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Home My WebLink AboutTIMBERLINE CHURCH - INSURANCE CERTIFICATE (3)BROTHERHOOD Il91UTUAL® 0ministryFirstsm Commercial I Insurance Coverage Summa These are your policy's Declarations. Renewal of 05M5AO358236 TIMBERLINE'CHURCH 29085 Timberline. Rd Fort Collins, CO 80525-2402 NAMED INSURED POLICY NUMBER' POLICY PERIOD 05M5A0358236 07/27/2020 at Key Facts About Your Policy These Declarations replace your previous ones. Your policy's Your policy contains a full explanation of your coverage. AGREEMENT: In return for the payment of the premium and TYPE OF ORGANIZATION: Church Institution FORM OF ORGANIZATION: Corporation Oolicy Overview COVERAGEDESCRIPTION DETAILS Property Coverage Page 3 - 7 Inland Marine Coverage Page 8 - 9 Liability Coverage Page 10 -18 Excess Liability Coverage Page 19 -19 Policy Premium Overview This premium is subject to adjustment at each ANNUAL PREMIUM: $75,502.00 Common Policy Forms FORM FORM NAME BN2A 1.1 Notice to our Policyt CL3001.0 ...... _. _..................... _.. BCP100 4.5 .. . _................. _............ ..... _.. BC L3011.0 .... CL0182 0101 BCL1001.1 ... _ .---..... _.. _. _. _. _. -... E_X06061.0 _ BN6025A-D 3.1 Conditional Terrorism Notice Terrorism -Related Loss ulti-Peril to 07/27/2021 at 12:01 a.m. Policy Number05M5A0358236 =' 9otherhood:MuYual Insurance Company Print Date June 17 2020- Policy Period: 07/27/2020 at 12 01 aim to !jI 07/27/2021 at 12 01 a.m:: 866215 706-9 American church Gcogp-C66adb 5551 001> - PO Box 2Z25' Fort Collins ,CO 805222225 =i Contact youragent with: your customer - - service questions including updatini:your -policy or reporting a claim www_6raYherfioodmutual:oom/payonlme Fiiryourconvemence you canmake.> premium payments online -A contain a summary of the coverage contained in the insurance policy. all the terms of the policy, we agree to provide the insurance stated in the policy. COVERAGE DESCRIPTION DETAILS Terrorism Premium $3,176 (See Notice Form BN6025A-D 3.1 for details) This premium is subject to adjustment due to premium audit provision. PAYMENTSCHEOULE: See invoice. FORM FORM NAME CL1001.0 . .,...,..... Common Policy Conditions .-. ..... -.... .. ....., CP11.0 ..... ........... ..... ... ........ ......... ,...... .... Table of Contents ....... ... ..... .:.......... ....... ......................... _............... ....... .............. . GL1001.0 �11..:..:.............. .... .... ... .... .... .............. ................ ............... ....... Commercial Liability Coverage ... ...... _......... ....:......_....-...._..........-.........._._..........._........-.-....-........-.-......._........_....._.._..... BN11A1:2 ..... ....... ..:......................_..........:.................._...................................._............................._........r-....._._................................... Customer Notice: Value -Added Benefits BN1B 1.0 ...........::.:. .... ....::............... _.._._.....-......-..........-:....-:-._.................................................,........._..................._ Notice Of Payment -Related Charges ............ ......-..................... G13210 06 .....,....: .......................-............-........- Notice To Policyholders ...... ... ... ... .... .... ... BN6EX 1.0 Notice- Terrorism Related Loss Brotherhood Mutual Insurance Company I www.broth 800.333.3735 I 6400 Brotherhood Way, P.O. Box 2227, Fort Wayne, IN 4680172227 ... .......... .........: ........ ......._. ___. M1 DEC 11/19 'Bear ye one another'slburdens and so fulfill the law of Christ" — Galatians 6:2 Page 1 of 19 'Ok BROTHERHOOD W MUTUAL® NAMED INSURED TIMBERLINE CHURCH POLICY NUMBER 05M5A0358236 POLICY PERIOD 07/27/2020 at 12:01 a.m. to 07/27/2021 at 12:01 a.m. Liability Coverage Summary IVlinistryFirstsm commercial multi -peril policy Declarations continued... The Coverages listed within these declarations are provided according to the terms of the designated coverage forms 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 (BGL114.5). Key Liability Coverage Facts; Schedule of Limits GENERAL OCCURRENCE LIMIT $1,000,000 GENERAL AGGREGATE LIMIT $3,000,000 Principal Liability Coverages E COVERAGE DESCRIPTIONS COVERAGE LIMIT COVFRArF Arr,RerA*M t IUR cnnaa Supplemental Coverages COVERAGE DESCRIPTIONS Incidental Contractual Liabili Additional Coverages COVERAGE LIMIT COVERAGE AGGREGATE LIMIT FORM $1,00.0,000' $3,000,000' GL1001.0 COVERAGE DESCRIPTIONS COVERAGE LIMIT COVERAGE AGGREGATE LIMIT FnRM Related Organizations/Operations The following entities are insured for designated related Coverages. Only o single limit applies to the lass. 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 I 6400 Brotherhood Way, P.O. Box 2227, Fort Wayne, IN 46801-2227 --........ ......... _........................................ -..........— — ——.-...._-............. ......... .... .... ... .... ... ....-------..--_........ __...... ....- .......... .- ------ ---- ..._ MI DEC 11/19 'Bear ye one another's burdens and so fulfill the law of Christ." — Galatians 6:2 Page 10 of 19 NAMED INSURED BROTHERHOOD POLICY NUMBER 01 MUTUAL, POLICY PERIOD *Liability Coverage Summary MinistryFirst'm commercial multi -peril policy Declarations continued... The Coverages listed within these declarations are provided endorsements. Only one liability coverage and one medical o a coverage form or endorsement represents the most we wil Coverage form (BGL114.5). Details of Related Organization/Operati, NAME Everyday Joe's Additional Coverages COVERAGE DESCRIPTIONS D efense Coverage Applies in addition to the liability limit unless o Counseling Acts Liability Coverage COVERAGE DESCRIPTIONS Counseling Ads Liabilitv Coveraze Cyber Liability Coverage COVERAGE DESCRIPTIONS Computer Use Liabilitv Coveras Costs) Only asingle limit applies to the loss. All coverage limits are subject to per person limit TIMBERLINE CHURCH 05M5A0358236 07/27/2020 at 12:01 a.m. to 07/27/2021 at 12:01 a.m. 'ding to the terms of the designated coverage forms and any other applicable forms or age will apply to an occurrence and any related loss. Any limit which is specifically stated within for the coverage to which such a limit applies. For application of limits, see Liability and Medical )KG» MINISTRY TYPE FORMS S Mason St Fort Collins, CO 80524-2812 Food/Clothing/Thrift BGL58R 4.5 Operation 8 5 Ti nberlinelRd Fort Collins CO 80525 2402 Food/Clothing/Thrift BGL58R 4.5 Operation COVERAGE LIMIT COVERAGE AGGREGATE LIMIT FORM $1,000,000' $3,000,000- BGL58R 4.5 specifically stated in an applicable coverage form. COVERAGE AGGREGATE LIMIT FORM $3;000,000" BGL63 4.1 COVERAGE LIMIT COVERAGE AGGREGATE LIMIT limit and all aggregate limits are subject to the general aggregate limit. FORM BGL87B 4.5 BGL87B 4.5 BGL87B 4.5 BGL87B Brotherhood Mutual Insurance Company M1 DEC 11/19 ye one 1800.333.3735 I 6400 Brotherhood Way, P.O. Box 2227, Fort Wayne, IN 4680172227 ._.,_....._..,_......