......... -..__._............ -......... _........._.....__.. 05813 .... --- Location 2 Building 1 Other _._...._............._......-.............,...._...... _.......... _......... .._................_......... ........ .....---......._.._._-. 05813 Location 2 Building 1 Other ..... ..............._...................................,... ....._.... ............................... .............................,............. ........_................... 06501 ... ...... .... _. 2908 S Timberline Rd Fort Collins CO 80525-2402 07900 Location 1 Building 1 Church Location 2 Building 1 Other 08101 •' Only a single limit applies to the loss. All coverage limits are subject to the general occurrence limit and all aggregate limits are subject to the general aggregate limit. + per person limit RATING BASIS 5,000 Square Feet ..........................I.............................1 2,000 Square Feet 2,000 Square Feet 1,000 Square Feet 1,000 Square Feet 4,800 Square Feet 30 Students 115,068 Square Feet 4,800 Square Feet Brotherhood Mutual Insurance Company I www.brotherhoodmutual.com 1 800.333.3735 I 6400 Brotherhood Way, P.O. Box 2227, Fort Wayne, IN 46801-2227 -- -- - - .............. ,... _........ - - - - ......... _ . . ......... .......... ............. ., ...... ....,...... .......... ................, .............................. .......... M1 DEC 03/18 "Bear ye one another's burdens and so fulfill the law of Christ" - Galatians 6:2 Page 15 of 18 ""* BROTHERHOOD MUTUAL. NAMED INSURED TIMBERLINE CHURCH POLICY NUMBER 05MSA0358236 POLICY PERIOD 07/27/2019 at 12:01 a.m. to 07/27/2020 at 12:01 a.m. Liability Coverage Summary MinistryFirst commercial multi -peril policy Declarations continued... The Coverages listed here are provided according to the terms of the designated coverage form and any other applicable forms or endorsements. Only one liability coverage and one medical coverage will apply to an occurrence and any related loss. Any limit which is specifically stated within a coverage form or endorsement represents the most we will pay for the coverage to which such a limit applies. For application of limits, see Liability and Medical Coverage form (BGL114.0). EXPOSURE DESCRIPTIONS ADDRESS / BUILDING DESCRIPTION CODE RATING BASIS Mission Church Location 1 Building 1 Church _..-- . ........_.. -.-� - -- ........._._.. 08101 -- - 2,500 Square Feet _.-.- -. Church -- -- -- Location 6 Building 1 Church ----._._.._........-.._....__..._._._.._.......---........._.....--- 08101 - 13,342 Square Feet _.._.......... _ ... -. _ -._....---- ...._._.... --- ..................... - Mobile Classroom Rated As A Church ---....__..............._........._......._.......... Location 6 Building 2 Mobile Classroom 08101 1,440 Square Feet Golf Cart 2908 S Timberline Rd Fort Collins CO 80525-2402 15002 3 Each Grounds - Excess of Five Acres 2908 S Timberline Rd Fort Collins CO 80525-2402 .......T._._......-...__.._..-._....----....---......_.__......._..- 15100 33 Acres - ----.....__....__...._....__....-......-..-. Vacant Land - 5 Acres or More 29918 Weld County Road 17 windsor CO 80550 - __ .- ........ 17401 - - - _.._ 200 Linear Feet - - .......----.-_......---....... Bleachers or Grandstands - -.-...- ........ .. . ..... 2908 S Timberline Rd Fort Collins CO 80525-2402 30035 1 Each Outreach Ministry 2908 S Timberline Rd Fort Collins CO 80525-2402 30130 1 At items/activities Bicycle Trip .._.....--------._._.-........._............._........._................._......_.._._.......-_.- 2908 S Timberline Rd Fort Collins CO 80525-2402 30130 ._.__.----........_._......- 1 # items/activities ... ......__......----...... _....-...... - _............_.-... Outreach Ministry .......__.-....----........