_._._......... _........._............_....._....._......... _.................... ................... ...................................... ........ ::.,_._.:_,..._._................... .......... ....... .. ... _.._.._...................... nd so fulfill the law of Christ" — Galatians 6:2 Page 11 of 19 �N BROTHERHOOD ON MUTUAL® NAMED INSURED TIMBERLINE CHURCH POLICY NUMBER 05M5AO358236 POLICY PERIOD 07/27/2020 at 12:01 a.m. to.0712712021 at 12:01 a.m. Liability Coverage Summary M'inistryFirstsm commercial multi -peril policy Declarations continued... The Coverages listed within these declarations are provided according to the terms of the designated coverage forms 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 limit applies. For application of limits, see Liability and Medical Coverage form (BGL114.5). Defense Reimbursement Coverage COVERAGE DESCRIPTIONS COVERAGE LIMIT COVERAGE AGGREGATE LIMIT FORM Covered Lawsuit Proceeding (Proceeding, Limit) $50,000 $100,000 BGL89 4.5 LawEnforcement Inq:..uiry.._.(_.Inqui:.y-Limit).....__.._._.._.__._........_:_......._...........................$10,.00....0.............................................................._...................._...........---....................._....._..........._._._._.._._._......................................................................B.....G......L...8.._9......4.......5 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 4.5 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' $500,000' BGL83 4.0 Employment Practices ("'Employment Pract ) Liability Cove rage erage COVERAGE DESCRIPTIONS Employment -Related Liability Coverage COVERAGE LIMIT COVERAGE AGGREGATE LIMIT FORM $1,000,000' $3,000,000' BGL854.5 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' BGL9514.5 Ad ditionallncidentalContractualLiablldyCoverage $1,000,000' $3,000,000' BGC9514.5 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 Activity) .._............_-.............-........._.............--._....._.._..........._._._............_._._........__......_........._....-_.................._................__................._..._...._..............._............................._._..._._.._......----- ....................................................................... ......................... ....................................................... Personal Injury Liability Coverage (Personal Violations) $1,000;000' $3;000,000' BGL411.0 _............_..... _..... ...........................,.,.................-.......... ................ -._........ _........,_:....:.... --........._._..._............ -.-.................................... .._..... ................................_-.............-----........_..........._._.__.._....... _.......... _._...........,................................-...,............... ,........... ,........... ... ............................... Personal Injury Liability Coverage (Unauthorized Access/ $1,000,000 $3,000,000' BGL411.0 Posting) ...........tia-.............................._.......-....._..._......._._.._-........_._....._...._...............---.._.....__._..............................._........._......................................................._._.........._...._................._..-_...__._....0,,....._._._............._..........._.....................................................,................................................-.........1..0 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 L Brotherhood Mutual Insurance Company I www.brotherhoodmutual.com 800.333.3735 I 6400 Brotherhood Way, P.O. Box 2227, Fort Wayne, IN 46801-2227 __......—_.--._........._...._...-..__.........._.__.... ........_._....... -- -.... ..... ... ... ..... .... ... ... ..... ... ... .... ....... _........... ........_............................... .............................. _._._....._..... _._...... ...... _................... ..... ._.... ...... _.._..... ........ _........ _..... ......1. M1 DEC 11/19 'Bear ye one another's burdens and so fulfill the law of Christ" — Galatians 6:2 Page 12 of 19 NAMED INSURED BROTHERHOOD POLICY NUMBER MUTUAL, POLICY PERIOD Liability Coverage Summary MinistryFirstsm commercial multi -peril policy Declarations continued... The Coverages listed within these declarations are provided endorsements. Only one liability coverage and one medical a coverage form or endorsement represents the most we wi Coverage form (BGL114.5). Medical Coverage COVERAGE DESCRIPTIONS Student/Dav Care Medical Nonowned Vehicle Coverage 0 COVERAGE DESCRIPTIONS Nonowned Vehicle Liabilitv ( Use Nonowiled Nurse Liability Coverage COVERAGE DESCRIPTIONS Nurses' Professional Liability Coverage Other Liability Coverage COVERAGE DESCRIPTIONS Terrorism Liability Coverage Only a single limit applies to the loss. All coverage limits are subject to 0per person limit TIMBERLINE CHURCH 05MSA0358236 07/27/2020. at 12:01 a.m. to 07/27/2021 at 12:01 a.m. ding to the terms of the designated coverage forms and any other applicable forms or ge will apply to an occurrence and any related loss. Any limit which is specifically stated within or the coverage to which such a limit applies. For application of limits, see Liability and Medical COVERAGE LIMIT COVERAGE AGGREGATE LIMIT FORM $5,000"+ $3,000,000' BGL93A 4.5 ---..-..----._................................................................-.................._._...........................................,..........................._..................................._..........._......_.......__ $10,000'+ $3,000,000` BGL914.5 COVERAGE LIMIT COVERAGE AGGREGATE LIMIT FORM $1,000,000' $3,000,000' BGL714.0 _....._—........._.._............_._......................-_.........................:.......:..._._.....-_- $1,000,000' ---- - — --- $3,000,000' — — -- --- BGL714.0 ----...---—............._._ $500 per vehicle ..............—................. ....... _..........._.......--....... ... — ................ _---.... — $1,000` -- — ---- BGL714.0 $3,000,000 BGL714.0 ..... .... .... ..... ................................. .... ... .... .... .... .... $500' .........................................-............_..........._................................................... ._....-......._........... $3,000,000' _......