_......................................_.........__....- 30130 ....._-........._..._.........._.........- 1 # items/activities ......._-....__..... -....--...._.._._.... - - Plavgrounds - ---- 2908 S Timberline Rd Fort Collins CO 80525-2402 30320 1 Each Softball Field Rated As Playground 2908 S Timberline Rd Fort Collins CO 80525-2402 30320 1 Each Books, Magazines and Stationery Store . ............._.....-............................,....._.._-...._.............._._.....---...._--................._._.-.-......................._............................._..._._....._..._......_...._... -_.__-_..._..........__.. Food or Drink - Retail Stores - NOC Location 1 Building 1 Church 83800 58,000 Sales Location 2 Building 1 Other 50,000 Sales P t I C I' 17 Pastor(s) as ora ounse ing Special Events High Hazard Activities For details regarding how these coverage limits will apply, see the How Much We Pay section of the High Hazard Activities Coverage Limits Form (BGL-21). ACTIVITY DESCRIPTION MEDICAL LIMIT OCCURRENCE LIMIT COVERAGE AGGREGATE LIMIT FORM Skate Park Operations $0 per person $100,000 $300,000 BGL214.1 Fireworks Sales $0 per person $100,000 $300,000 BGL214.1 Fireworks Display $0 per person $100,000 -_...__......._..........._.._...................._........._._......._-.._.-..-. $300,000 _. _ . ....-. ..._ .-... . BGL214.1 -__-..---- Construction Oversight -....._.......__....._....._............_....._..... $0 per person $100,000 $300,000 BGL214.1 Other Liability and Medical Forms FORM FORM NAME BCL966CO 1.0 Additional Policy Definition BGL114.0 Liability And Medical Coverage Form BGL59RA 4.0 Related Org Principal and Additional Cov GLO163 0108 Exclusion War and Military Action GL8901.0 Lead Liability Exclusion FORM FORM NAME BGL10OAl2.2 Commercial Liability Endorsement ..... ._.... ..... ---._.__................__...-.__._.__._..--------_.-__...._._...._.-._ BGL1521.0 Additional Insured Endorsement _ .... ... _... _.. EX9091.0 Asbestos Exposure Exclusion GL095012 99 Known Injury or Damage Amendments BGL939AISP 1.0 Provision Modification -Excess Liability Only a single limit applies to the loss All coverage limits ore subject to the general occurrence limit and all aggregate limits are subject to the general aggregate limit. + per person limit Brotherhood Mutual Insurance Company I www.brotherhoodmutual.com 1 800.333.3735 1 6400 Brotherhood Way, P.O. Box 2227, Fort Wayne, IN 46801-2227 M1 DEC 03/18 'Bear ye one anther's burdens and so fulfill the law of Christ" - Galatians 6:2 Page 16 of 18 BROTHERHOOD MUTUAL. NAMED INSURED TIMBERLINE CHURCH POLICY NUMBER 05M5A0358236 POLICY PERIOD 07/27/2019 at 12:01 a.m. to 07/27/2020 at 12:01 a.m. Liability Coverage Summary MinistryFirstsm commercial multi -peril policy Declarations continued... The Coverages listed here are provided according to the terms of the designated coverage form and any other applicable forms or endorsements. Only one liability coverage and one medical coverage will apply to an occurrence and any related loss. Any limit which is specifically stated within a coverage form or endorsement represents the most we will pay for the coverage to which such a limit applies. For application of limits, see Liability and Medical Coverage form (BGL114.0). FORM FORM NAME .......... EX939ESP 4.0 Additional Exclusions GL1270 06 06 Conditional Terrorism Exclusion Additional Insureds NAME LOAN/REFERENCE NUMBER City of Fort Collins, Additional Insured Satellite Shelters, Additional Insured FORM FORM NAME ...............................__.....--.....................