_.......L.7.........._._. BGL714.0 $1,000^.................................. ... ... .... ... .... .... ... .._._.... .... ... .83,OOQ000*..........,... .... ... ... ... .... ..........................,............... ......... . ...................... ...._BG L914.0 $80,000 per vehicle, $ 2 5 0 $160,000` BGL977 3.0 deductible $150,000' BGL778410 COVERAGE LIMIT COVERAGE AGGREGATE LIMIT FORM $1,000,000' $3,000,000' BGL234 4.1 COVERAGE LIMIT COVERAGE AGGREGATE LIMIT FORM $1,006,000 $3,000,000 BGL0250 3.1 ,al occurrence limit and all aggregate limits are subject to the general aggregate limit. Brotherhood Mutual Insurance Company I www.br Ml DEC 11/19 com 1800.333.3735 I 6400 Brotherhood Way, P.O. Box 2227, Fort Wayne, IN 46801-2227 'Bear ye one another's r burdens and so fulfill the law of Christ:' — Galatians 6:2 Page 13 of 19 NAMED INSURED TIMBERLINE CHURCH BROTHERHOOD POLICY NUMBER 05M5A0358236 MUTUAL POLICY PERIOD 07/27/2020 at 12:01 a.m. to 07/27/2021 at ® 12:01 a.m. Liability Coverage Summary MinistryFirstsm commercial multi -peril policy Declarations continued... The Coverages listed within these declarations are provided according to the terms of the designated coverage forms 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 (BGLI14.5). 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 Broadened Wage Loss Reimbursement Co eera.e............-....-........_.........................10ef.............._.... 8 $ $ P ............ ... ........... $3,000,000 BGL9941.0 occurrence Dam;...etoRe liefWorker'-.T.._..I_..-a --- -- g s oo s and Equipment Coverage -._+-,....... $2,500 , $10,000 per $3,000,000 BG19941.0 occurrence ---..y LiabilityCoveragefor — -- — — Primary Liability Coverage for Relief Workers _.....__................................._-.........__.-._.._.— $1,000,000` ------ -----.._—...-----__--.......-........_............__._........-.................. $3,000,000` BGL9941.0 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`+ $250,000` BGL993 4.0 Broadened Wage Loss Reimbursement Coverage (Emotional $10,000'+ $50,000` BGL993 4.0 Injury) Individual Counseling Coverage $10,000`+ $50,000` BGL993 4.0 Damage to Security -Related Equipment $2,500`+............... ..............................._........_............. ......__......._........... $10,000` BGL_.993 4.0 _. ---_...------r--------_.---............-_.................................................................._...................._....... Primary Coverage for Specified Individuals See Form See Form BGL993 4.0 -.....— — - — --- - -- - - ...._ Enforcement of Security Policy or Weapons Policy $1,000,000` $1,000,000` BGL993 4.0 Negligent Infliction of Emotional Distress Arisingm froSecurity $1,000,000' $1,00.0,000` BGL993 4.0 Operations 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 --,..—.--._.._.._.._......._-...... ....-._...._._._......._.. —------- —---._.—..... .... _.......... MI DEC 11/19 "Bear ye one another's burdens and so fulfill the law of Christ:' — Galatians 6:2 Page 14 of 19 '*�"A� BROTHERHOOD IN MUTUAL. Liability Coverage Summary MinistryFirstsm commercial multi -per The Coverages listed within these declarations are provided acc endorsements. Only one liability coverage and one medical cove a coverage.form or endorsement represents the most we will pa Coverage form (BGL114.5). Traumatic Incident Response Coverage COVERAGE DESCRIPTIONS Additional Medical Expense Coverage Broadened Wage L6ff Reimbursement Coverage (Inc Emotional Injury) Coverage Worldwide Liability Extension Coverage COVERAGE DESCRIPTIONS Limited Worldwide Kidnap and Extortion Expense Reimbursement Coverage Expanded Medical Coverage for Short -Term Foreign Trip Participants . Wage Reimbursement Coverage COVERAGE DESCRIPTIONS Wage Loss Reimbursement Coverage Only a single limit appliesto the loss. All coverage limits are subject to the ger �per person limit ' NAMED INSURED TIMBERLINE CHURCH POLICY NUMBER 05M5A0358236 POLICY PERIOD 07/27/2020 at 12:01 a.m. to 07/27/2021 at 12:01 a.m. I policy Declarations continued... rding to the terms of the designated coverage forms and any other applicable forms or age will apply to an occurrence and any related loss. Any limit which is specifically stated within for the coverage to which such a limit applies. For application of limits, see Liability and Medical COVERAGE LIMIT COVERAGE AGGREGATE LIMIT $50,000`+ $1,000;OOW I,000,UUU- BGL991D 4.1 y l,Uuu,000- COVERAGE LIMIT COVERAGE AGGREGATE LIMIT See form See form See form See form COVERAGE LIMIT COVERAGE AGGREGATE LIMIT $3,500+ $35,000 per occurrence val occurrence limit andall aggregate limits are subject to the general aggregate limit. FORM BGL111T 1.3 BGL111T 1.3 FORM BGL99 4'.0 Brotherhood Mutual Insurance Company MI DEC 11/19 ye one 800.333.3735 I 6400Brotherhood Way, P.O. Box 2227, Fort Wayne, IN 46801-2227 ................... ......... _.._..... ............. .......................................... ,................. . ................... _........... nd so fulfill the law of Christ" — Galatian"s 6:2 Page 15 of 19 NAMED INSURED TIMBERLINE CHURCH BROTHERHOOD POLICY NUMBER 05M5A0358236 POLICY PERIOD 07/27/2020 at 12:01 a.m. to 07/27/2021 at �� MUTUAL, 12:01a.m. Liability Coverage Summary MinistryFirstsm commercial multi -peril policy Declarations continued... The Coverages listed Within these declarations are provided according to the terms of the designated coverage farms 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 (BGL114.5). Sexual Acts Liability Coverage COVERAGE DESCRIPTIONS COVERAGE, LIMIT COVERAGE AGGREGATE LIMIT FORM Redemptive Employment/Appointment $300,000* $300,000* BGL613 4.5 ._..... .................._...............-_........_..........................................I.._................ .......... Sexual Acts Liability Coverage With Screening $1,000,000* $1,000,000* BGL614.5 Sexual Harassment Uabdlty Coverage (other than your $1000,000` $1,000,000* 1361-614.5 employees) ._..._...........-.-.................................._._............__......"-__..._..._—.........—"--._-,__............._......._............................_....._.................._..................._....._.........................................._.............._.......:....._...:..__........_..._.........-.__........_._...._.............................__................................... ,proper Reporting of Sexual Acts Liability Coverage $1,000,000* $1,000,000* BG0 .5 ,proper Supe"rvision of Convicted Sexual Offenders Liability $1,000,000' $1,000,00w BGL614.5 Coverage - — .....:.._.__._....__........ 5 ................_.........................................-......,...000..........-..*..+ ............_._.....-............--_ - _-- --... _...$1...__0._0,000 ..._-.........................................................._.....,............................................._............._..BGL6..............1....4._..5. Outside CounsehngReimbursement Coverage. $ _..._......_._-.- ......... ......._._..--- -----.....__.....-i-o-n- . —....._.__............._........_...........-. SexuaLActs Medical Payment Extension-$10;000- ................................................................_..._...__.............._._._.....-.-.............._..............._..................-_........-..........._._............................................................... $100,000* BGL614.5 Schedule of Liability Exposures 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 policyinception date. Declared premises must be owned, occupied, or rented by you or your scheduled related organizations. EXPOSURE DESCRIPTIONS Book/Magazines/Stationery Stores- Small Thrift Shop Coffee ADDRESS / BUILDING DESCRIPTION Location 4 Building 1 Office ................... _.................--.............................._................................. Location 1-Building 1 Church CODE 04504 05813 Location 1 Building 1 Church 05813 1Church 05813 Location 2 B. . ........................................... _........................ ........... Location 2 Building 1 Other ............................ 2908S Timberline Rd Fort Collins CO 05813 RATING BASIS 5,000 Square Feet 2,000_Square Feet 2,000 Square Feet 1,000 Square Feet 1,000 Square Feet 4,800 Square Feet .......................................................... 1,000 Square Feet After School Ministry 2908 5 Timberline Rd Fort Collins CO 80525-2402 07900 30 Students Medical including students ... -...... ._.__.._._._._.._.._.._._._..........._._......... ... .... ... ... .... .... ... ... ... ... I ...... _............ __....... _.._..__._................ .......................................... Church ......._.......... ................................. _....... ..........-...... .... ... .... ._... ... ... ,................................... _................. ..._.......... Location 1 Building 1 Church 08101 .... ... ..... _................ .-...._.................. _....._.._........ _...... _............. 115,068Square Feet ........ ............. _._._................ ............................... ......_................ __............ _.......... Location 2 Building 1 Other _._._..--.._.__........--.._:_..........._........__...-:......_.............. 4,800 Square Feet Mission Church Location 1 Building 1 Church 08101 2,500 Square Feet * Only a single limit applies to the loss. Ali coverage limits are subject to the general occurrence limit and all aggregatelimits are subject to the generol aggregate limit. +per person limit Brotherhood Mutual Insurance Company I www.brotherhoodmutual.com 1 800.333.3735 1 6400 Brotherhood ...............rhood Way, P.O. Box 2227, Fort Wayne, IN 46801-2227 .._._ -----------'--._.._.__.._._.........._.-............... _...................................................— ...... ....... ---........................_............................................... ... ......... ........ _.......................................... ...... .... ... ... ... ... ... .... .. Ml DEC 11/19 "Bear ye one another's burdens and so fulfill the law of Christ." — Galatians 6:2 Page'16 of 19 BROTHERHOOD MUTUAL lViability Coverage Summa MinistryFirstsm commercial multi-G The Coverages listed within these declarations are provided acl endorsements. Only one liability coverage and one medical cov a coverage form or endorsement represents the most we will p, Coverage form (BGL114.5). EXPOSURE DESCRIPTIONS ADDRI ..... Church Locatio ... .............. Mobile Classroom Rated As A Church Locatio ...... .......... _... -- - :...... Golf Cart 2908 S ..... ..................... ...... ............ ._............_-._......-----_-_..__.._._.-....-----....._.... ........ .. Grounds - Excess of Five Acres 2908 S Vacant Land - 5 Acres or More 29918' Outreach Ministry .............................................- Playgrounds Softball Field Rated As Playground Books, Magazines and Stationery Stores .._...._.. .._. _....._...._..........-......-._................_.. .. .. ........................ Food or Drink - Retail Stores - NOC __._....-._._............ -...... ......... _._................ -.................... - ......................... . Pastoral Counseling ................. ..... ... .... ... .... ... .... .... .... ... ._... .... ... ........ . Special Events 0 High Hazard Activities NAMED INSURED POLICY NUMBER POLICY PERIOD policy Declarations continued... TIMBERLINE CHURCH 05M5A0358236 07/27/2020 at 12:01 a.m. to 07/27/2021 at 12:01 a.m. ding to the terms of the designated coverage forms and .any other applicable forms or age will apply to an occurrence and any related loss. Any limit which is specifically stated within for the coverage to which such a limit applies. For application of limits, see Liability and Medical ING DESCRIPTION ...........................---...._-. CODE .......:.. .... ... RATING BASIS ........................... -- - 1 Church ... 08101 ....... . ...... -q-............ - 13,342 Square Feet ,..... ...........-.-.. .. 2 MobileClss............. ........... ............................ ....... ................ .......08101............................ ::. 11.................._.....-..-.....:-......-. 1440 Square Feet -.._.__.......... ...._.-..-..-....-..-. Rd Fort Collins CO 80525-2402 ........... .. . ... 15002 ...: 3 Each Rd Fort Collins CO 80525 2402 ........... ..- . .......... 15100 ........................_ ...... - ... 33 Acres Road 17 windsorCO 80550 .......... ..::::.::...... ....... .:.:..:......:.....:............_.._...:.....-..:............................ 17401 ....... ........._..-..-:..-....--.---_.--......_........._....._.._...............-.... ....... ... .... 200 Linear Feet Rd: Fort Collins CO 80525-2402 30035 ... .............................. ......... ...... ........... 1 Each Rd Fort,Collms CO 80525 2402 c .--............... _..............:.................................... _.-....................._.._.._.... ......................_.....................:...... 30130 ................ ..... 1 #items/activities .... .... ...:..........-........................ -..-........... ...._._:_._:...._.._:_._:. 2908 S Timberline Rd Fort Collins CO 2908 S Timberline Rd Fort Collins CO 2908.5 T.......................................................................................... Timberline Rd Fort Collins CO ._ .......... ....... ......4..,.... ...................................... .............................................._. L. Building .................. ..._..................................---.....::...._ ................... - .... -...... Location 11 Building 1 Church Locationl2 Building 1 Other 83800 I 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 LIMI F OCCURRENCE LIMIT cOVERAGE AGGREGATE LIMIT FORM Skate Park Operations ... .-. .. $O per person $100,000 0oo,b00 BGL214.1 Fireworks Sales ....... ._-- -- -.-. .... $0 per person l $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 FORM FORM NAME BCL966CO 1.0 . _............ .. — Additional Policy Definition - ....__ __._ ................ - ........ BGL100Al2:2 ......... Commercial Liability. Endorsement BGL114.5 Liability And Medical Coverage _...--`._ Form BGLI521.0 ......:.. .......` - Additional Insured Endorsement , -. - .. -- -- .......... BGL59RA 4.0 ----... .. .I. Related Org Principal and Additional .... ...... Cov EX90910 ............. ....::,-...... .....-- Asbestos Exposure.Exclusion .......................... --..... GL0163 0108 - - .... -._...-.....__......__.._......_....:.......:.....:......:....:................................. Exclusion War and Military Actin - . ............................-..:......................:_.::.._.:......_....._..._............-__.-...._...............-___-.__._.-.........-..._............_..__...,..................... GL095012 99 Known Injury or Damage Amendments .. ........... ... ..., .... GL89010 Lead Liability Exclusion -....................................................-_....... y.....-.....-.. BGL939AISP 1.0 Provision Modification -Excess Liability ............_._.................................._,................,-.......................,... ......................-.......P-....-..Y.....-............._.. -•.-_.__._---.-.-..........._.... EX939ESP 4.0 Additional Exclusions G87B 0418 Extended Broad Sco e C ber LiabilityCov Only a single limit applies to the loss. All coveragelimits are subject to the 10er person limit limit and all aggregate limits are subject to the general aggregate limit. Brotherhood Mutual Insurance Company ye one 1 800.333.3735 I 6400 Brotherhood Way, P.O. Box 2227, Fort Wayne, IN 46801-2227 ... ................................................................. .......__.-..-.........-......-..........-......... _.-........_......... _.........._.-.-.........-.-.-......-............-........:.:..._.-._............................. .... .... ...... ... .... .. and so fulfill the law of Christ" — Galatians 6:2 Page 17 of 19 NAMED INSURED TIMBERLINE CHURCH BROTHERHOOD POLICY NUMBER 05M5A0358236 POLICY PERIOD 07/27/2020 at 12:01a.m. to.07/Z7/2021 at MUTUAL® 12:01a.m. Liability Coverage Summary MinistryFirstsm commercial multi -peril policy Declarations continued... The Coverages listed within these declarations are provided according to the.terms of the designatedcoverage forms 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 (BGL114.5). FOR . .-....------ - . . --_......... — ..... -..... -..... ..... ... .... .... ... ... .... ... .... .... ... ... ... .... ... ,.... ... ... EX0281 2.4 NBC Terrorism Exclusion Additional Insureds FORM . FORM NAME ..................................................-._.................................................-_................ ... ... ... ... .... ... ...... ... ................................................. ...... ........... GL1270 06 06 Conditional Terrorism Exclusion NAME LOAN/REFERENCE NUMBER INTEREST ADDRESS City of Fort Collins, Additional Other: Loc 02 Outdoor area 215 N Mason St Fort Collins, CO 80524 -4402 Insured .-- ..... .----._.___._._....--._.....----....... --...... --......... _..................................... ...............................................:..............................._...:..............................__................_:...................................................................................................._,._,......_._...............-......... Satellite Shelters, Additional Other: 0602 PO Box 97 Dupont, CO 80024 -0097 Insured 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 I 6400 Brotherhood Way, P.O. Box 2227, Fort Wayne, IN 46801-2227 MI DEC 11 19_....__......-_.........__............................................................_.................---._...........................-............ .....,.............. ................. _..--- ......_............................._..._.........................-.................................. ........... . / "Bear ye one another's burdens and so fulfill the law of Christ." - Galatians 6:2 Page 18 of 19 BROTHERHOOD commercial Excess Liabil MinistryFirstsm commercial multi - In return for the payment of the premium, and subject to all the Liability Coverage endorsement BGL939 4.2. Key Excess Liability Coverage Facts NAME OF INSURED ADDRESS EXCESS LIABILITY POLICY PERIOD EXCESS LIABILITY ANNUAL PREMIUM Excess Liability Coverage -Limit of I Coverage Limit (per Occurrence) Coverage Aggregate Limit Deductible/Retention Optional Excess Coverage Information COVERAGE Directors and Officers Sexual Acts Employment Practices Cyber Optional Coverage Limits are the some as the Excess Liability Schedule of Underlying Insurance TYPE! INSURER Automobile Liability Brotherhood Mutual Insurance Employer's Liability Brotherhood Mutual Insurance 0 NAMED INSURED TIMBERLINE CHURCH POLICY NUMBER 05M5A0358236 POLICY PERIOD 07/27/2020 at 12:01 a.m. to 07/27/2021 at 12:01 a.m. Supplemental Coverage Summary I policy Declarations continued... of the policy, we agree with you to provide the insurance as stated in the Excess/Umbrella _RLINE CHURCH S Timberline Rd, Fort Collins, CO 80525-2402 2020 to 7/27/2021 at 12:01 a.m. at the location listed above STATUS Included Excluded Excluded Excluded Aggregate limits shown above, unless otherwise specified. POLICY PERIOD POLICY NUMBER 05A0358237 LIMIT $4,000,000 N/A N/A N/A LIMITS OF LIABIUTY See applicable declarations page. 05W0358238 $100000/$500000/$100000 Brotherhood Mutual Insurance Company M1 DEC 11/19 1 800.333.3735 1 6400 Brotherhood Way, P.O. Box2227, Fort Wayne, IN 46801-2227 "Bear ye one another's burdens and so fulfill the law of Christ" — Galatians 6:2 Page 19 of 19 4' BROTHERHOOD IN MUTUAL® NAMED INSURED TIMBERLINE CHURCH POLICY NUMBER 05M5A0358236 POLICY PERIOD 07/27/2020 at 12:01.a.m..to 07/27/2021 at 12:01 a.m. MinistryFirstsm commercial multi -peril policy Declarations continued... r: 11 Brotherhood Mutual Insurance Company I www.brotherhoodmutual.com 1800.333.3735 I 6400 Brotherhood Way, P.O. Box 2227, Fort Wayne, IN 46801-2227 —_........._.._.,......................I......_._. __ ... ..... M1 DEC 11 19 __...........---------......---------------........... _ _.._....._......... ......................................._..............._...._..........-.-.........................._... - - - / 'Bear ye one another's burdens and so fulfill the law of Christ." — Galatians 6:2 Page 2 of 19 NAMED INSURED TIMBERLINE CHURCH � M BROTHERHOOD POLICY NUMBER 05M5A03.58236 MUTUAL ® POLICY PERIOD 07/027a/2020 at 12:01 a.m. to 07/27/2621 at 01property Coverage Summar MinistryFirstsm commercial multi -peril policy Declarations continued... We provide the Commercial Property coverage at the declared remise(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 app icable forms or endorsements. Property Coverage Details PROPERTY DEDUCTIBLE $10,000 GLASS DEDUCTIBLE $10,000 Schedule of Locations LOCATION n 2/1 4/1 .......... 