-......., ............. ......._... EX0281 2.4 NBC Terrorism Exclusion INTEREST ADDRESS Other: Loc 02 Outdoor area 215 N Mason St Fort Collins, CO 80524 -4402 Other: 0602 PO Box 97 Dupont, CO 80024 -0097 W. •' Only a single limit applies to the loss All coverage limits are subject to the general occurrence limit and all aggregate limits are subject to the general aggregate limit. per person limit Brotherhood Mutual Insurance Company I www,brotherhoodmutual.com 1 800.333.3735 I 6400 Brotherhood Way, P.O. Box 2227, Fort Wayne, IN 46801-2227 .... ....._........_.... .... .._..... .... ........... ......_... ... ..... .... .__....-.................. .... ...,.................. ......................,_......._.............-_............_.......... _........ _...............................-......... -.......................................... ,....... M1 DEC 03/18 "Bear ye one another's burdens and so fulfill the law of Christ." — Galatians 6:2 Page 17 of 18 NAMED INSURED TIMBERLINE CHURCH BROTHERHOOD POLICY NUMBER 05M5AO358236 MUTUAL - POLICY PERIOD 07/27/2019 at 12:01 a.m. to 07/27/2020 at 12:01 a.m. ' Commercial Excess Liability Supplemental Coverage Summary MinistryFirst" commercial multi -peril policy Declarations continued... In return for the payment of the premium, and subject to all the terms of the policy, we agree with you to provide the insurance as stated in the Excess/Umbrella Liability Coverage endorsement BGL939 4.2. Key Excess Liability Coverage Facts NAME OF INSURED TIMBERLINE CHURCH ADDRESS 2908 S Timberline Rd, Fort Collins, CO 80525-2402 EXCESS LIABILITY POLICY PERIOD 7/27/2019 to 7/27/2020 at 12:01 a.m. at the location listed above EXCESS LIABILITY ANNUAL PREMIUM $3,556 Excess Liability Coverage - Limit of Insurance Coverage Limit (per Occurrence) $4,000,000 Coverage Aggregate Limit $4,000,000 Deductible/Retention N/A Optional Excess Coverage Information COVERAGE STATUS LIMIT - Directors and Officers Included $4,000,OOC Sewaal Acts ._ Ewe N/A Employment Practices Excluded N/A Cyber Excluded N/A Optional Coverage Limits are the same as the Excess Liability per Occurrence"and. Aggregate limits shown above, unless otherwise specified. Schedule of Underlying Insurance TYPE INSURER POLICY PERIOD POLICY NUMBER LIMITS OF LIABILITY General Liability Brotherhood Mutual Insurance Company 07/27/2019 - 07/27/2020 05M5AO358236 $1,000,000 Occ/$3,000,000 ASS Automobile Liability Brotherhood Mutual Insurance Company See applicable declarations page. 05A0358237 $1,000,000 Employer's Liability Brotherhood Mutual Insurance Company See applicable declarations page. 05WO358238 $100000/$500000/$100000 Brotherhood Mutual Insurance Company I www.brotherhoodmutual.com 1800.333.3735 1 6400 Brotherhood Way, P.O. Box 2227, Fort Wayne, IN 46801-2227 _--._... —..... _ -.—._—._..-.�..--..-._._....._.................._...........................................-............................ ._.................. .._............._...._.......................... ....... ....._........... -..-..... -........... -...... -... ..._....... __.--...-._...... _.._... M1 DEC 03/18 "Bear ye one another's burdens and so fulfill the law of Christ"— Galatians 6:2 Page 18 of 18 BROTHERHOOD MUTUAL. NAMED INSURED TIMBERLINE CHURCH POLICY NUMBER 05M5A0358236 POLICY PERIOD 07/27/2019 at 12:01 a.m. to 07/27/2020 at 12:01 a.m. MinistryFirstsm commercial multi -peril policy Declarations continued... Brotherhood Mutual Insurance Company I www.brotherhoodmutual.com 1 800.333.3735 1 6400 Brotherhood Way, P.O. Box 2227, Fort Wayne, IN 46801-2227 ............................._..............................-..-....... ....... ........ .._._..._.._-..__-....._..... ..._.._..._........... ...... ,._..._....-....... .__...................... _................ ....,........... ..,........ ,.................................. _._...._.