6/1 - -... ...... 6/2 Schedule of Buildings and Personal Pro _CHURCH. 2908f5T Mortgagee Firstbank Isaoa '.DESCRIPTION COVERAGE LIMIT OF PROPERM & Law Cost of Construction ............................................ Building Ordiri Law Increased Law Increased Debris DESCRIPTION Church ADDRESS 2908 S'Timberline Rd Fort Collins, CO 80525-2402 ... ... _.... .._........... _......._..... .. ...___._._._._....... _- - - ._........_.__... 2908 STimberline Rd Fort Collins, CO 80525-2402 144 S Mason St Fort Collins, CO 80524-2812 Office 1136 E Stuart St Fort Collins, CO 80525-1195 .................. .....-.-__.---.-..----.......----_._..---........._._.._._._......................._.........-............._........_.._.......................-_._..............---:..... Church 360 Crossroads Blvd Windsor CO 80550-7264 .... ........ .. ...... ......... ... ...... _ .. - ........... Mobile Classroom 360 Crossroads Blvd Windsor, CO 80550 7264 rline-Rd Fort:Collms, . CO'80525-2402 LOCATION 1/1 ' 8755590 8755620 10403 W Colfax Ave Lakewood, CO 80215-3811 TRANCE EQ DED VALUATION TYPE AUTO INCR PERIL TYPE FORM Amount N/A Replacement Cost 0% Special with Theft BCP85 4.5 N/A N/A PLAYGROUND EQUIPMENT2908 5 Tlimb line Rd Fort Collins, CO 80525-2402 LOCATION I COVERAGE DESCRIPTION COVERAGE LIMIT COINSURANCE EQ DED VALUATION TYPE AUTOINCR PERILTYPE FORM (INCL. TYPE OF PROPERTY) Property -in -the -Open $133,000 Agreed (Amount N/A Replacement Cost 0% Special with Theft BCP85 4.5 11 Brotherhood Mutual Insurance Company Ml DEC 11/19 tual.com 1800.333.3735 I 6400 Brotherhood Way, P.O. Box 2227, Fort Wayne, IN 46801-2227 ............_.............................................................................................................................. ........ .... .... ... ... ..... ... .................................. ......................................................................................... "Bear ye one another's urdens and so fulfill the law of Christ"— Galatians 6:2 Page 3 of 19 J NAMED INSURED TIMBERLINE CHURCH BROTHERHOOD POLICY NUMBER 05M5A0358236 POLICY PERIOD 07/27/2020 at 12:01 a.m: to 07/37/2621 at MUTUAL® 12:01a.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. COVERAGE DESCRIPTION COVERAGE LIMIT COINSURANCE EQ DED VALUATION TYPE AUTO INCR PERIL TYPE FORM (INCL TYPE OF PROPERTY) - - COFFEEHOUSE 144 S Mason St Fortcoliins, CO 80524-2812 LOCATION 2%1 _ - . - COVERAGE DESCRIPTION COVERAGE LIMIT COINSURANCE EQ DED VALUATION TYPE AUTO INCR PERIL TYPE FORM (INCL TYPE OF PROPERTY) - Personal Property $199,000 Agreed Amount N/A Replacement Cost 4% Special with Theft BCP85 4.5 0MCE 1136.E Stuart St Fort CQIIins,.CO 80523Ti95, - LOCAT16N 4%' COVERAGE DESCRIPTION COVERAGE LIMIT COINSURANCE EQ DED VALUATION TYPE AUTO INCR PERIL TYPE FORM (INCL TYPE OF PROPERTY) Personal Property $84,000 Agreed Amount N/A Replacement Cost 46/o Special with Theft BCP85 4.5 CHURCH' _ LOCATIOPO/1 Mortgagee Rrstbank Isaoa 8755590 8755620 10403 W 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 _-- -- $2,988,000 _ _1... - --- Agreed Amount N/A Replacement Cost 0% Special with Theft BCP85 4.5 BCP8 Personal Property p y $104,000 _, Agreed Amoiiht N/A Replacemehf Cost „- 4% � Special with Theft BCP85 4.5 MOBILE CLASSROOM 360 Crossroads EIIW Windsor, CO 80S504264 LOCAT.IDN 6/2 !! COVERAGE DESCRIPTION COVERAGE LIMIT COINSURANCE EQ DED VALUATION TYPE AUTO INCR PERIL TYPE (INCL TYPE OF PROPERTY) Building $106,000 Agreed Amount N/A Replacement Cost 4% Soecial with FORM BCP85 4.5 0 Brotherhood Mutual Insurance Company I www.brotherhoodmutual.com 1800.333.3735 1 6400 Brotherhood Way, P.O. Box 2227, Fort Wayne, IN 46801-2227 �.......1.....------ ..----....--..... ---....-._.__...... ..-......................................_._...................... . ............. ...... .................. ........_-...----........._......................................................................_._...I....... DEC / 9 "Bear ye one another's burdens and so fulfill the law of Christ" — Galatians 6:2 Page 4 of 19 'Ok BROTHERHOOD 10 MUTUAL. roperty Coverage Summar MinistryFirst$" commercial multi -per We provide the Commercial Property coverage at the declared I to the terms of the designated coverage form and any other app Schedule of Additional Coverages: All Loc The policy's property deductible applies to each of these COVERAGE DESCRIPTION Property Off Premises Inter -Continent _ Owned Personal Property - Parsonage —� Building/Personal Property - Newly Acquired/Constructe Outside Objects/Structures For any one landscaping item '--...... Each loss caused by wind — ..._ Detached Structures and their Contents (Unscheduled) Owned Personal Property - Dwellings _ Contents - Buildings and Structures Described on the NAMED INSURED POLICY NUMBER POLICY PERIOD policy Declarations continued... TIMBERLINE CHURCH 05M5A0358236 07/27/2020 at 12:01 a.m. to 07/27/2021 at 12:01 a.m. ,(s) for the coverage and limits indicated. The Coverages listed here are provided according forms or endorsements. Details are found on the Commercial Property Coverages BCP12 4.5 form. LIMIT DEDUCTIBLE FORM $10,000 BCP12 4.5 1, $25,000 total+ — -- - — -$10,0 -'- .......--BCP12-- $10,000 BCP12 4.5 4.5 wrvriey auu. Jcwrluu� - -- --...._.._....._._._....._._ Spoilage Ya,VVV tLa55 rrom speanea penis omy. uouoleo on speanea 41,w,000 holidays) ........__........................,............ ._................... ................. ..... ................. ...... ........... --- ......... ._.... — $5;000 $10,000 b(-FIL 4.S BCP12 4.5 Damage to Buildings and PersonalPrope_t from Animals _ $2,500 (Except types of damage excluded in policy form) $10,000 BCP12 4.5 + If the loss resulted from a covered peril and the property is off premises for no longer than 180 days. ++ Coverage applies for 180 days from the time construction begins orlthe new property is acquired. +++ Only applies if the limit of insurance shown for the structure is no ore 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 form. COVERAGE DESCRIPTION COVERAGE LIMIT FORM Debris Removal Expense - Partial or Total Loss Partial Loss: Remaining Limit for Covered Property - Total BCP12 4.5 Loss: $10,000 Eme"rgency Removal _........—........ _ Coverage applies up to 30 days after property is first moved BCP12 4.5 _.................._.................._,...................----......_......_............................._._.:.. Fire Department Service Charges ._._..----.....__.—_.....----.._.-.____—....----.._�__..............................._._._........._......_._....._.......,....g_............__ -............_..' $25,00.0 ................ _._................... BCP12 4.5 F re Extinguisher Recharge ...........................y......................................................__..................._.....-..............................................................__...........__........_..- $25,000_ if rechared:within30 da s BCP12 4.5 Pollutant Clean -Up and Removal $10,000 (annual aggregate)* BCP121-1 4.5 Installed Lock RecaliUmflon $5,000 If recalibrated within 10 days BCP12 4.5 Arson Reward $15 000'" BCP12 4:5 Papersand Records—'—......—....._—.__...................................... .��_... .._pert-......._._.._._............_..._.....__ $25,000...................................................................................................................................._.........__........ .... ..... ..... .................. ._..... ......................_BCP124.5 ................._..........................i...................�............�......................_...............................................:-................................................_........._.................A�..i........................................................_......_......_................._._........2_..._.... Personal Property Owned.by Others (non -clergy) $2,SOO per person/$10,000 maximum{excess) BCP12 4:5 Personal Property Owned by Clergy $30,000'(excess) BCP12 I'll4.5 I nett or vanaallsm Rewara ` If the loss resulted from a covered peril and was reported within " Or the amount paid to the insured as a result of the direct loss, Additional limits are available El 4:5 than the limit stated above. Brotherhood Mutual Insurance Company M1 DEC 11/19 ye one tual.com 1 800.333.3735 1 6400 Brotherhood Way, P.O. Box 2227, Fort Wayne, IN 46801-2227 burdens and so fulfill the law of Christ" —Galatians 6:2 Page 5 of 19 NAMED INSURED TIMBERLINE CHURCH BROTHERHOOD POLICY NUMBER 05M5A0358236 MUTUAL. POLICY PERIOD 07/27/2020 at 12:01 a.m. to 07/Z7/2021 at 2:01 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. Optional Coverages: All Locations Combined Ordinance or Law Enforcement Coverage COVERAGE DESCRIPTION COVERAGE LIMIT DEDUCTIBLE FORM Ordinance or Law A - Increased Building Loss $500,000 $10,000 BCP138B 4.5 _ Ordinance or Law B -Increased Debris Removal $10,000 BCP138B 4.5 _ Ordinance or Law C -Increased Cost of Construction _$250,000 _ $250,000 " $10,000 BCP1388 4.5 Organizational Optional Theft. Coverage. COVERAGE DESCRIPTION COVERAGE LIMIT DEDUCTIBLE FORM Theft of Money and Securities $10,000 $250 BCP36 4.5 Theft of Building Materials $5,000 $250 BCP36 4:5 Ministry Personnel Dishonesty Coverage COVERAGE DESCRIPTION COVERAGE LIMIT DEDUCTIBLE FORMIllft Personnel Dishonesty Coverage $100,000 N/A - BCP37A 4. Earnings and Donations and Extra Expense Coverage Part COVERAGE DESCRIPTION COVERAGE LIMIT DEDUCTIBLE FORM Earnings and Donations $25,000 N/A BCP714.6 Extra Expense $100,000 N/A BCP714.6 Water Damage - Flood, Backup, and Subsurface COVERAGE DESCRIPTION COVERAGE LIMIT DEDUCTIBLE FORM Water Damage -Flood, Back-up, and Subsurface $10,0.00 $10,000 BCP27 4.5 Sewer and Drain Back-up Extension COVERAGE DESCRIPTION COVERAGE LIMIT DEDUCTIBLE FORM Sewer/Drain Backup Extension See Building/Personal Property Limit $10,000 8CP135 4.1 Systems / Equ ipment. Breakdown Coverage COVERAGE DESCRIPTION COVERAGE LIMIT DEDUCTIBLE FORM Systems/Equipment Breakdown Coverage Building/Personal Property Limit $10,000 BSEB100 4.1 Brotherhood Mutual Insurance Company I www.brotherhoodmutual.com 1800.333.3735 1 6400 Brotherhood Way, P.O. Box 2227, Fort Wayne, IN 46801-2227 -----...........-_........_.__...—......---._...._.—._—.-..... —.....-.......................................................-.............................._............._.........._._....._.... ._...-.... --._ ...----......__._....._._............ - ......... I ............ .... MI DEC 11/19 'Bear ye one another's burdens and so fulfill the law of Christ" — Galatians 6:2 Page 6 of 19 BROTHERHOOD MUTUAL® property Coverage Summai MinistryFirstsm commercial multi-pel We provide the Commercial Property coverage at the declared to the terms of the designated coverage form and any other ap Rented Personal Property of Others Cove. COVERAGE DESCRIPTION Rented Personal Property of Others Interior Building Damage Coverage COVERAGE DESCRIPTION Interior Building Damage Coverage -Including Gutters/ Downspouts Coverage Terrorism. Loss Coverage COVERAGE DESCRIPTION Certified and Non -Certified Terrorism Loss Additional Property Forms 0 FORM FORM NAME BCP0643 0108 Exclusion - War and ro Additional Interests NAME TYPE Konica Minolta Premier Loss Payee Finance LOAN NAMED INSURED POLICY NUMBER POLICY PERIOD I policy Declarations continued... TIMBERLINE CHURCH 05MSA0358236 07/27/2020 at 12:61 a.m. to 07/27/2021 at 12:01 a.m. s) for the coverage and limits indicated. Th"e Coverages listed here are provided according orms or endorsements. COVERAGE LIMIT DEDUCTIBLE FORM $10,000 $1,000 BCM2 4.5 COVERAGE LIMIT $35,014,000 DEDUCTIBLE $10,000 FORM BCP49 4.0 COVERAGE LIMIT DEDUCTIBLE_ FORM $35,014,000 $10,000 BCL0600 3.0 FORM FORM NAME BCP500 4.5 Loss Free Deductible Reduction End Kcl BN12V 1.0 --.—.__._._._............ _ Notice Regarding Building Valuation BN25671.0 .-.- -......_..--_-.........._...._....._.............._...........-.__.............. ...........--........ Notice Water Damage/Flood Coverage ......... ......... - - CP1321.0 ......... ......- --- . Loss Payable Options CL1630 06 06 ._......................................_.........._............--.._..........................-_......................................................................................, ... .. Conditional Terrorism Exclusion' ................ ,... ,..... ..... ... .... ... ,.... .... INTEREST Other: Copier ADDRESS PO Box 5000 Johnston, IA 50131 -5000 Brotherhood Mutual Insurance Company 11/19 "Bear ye one another's 1800:333:3735 I 6400 Brotherhood Way, P.O. Box 2227, Fort _........ _...... .. - - ------...— --- and so fulfill the law of Christ." — Galatians 6:2 IN 46801-2227 Page 7 of 19 NAMED INSURED Pf"I BROTHERHOOD POLICY NUMBER 09 MUTUAL. POLICY PERIOD Inland Marine Coverage Summary MinistryFirstsm commercial multi -peril policy Declarations continued... Schedule of Inland Marine Coverages: All Locations TIMBERLINE CHURCH 05MSA0358236 07/27/2020 at 12:01 a.m. to 07/27/2021 at 12:01 a.m. u COVERAGE DESCRIPTION COVERAGE LIMIT DEDUCTIBLE FORM —._._.-.................................... — — - -._._..........................................................._..__.........._.....-._...........----...._._..............-..__...................... 100 FOOT SPEAKER CONNECTING CABLE S50 Brotherhood Mutual Insurance Company I www.brotherhoodmutual.com 1800.333.3735 1 6400 Brotherhood Way, P.O. Box 2227, Fort Wayne, IN 46801-2227 Mt DEC 11/19 'Bear ye one another's burdens and so fulfill the law of Christ." — Galatians 6:2 Page 8 of 19 BROTHERHOOD MUTUAL® ®Inland Marine Coverage Su MinistryFirst" commercial multi-pe NAMED INSURED POLICY NUMBER POLICY PERIOD mary policy Declarations continued... TIMBERLINE CHURCH 05MSA0358236 07/27/2020 at 12:01 a.m. to 07/27/2021, at 12:01 a.m. COVERAGE DESCRIPTION COVERAGE LIMIT DEDUCTIBLE FORM --- -.. WHIRLWIND 24 CHANNEL SNAKE (BLUE) NO — --...._........._._....