-. Mt DEC 03/18 'Bear ye one anther's burdens and so fulfill the law of Christ," — Galatians 6:2 Page 2 of 18 ;-*; BROTHERHOOD 00 MUTUAL. NAMED INSURED TIMBERLINE CHURCH POLICY NUMBER 05M5A0358236 POLICY PERIOD 07/27/2019 at 12:01 a.m. to 07/27/2020 at 12:01 a.m. •Property Coverage Summary MinistryFirstsm commercial multi -peril policy Declarations continued... We provide the Commercial Property coverage at the declared premise(s) for the coverage and limits indicated. The Coverages listed here are provided according to the terms of the designated coverage form and any other applicable forms or endorsements. Property Coverage Details PROPERTY DEDUCTIBLE $2,500 GLASS DEDUCTIBLE $2,500 Schedule of Locations LOCATION # DESCRIPTION ADDRESS 0101 — - Church ..... . .............,.............. ---......... _......... --......... ------...._..... 2908 S Timberline Rd Fort Collins, CO 80525-2402 ..................... .._..._._...---..............._........_.._..........__._..__...- .... -- — .....-_..... --..... - ._...._—..-.._.._..-- 0102 Playground Equipment ...................__.................................................._...................................................................,...........................................,........,..............................................................................._..................................... 2908 S Timberline Rd Fort Collins, CO 80525-2402 0201 _..____-._—_....__......._.................... Coffee House .... _....... ........ _.... ............ .._......._.._...._._............._._......................._........... 144 S Mason St Fort Collins, CO 80524-2812 . ... ......-__........................... ... ...................... ........... ............ ......................... ................ .._................... ..... 0401 .. ...................._.._... -..--...._...__...— Office —....— - - ..... - - -- ._._..__ ...._._.. - .._ 1136 E Stuart St Fort Collins, CO 80525-1195 — —..---........_.._........ -._._.._..__..._........__....._..._._..----......_._......._. 0601 Church _._-..... __..._.__...-...._....... ------ 360 Crossroads Blvd Windsor, CO 80550-7264 -- 0602 Mobile Classroom 360 Crossroads Blvd Windsor, CO 80550-7264 Schedule of Buildings and Personal Property • CHURCH 2908 5 Timberline Rd Fort Collins, CO 80525-2402 LOCATION 0101 Mortgagee Firstbank Isaoa Loan#8755590 8755620 10403 W Colfax Ave Lakewood, CO 80215-3811 is COVERAGE DESCRIPTION COVERAGE LIMIT COINSURANCE EQ DIED VALUATION TYPE AUTO INCR PERIL TYPE FORM (INCL. TYPE OF PROPERTY) Building $28,879,000 Agreed Amount_ N/A Cost 0% Special with Theft BCP85 4.0 Ordinance or Law -increased $28,879,000 NjA _Replacement N/A N/A N/A N/A BCP138 4.0 Building Loss(ORD&LAW1) Ordinance or Law_ - $300,,000 "'.__._........_...N/A NjA N/A N/A N/A BCP138 4.0 Incr. Debris Removal (ORD&LAW2) .--,-000- Ordinance or L.a._w..-...I._n_c....r_. ._Cost -NjA ..........—._ -----........ BCP138 4.0 of Constr.(ORD&LAW 3) PLAYGROUND EQUIPMENT 2908 S Timberline Rd Fort Collins, CO 80525-2402 LOCATION 0102 COVERAGE DESCRIPTION COVERAGE LIMIT COINSURANCE EQ DIED VALUATION TYPE AUTO INCR PERIL TYPE FORM (INCL. TYPE OF PROPERTY) Property -in -the -Open $133,000 Agreed Amount N/A Replacement Cost 0% Special with Theft BCP85 4.0 Brotherhood Mutual Insurance Company I www.brotherhoodmutual.com 1 800.333,3735 I 6400 Brotherhood Way, P.O. Box 2227, Fort Wayne, IN 46801-2227 — — -- - - -- ... ... .._.. - -- ..__... --........ _........._........._......_........._..................f.........._.._....................._..._.....z................ ..............................._............