__.-.-......_....—_......-.......-----------_._..- MN OR SIN ........................_.......$150 — — -- - — $300- ...............__............. - ..........._._-._.._..........__..............-.....-- RAPC012 CHANNEL SNAKE NO MN OR SN- �'_..__....._.__.........__.....__......_... _____ PEAVEY BASS AMP MN-300CHS SN-CK250376 _ ........................................................................................................................................................................................................................_...._....- - $350 PEAVEY BASS SPEAKER ENCLOSER MN-21OTN SN-00124250/JHA23 $200 2 GREY PLASTIC TUBS MISC CABLES/MICS2-SHURE CORDED MICS $130 212-XLR CABLES 20 EACH .....-..-.-............-.........-.._. .................... ...... ._................................_............._.......$40.. ............ ._.............. .-............ _._..........------ --.....-............. .... - - 1 LARGE GREEN PLASTIC TUB POWER CORDS 2 YELLOW 50' CORDS- $230 2 YAMAHA SPEAKERS (MONITOR TYPE) MNISM121V SN-07717877 & ., ...... . .. ........ ..... $800 ......._..............-._._.__ FENDER GUITAR AMPLIFIER MN-CHAMP25 PR201300 SN-LO-319980 ...........................-.........-:....................,........ .._.......-_.----........_._.._..............--_. $300 2 SO0 DTECH SPEAKERS CX4C MN-SMZ SN1951204121 & 941002749 $900 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 --- PEAVEY AMP MN-PV8.5C ENCLOSED IN A BLACK TRAVEL CASE.._.............__.....-_...........$600 ..........................:................................,............._............ - _.........--__...._..........- .............._.. JVC VHS PLAYER/RECORDER MN-HRS35000 SN024JO786ENCLOSEDIN A - -_................ $200 ....................................._................................................... - - - --...--.'. ....................................................._. TASCAM CD/CASS PLAYER MN-CD-A500 SN,0120716 ENCLOSED IN A -_ ........... .... ............... ................. ................. .......... .-... .......... .-...... .......... _...... .... ..... ........---................ .............. ..... .... .... .. $200 2 ALESIS REVERE UNITS ENCLOSED'IN A'SKB TRAVEL CASE @$250...................................$500....................................................................................................................................................................................... - ALESIS COMPRESSOR ENCLOSED IN A SKB TRAVEL CASE........................................................................$200_...........................-........................... ......... ............---._._........................................_.......................... _................. ALESIS EQ UNIT MN-MEQ230 SIN -QS1606611 ENCLOSED IN A SKB $150 _........-. .�.:... -- ...._.. -..___.......__.........__..:-_......_.................................-..............:.................... .............-........._............. SOUNDTECH EQ UNIT MN _Q150 ENCLOSED IN A SKB TRAVEL CASE........................... ---.... - - - .....-......__.._._.--._.....................L.... _....-,......_..... .... ... ... ... ............ ......... ...-...... ... ... ............ .................... ..... _....._...... ........................ _._..................... _................... _. $150............................................................. MACKIE MIXER'CONSOLE MN-T36459 $600 ............_.._...........---...._.-_..__...... - - -- ----..........................._._.....................I._..........._. .._. 2 EV LARGE STAGE SPEAKERS (WITH COVERS) MN-1512ER ...._..._........._._;......._..........................__........._.._._..............._._..__...........-_................---_............_..._._....._.. $1,000 KURZEWIL KEYBOARD W/TRAVEL CASE MN-K2000 SN-499603050354 $1,000 ROLAND KEYBOARD (NO CASE) MN-A90EX SN-ZJ96360 ..._._ $750 ------... --._...._...... -_-....... ..................---=....---......._......._.._._._..........................:...............:.:...............................................................................................::....................................................................................................................................................,........................................................,. ROLAND PIANO AMP MN-KC500 SN-CP16045 $500 _ ......_.._.._._..........--........._........._......-_...-.......-__.....-__..-_.......-._............- ROLAND V-DRUMS CLUB SERIES (ELECTRONIC) MN-TD6 SN_-AQ46183 ........................... ....... __..-........-_._.............-_._._...,....................-_....... ...... ....... .........-.-..-._....... $1,100 YAMAHA CLAVINOVA.KEYBOARD MN-CLP123 SN-04685.8 BASSAMP W/ONBOARD MIXER MN-SW65 SN-So11205842. _.. -:.: $499 ........................ ................ ,......... ....... ........._. _.-_..__.. - ................................. ............................ ..............._.....................................:................. AKAI DVD PLAYER (STORED IN CABINET) MN; DVPS760 SN-02040 74364 ....... ........................... ........... ................................. ...................... ......... ...._..................... $200 _............ -- ...----------_...--- -- --..._... .-_.._.............._.._...........:_.-..__.-... SONY CD PLAYER (STORED IN CABINET)MN-CDP390 SN-867914 -- -- - --......... ...... :.......................... ............... ............ ......................... ........_..................................-........................................... .....:............:::............................................_........................................_........................----......................._..............._... $250 ..._.-.-...... .... .... ... ... .... .... ..... ._._......................... ___ ...... .... ... _..................... ..... - YELLOW TOOL BOX W/MISC PATCH CABLES, ORANGE 50' POWER CORD, #2610201783) REPLACEMENT 11 Brotherhood Mutual Insurance Company I www.brotherhoodmu�ual.com 1800.3.33.3735 I 6400 Brotherhood Way, P.O. Box 2227, Fort Wayne, IN 46801-2227 -----------._........ ....-...-_._........_...............-.........._....................................................-_.................................................................---...........-__..............._.......................-_._.......................................__.............. M1 DEC 11/19 "Bear ye one another's burdens and so fulfill the law of Christ"- Galatians 6:2 Page 9 of 19