_....................._......Pa.... of 18 M1 DEC 03/18 "Bear ye one another's burdens and so fulfil the law o Christ" .Galatians 6 g NAMED INSURED TIMBERLINE CHURCH j BROTHERHOOD POLICY NUMBER 05MSA0358236 MUTUAL POLICY PERIOD 07/27/2019 at 12:01 a.m. to 07/27/2020 at 12:01 a.m. Property Coverage Summary MinistryFirstsm commercial multi -peril policy Declarations continued... We provide the Commercial Property coverage at the declared premise(s) for the coverage and limits indicated. The Coverages listed here are provided according to the terms of the designated coverage form and any other applicable forms or endorsements. COFFEE HOUSE 144 S Mason St Fort Collins, CO 80524-2812 LOCATION 0201 COVERAGE DESCRIPTION COVERAGE LIMIT COINSURANCE EQ DED VALUATION TYPE AUTO INCR PERIL TYPE FORM (INCL. TYPE OF PROPERTY) Personal Property $191,000 Agreed Amount N/A Replacement Cost 4% Special with Theft BCP85 4,C) OFFICE 1136 E Stuart St Fort Collins, CO 80525-1195 LOCATION 0401 COVERAGE DESCRIPTION COVERAGE LIMIT COINSURANCE EQ DED VALUATION TYPE AUTO INCR PERIL TYPE FORM (INCL. TYPE OF PROPERTY) Personal Property $52,000 Agreed Amount N/A Replacement Cost 4% Special with Theft BCP85 4.0 CHURCH 360 Crossroads Blvd Windsor, CO 80550-7264 LOCATION 0601 Firstbank Isaoa Loan#8755590 8755620 10403 N.' Colfax Ave Lakewood, CO 80215-3811 COVERAGE DESCRIPTION COVERAGE LIMIT COINSURANCE EQ DED VALUATION TYPE AUTO INCR PERIL TYPE FORM (INCL. TYPE OF PROPERTY) Building $2,945,000 Agreed Amount N/A Replacement Cost 0% Special with Theft BCP85 4.0 ... - ..............._---_.._.—_-----`-__....__......_..........-__......._....A...................IRIe....I..,........_............_._..................._.........p....-........_....._...._-....--'--'--_..._......._._......._..._.._.—...-.- Personal Property $100,000 Agreed Amount N/A Replacement Cost 4 k Special with Theft BCP85 4.0 MOBILE CLASSROOM 360 Crossroads Blvd Windsor, CO 80550-7264 LOCATION 0602 COVERAGE DESCRIPTION COVERAGE LIMIT COINSURANCE EQ DED VALUATION TYPE AUTO INCR PERIL TYPE FORM (INCL. TYPE OF PROPERTY) Building $101,000 Agreed Amount N/A Replacement Cost 4% Special with Theft BCP85 4.0 — -----...........................__...._.-.._.-......_....._......_.._._........_.._............_....._..__..........-....---------..__.._._.._._._.. --'-- Personal Property $15,000 Agreed Amount N/A Replacement Cost 4% Special with Theft BCP85 4.0 Brotherhood Mutual Insurance Company I www.brotherhoodmutual.com 1 800.333.3735 1 6400 Brotherhood Way, P.O. Box 2227, Fort Wayne, IN 46801-2227 .... .... ...... _...... ..... -..- ..................-._..... — - — — -- ._.-......-_.-.._-.._._..-........--...._-...--............,..........— _.. _.-......-....--....._........-.........._....— ................ Mt DEC 03/18 "Bear ye one another's burdens and so fulfill the law of Christ:' — Galatians 6:2 Page 4 of 18 P,1 BROTHERHOOD MUTUAL, NAMED INSURED TIMBERLINE CHURCH POLICY NUMBER 05M5A0358236 POLICY PERIOD 07/27/2019 at 12:01 a.m. to 07/27/2020 at 12:01a.m. •Property Coverage Summary MinistryFirstsm commercial multi -peril policy Declarations continued... i We provide the Commercial Property coverage at the declared premise(s) for the coverage and limits indicated. The Coverages listed here are provided according to the terms of the designated coverage form and any other applicable forms or endorsements. Schedule of Additional Coverages: All Locations The policy's property deductible applies to each of these coverages. Details are found on the Commercial Property Coverages BCP12 4.1 form. COVERAGE DESCRIPTION COVERAGE LIMIT DEDUCTIBLE FORM Declarations on soecified $2.500 BCP12 4.1 holidays) Spoilage $5,000 $2,500 BCP12 4.1 -- ......._....__..._....._._......_...__.......................-.._....__.........._._._._ -xc—1 .----------.— .. Damage to Buildings and Personal Property from Animals _ $2,500 (Except types of.damage excluded in -policy form) $2,500 _ BCP12 4.1 Building Glass Included; no per pane or per plate limits $2,500 BCP12 4.1 + If the loss resulted from a covered peril and the property is off premises for no longer than 780 days. ++ Coverage applies for 180 days from the time construction begins or the new property is acquired. +++ Only applies if the limit of insurance shown for the structure is no more than $10,000 and there is no limit of Organizational Personal Property shown on the declarations for the structure. The policy's property deductible does not apply to the following coverages. Details are found on the Commercial Property Coverages BCP12 4.1 form. COVERAGE DESCRIPTION COVERAGE LIMIT FORM Debris Removal Expense - Partial or Total Loss Partial Loss: Remaining Limit for Covered Property - Total BCP12 4.1 If the loss resulted from a covered peril and was reported within 180 days. Or the amount paid to the insured as a result of the direct loss, if less than the limit stated above. "• Additional limits are available Brotherhood Mutual Insurance Company I www,brotherhoodmutual.com 1 800.333.3735 1 6400 Brotherhood Way, P.O. Box 2227, Fort Wayne, IN 46801-2227 .._--- .-..-- -- ........._........._...._........---- M1 DEC 03/18 "Bear ye one another's burdens and so fulfill the law of Christ"— Galatians 6:2 Page 5 of 18 F6 BROTHERHOOD MUTUAL NAMED INSURED TIMBERLINE CHURCH POLICY NUMBER 05M5A0358236 POLICY PERIOD 07/27/2019 at 12:01 a.m. to 07/27/2020 at 12:01 a.m. Property Coverage Summary MinistryFirst" commercial multi -peril policy Declarations continued... We provide the Commercial Property coverage at the declared premise(s) for the coverage and limits indicated. The Coverages listed here are provided according to the terms of the designated coverage form and any other applicable forms or endorsements. Optional Coverages: All Locations Combined Ordinance or Law Enforcement Coverage COVERAGE DESCRIPTION Increased Building Loss (Ord & Law A) -------- --.... - Increased Debris Removal (Ord &Law Organizational Optional Theft Coverage COVERAGE LIMIT DEDUCTIBLE FORM BCP138B 1.1 COVERAGE DESCRIPTION COVERAGE LIMIT DEDUCTIBLE FORM Theft of Money and Securities $10,000 $250 BCP36 4.2 - - — — _........ .._.__... - ._._....__.....---- - -- --.. Theft of Building Materials $5,000 $250 BCP36 4.2 Ministry Personnel Dishonesty Coverage COVERAGE DESCRIPTION Personnel Dishonesty Covera- COVERAGE LIMIT $100,000 DEDUCTIBLE FORM N/A BCP37A 4.0 Income, Extra Expense, and Donations Coverage Part COVERAGE DESCRIPTION COVERAGE LIMIT DEDUCTIBLE FORM Earnings and Expenses $25 1. 000 N/A BCP71 1.1 Extra Expense ... - — _.-$100,000 _._.. . _, . N/A - BCP711.1 Water Damage Coverage Part COVERAGE DESCRIPTION COVERAGE LIMIT DEDUCTIBLE FORM Water Damage $10,000 $2,500 BCP27 4.1 Sewer and Drain Backup Extension COVERAGE DESCRIPTION COVERAGE LIMIT DEDUCTIBLE FORM Sewer/Drain Backup Extension See Building/Personal Property Limit $2,500 BCP135 4.1 Systems / Equipment Breakdown Coverage COVERAGE DESCRIPTION COVERAGE LIMIT DEDUCTIBLE FORM Systems/Equipment Breakdown Coverage Building/Personal Property Limit $2,500 BSEB100 4.1 Brotherhood Mutual Insurance Company I www.brotherhoodmutual.com 1 800-333.3735 1 6400 Brotherhood Way, P.O. Box 2227, Fort Wayne, IN 46801-2227 — ---- - .._...... ...... ...- — - - --------...._..................................................._........_............................ --------._._...- -- -.._._...._.._....__....................-.................... MI DEC 03/18 "Bear ye one another's burdens and so fulfill the law of Christ." - Galatians 6:2 Page 6 of 18 -", BROTHERHOOD ON MUTUAL NAMED INSURED TIMBERLINE CHURCH POLICY NUMBER 05M5A0358236 POLICY PERIOD 07/27/2019 at 12:01 a.m. to 07/27/2020 at 12:01 a.m. Wroperty Coverage Summary MinistryFirst" commercial multi -peril policy Declarations continued... We provide the Commercial Property coverage at the declared premise(s) for the coverage and limits indicated. The Coverages listed here are provided according to the terms of the designated coverage form and any other applicable forms or endorsements. Other Optional Coverages COVERAGE DESCRIPTION COVERAGE LIMIT DEDUCTIBLE FORM Certified and Non -Certified Terrorism Loss $34,609,000 $2,500 BCL0600 3.0 Interior Building Damage Coverage -Including Gutters/ $34,609,000 $2,500 _ BCP49 4.0 Downspouts Coverage Rented Personal Property of Others $10,000—� $1,000 BCP12 4.1 Additional Property Forms FORM FORM NAME BCP0643 0108 exclusion - War and Military Action ----- ...._.__.,--___.... BCP88 4.0 ...._..._—.-..-__-e ---______.......__........_........._._....._..__...._..._.. Movement &Volcanic Eruption Excl BN151.0 -- _Earth Notice To Mortgagee ....._._.....__... CP017110 08 11008 ionW..ter_...-.-........_..... Exclusion Water Damage .....................................__........._............_........_................._..... CP1111.0 ..-._.-...._...._................ Automatic Increase EX06512.3 NBC Terrorism Exclusion Additional Interests 1111011 NAME Konica Minolta Premier Finance is TYPE LOAN NUMBER Loss Payee FORM FORM NAME BCP500 4.0 Loss -Free Ded Reduction Endorsement ........._..._......._...._.........---............. BN12V 1.0 ............... ._.............. ._—....._. .............................__......._.._._..........._........—........ -... — — ._........... Notice Regarding Building Valuation _........._....._.._.._. _.... --—........ BN25671.0 _...__.... Notice Water Damage/Flood Coverage ........_.................-..........._......__............_.._... CP1321.0 ---..p_._.........._..........__._.._..._......._.._—_._.__..._ Loss Payable Options CL1630 06 06 _............_....... ........_............._.......... ......... _........ —.. ......... ................. ..... Conditional Terrorism Exclusion INTEREST Other: Copier ADDRESS PO Box 5000 Johnston, IA 50131 -5000 Brotherhood Mutual Insurance Company I www.brotherhoodmutual.com 1 800.333.3735 1 6400 Brotherhood Way, P.O. Box 2227, Fort Wayne, IN 46801-2227 M1 DEC 03/18 'Bear ye one another's burdens and so fulfill the law of Christ," — Galatians 6:2 Page 7 of 18 BROTHERHOOD MUTUAL. NAMED INSURED TIMBERLINE CHURCH POLICY NUMBER 05M5A0358236 POLICY PERIOD 07/27/2019 at 12:01 a.m. to 07/27/2020 at 12:01 a.m. Inland Marine Coverage Summary MinistryFirstsm commercial multi -peril policy Declarations continued.,. Schedule of Inland Marine Coverages: All Locations COVERAGE DESCRIPTION COVERAGE LIMIT DEDUCTIBLE FORM Computer Hardware ....._.........._....-_.-_.........................................._....__-_... $34,633 $500 BIM7201 4.0 _-.-_......_.._............-...._........_....................------...................._._.--_.--_ _ -__. _......._. -...._-_-...... Actual Cash Value TOSHIBA PA 5254U .4 59693704A $1,300 IBM 2611-412 412 AA-DHKLT IBM 2611412 AADFVN6 _.......------_- _........-.---..........__...-..........._---- SONY PCG F680 4-650-186-11 SKID -.-._.__........_..-.$22.7.._ --_.-._......._-..._._........_._..-.. .— -.....-....... ._-....._...._....._....._.-......._ ----......_............_.......___ ----_...-----._.._.................. TOSHIBA SATELLITE 1800-S203 X1071541PU -._-._...._.....-.__.._$..1_,4_10 $1,154 _-.-.......__....__....... _._.. -.------...................................-- SONY PCG EX370 28332430-3531019 _-...-...._............................................_._....._._...._.......-_�__. $1,978 SONY 992L 992L 28332430-3530806 - - $11,,978 COMPAQ PRESARI0 4784 TWO1211698 $450 --'---' cnNv oorr. naznnr FrTTaI-_4SS�1-nnS- 81.885 EXTREME POWERED SPEAKER MN-MPA5500 $IV-B1110077 8400 ....... ----_.........-_................ -.... -- .._.._.....— - ....----- ._-...._.-..... - EXTREME COMPANION SPEAKER MN-MP5601 SN-H24949 $300 -._..._._.. - $10._..._........_.._....0 -........- ---- ........ __._.._ - FENDER MICROPHONE W/XLR CABLE IN 4 BELMORE PORTABLE MUSIC STANDS NO SN OR MN @ $65 EACH $260 - — Brotherhood Mutual Insurance Company I www.brotherhoodmutual.com 1 800.333.3735 1 6400 Brotherhood Way, P.O. Box 2227, Fort Wayne, IN 46801-2227 M1 DEC 03/18 "Bear ye one another's burdens and so fulfill the law of Christ." - Galatians 6:2 Page 8 of 18 BROTHERHOOD MUTUAL. NAMED INSURED TIMBERLINE CHURCH POLICY NUMBER 05M5A0358236 POLICY PERIOD 07/27/2019 at 12:01 a.m. to 07/27/2020 at 12:01 a.m. •Inland Marine Coverage Summary MinistryFirstsm commercial multi -peril policy Declarations continued... 0 0 COVERAGE DESCRIPTION COVERAGE LIMIT DEDUCTIBLE FORM ..... .......... ......... ... ......___... _.. _ WHIRLWIND 24 CHANNEL SNAKE (BLUE) NO MN OR SN " $300 .... ............................... _...--- ——............................-............................................................................................................—......... .... .......... ,....... .................. ......... _...... ....... ............ ... ... ... ..... ..... ..... ... ..........—...._... .. RAPCO 12 CHANNEL SNAKE NO MN OR SN $150 _ _.._._...—._....—.._...._............._....._................_.�_. _. _—.PEAVEY BASS AMP MN-300CHS SN-CK250376_....__...-._......_......._...$350 - — ----- ..._......... -- ...... _.. -- — --—....—.................... ......................_......................................._....._...........................,.........._.....................................,...........,..............._......_._....--............................._...................................................-.__........- 2 ULTIMATE SPEAKER STANDS SN-282582 & 282600 $150 —..__.-._ --..-.—._.............. .... ----- -- SOUNDTECH AMP MN-PL502 ENCLOSED IN A BLACK TRAVEL CASE $300 .__... .... .---........... _-___......__.....--.._. ._...-- ......—.. _. —.—._.._...........-------- PEAVEY AMP MN-PV4C ENCLOSED IN A BLACK TRAVEL CASE $400 — _ .—.....---- — -- —.....__......._........---....._.._....._._......_......._....._.._._.._........... ....._..__.._.... ._._.....-_ _-._._—._..----- MACKIE MIXER CONSOLE MN-T36459$600...................................._._....._.............._...........--___.-....._..-.....-.—_.-._..__._..__....--.,...... 2 EV LARGE STAGE SPEAKERS (WITH COVERS) MN-1512ER $1,000 KURZEW IL KEYBOARD W/TRAVEL CASE MN-K2000 SN-4996030SO354 $1,000 ROLAND KEYBOARD (NO CASE) MN-A90EX SN-Z196360 _ $750 ROLAND PIANO AMP MN-KC500 SN-CP16045 $500 YtLLUW ROLAND 88 KEY BLACK KEYBOARD MODEL RD 700SX S#ZTO1521 $1,450 _ ROLAND 88 KEY BLACK KEYBOARD MODEL RD 700SX SXZT01371 $1,450 Photographic Equipment_._...._........_.__....._...._......__......_............—._. _ $10,900_.............._._......----.._._$500 IIV113500105 ....................._.-_............_..._...... ........... _....—... ..CANON XLI3CCD DIGITAL VIDEO CAMCORDER NTSC (MODEL.._...................-_..........$2,500_ ............ ....................__..._...... ...__._....—_..._._...... #2610201783) 1 CANON XLI 3CCD DIGITAL VIDEO CAMCORDER NTSC (MODEL $2,500 ....... -"_—.-__-_._._.—_._......—...._..._.._.......... .... ._............................ #2720700128) 1 OLYMPUS CAMEDIA E-10 (MODEL #E-10) — $400 REPLACEMENT Brotherhood Mutual Insurance Company I www.brotherhoodmutual.com 1 800.333.3735 1 6400 Brotherhood Way, P.O. Box 2227, Fort Wayne, IN 46801-2227 M1 DEC 03/18 — -'Bear ye one another's burdens and so fulfill the law of Christ" — Galatians 6:2 Page 9 of 18