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HomeMy WebLinkAbout128365 NATIONAL RESEARCH - INSURANCE CERTIFICATE (3)StateFarm • 8 S a �o T'F STATEFARM FIRE AND CASUALTY COMPANY gA STOCK COMPANY WITH HOME OFFICES IN BLOOMINGTON, ILLINOIS DECLARATIONS AMENDED MAR 32020 Atlanta GA 30346-2117 Addl Insured -Section II Only M-20-2388-FA65 F U 001993 3123 CITY OF FORT COLLINS 3000 LAPORTE AVE FORT COLLINS CO 80521 Illlljl�l'���Y11�1�1�1�1i�I�illLlll�ll�lllljllri}1I1�111�1i1�1 Office Policy Policy Period Effective Date Expiration Date 12 Months MAY 1 2020 MAY 1 2021 The poly period be�ins and ends at 12:01 am standard time at a premises ocatfon. Named Insured POLICY CONFLUENCE INC DBA NATIONAL RESEARCH. 2955 VALMONT RD STE 360 BOULDER CO 80301-1360 Automatic Renewal -If the policy period is shown as'12 months, this policy will be renewed automatically subject to the premiums, rules and forms in effect for each"succeeding policy period. If this policy is terminated, we will give you and the Mortgagee/Lienholder written notice in compliance with the policy provisions or as required by law._ Entity: Corporation Reason for Declarations: Your policy is amended MAR 3 2020 ADDITIONAL INSURED ADDED PREMIUM ADJUSTMENT FORM CMP-4786 ADDED Other items shown are effective With the policy's 2020 renewal Endorsement Premium None Discounts Applied: Years in Business Enclosed Building Prepared MAR 25 2020 0 Copyright State Farm Mutual Automobile Insurance Company, 2008 CMP-4000 Includes copyrighted material of Insurance Services Office, Inc., with its permission. 016946 290 Al Continued on Reverse Side! of Page N Page 1 of 6 530-586 a.2 05-31.2011 loif32310 DECLARATIONS (CONTINUED) Office Policy for CITY OF FORT COLLINS Policy Number 96-05-B398-8 SECTION 1- PROPERTY SCHEDULE Location Location of Limit of Insurance* Limit of Insurance' Seasonal Number Described Increase - Premises Coverage A - Coverage B - Business Buildings. Business Personal Personal Property Property 001 2955 VALMONT RD STE 300 No Coverage $ 75,600 25% BOULDER CO 80301-1360 *As of the effective date of this policy, the Limit of Insurance as shown includes any increase in the limit due to Inflation Coverage. SECTION I:- INFLATION COVERAGE INDEXES) Cov A - Inflation Coverage Index: Cov B - Consumer Price Index: SECTION I - DEDUCTIBLES N/A 257.3 Basic Deductible $1,000 Special Deductibles: Money and Securities $250 Employee Dishonesty $250 Equipment Breakdown $1,000 Other deductibles may apply - refer to policy. Prepared MAR 25 2020 © Copyright, State Farm Mutual Automobile Insurance Company, 2008 CMP4000 Includes copyrighted material of Insurance Services Office, Inc., with its permission. 015946 Continued on Next Page Page 2 of 6 StateFann • • e DECLARATIONS (CONTINUED) Office Policy for CITY OF FORT COLLINS Policy Number 96-05-B398-8 SECTION I --EXTENSIONS OF COVERAGE - LIMIT OF INSURANCE EACH DESCRIBED PREMISES c The coverages and corresponding limits shown below apply separately to each described premises shown in these Declarations, unless indicated by "See Schedule." If a coverage does not have a corresponding limit shown below, but has "Included" indicated, please refer to that policy provision for an explanation of that coverage. �o LIMIT OF COVERAGE INSURANCE Accounts Receivable On Premises $50,000 Off Premises $15,000 Arson Reward $.5,000 Back -Up Of Sewer Or Drain $15,000 Collapse Included Damage To Non -Owned Buildings From Theft, Burglary Or Robbery Coverage B Limit Debris Removal 25% of covered loss Equipment Breakdown Included Fire Department Service Charge Fire Extinguisher Systems Recharge Expense $5,000 Forgery Or Alteration $10,000 Glass Expenses Included Increased -Cost Of Construction And Demolition Costs (applies only when buildings are 10% insured on a replacement cost basis) Money And Securities (Off Premises) $5,000 Money And Securities (On Premises) $10,000 Money Orders And Counterfeit Money $1,000 Newly Acquired Business Personal Property (applies only if this policy provides $100,000 Coverage B - Business Personal Property) Newly Acquired Or Constructed Buildings (applies only if this policy provides $250,000 Coverage A - Buildings) Prepared I , MAR 25 2020 © Copyright; State Farm Mutual Automobile Insurance Company, 2008 CMP-4000 Includes copyrighted material of Insurance Services Office, Inc., with its permission. 015947 290 Continued on Reverse Side of Page Page 3 of 6 N DECLARATIONS (CONTINUED) Office Policy for CITY OF FORT COLLINS Policy Number 96-05-B398-8 Ordinance Or Law - Equipment Coverage Included Outdoor Property $5,000 Personal Effects (applies only to those premises provided Coverage B - Business $5,000- Personal Property) Personal Property Off Premises $15,000 Pollutant Clean Up And Removal $10,000 Preservation Of Property 30 Days Property Of Others (applies only to those premises provided Coverage B - Business $2,500 Personal Property) Signs $2,500 Unauthorized Business Card Use $5,000 Valuable Papers And Records On Premises $50,000 Off Premises $15,000 Water Damage, Other Liquids, Powder Or Molten Material Damage Included SECTION I - EXTENSIONS OF COVERAGE - LIMIT OF INSURANCE PER POLICY The coverages and corresponding limits shown below are the most we will pay regardless of the number of described premises shown in these Declarations. COVERAGE Dependent Property- Loss Of Income Employee Dishonesty Utility Interruption - Loss Of Income Loss Of Income And Extra Expense LIMIT OF INSURANCE $5,000 $10,000 $10,000, Actual Loss Sustained - 12 Months Prepared MAR 25 2020 © Copyright, State Farm Mutual Automobile Insurance Company, 2009 CMP-4000 Includes copyrighted material of Insurance Services Office, Inc,, with its permission. 015947 Continued on Next Page Page 4 of 6 StateFann ❑ owl DECLARATIONS (CONTINUED)' 67J` l��• Office Policy for CITY OF FORT COLLINS Policy Number 96-05-8398-8 SECTION II - LIABILITY LIMIT OF S COVERAGE INSURANCE $ Coverage L - Business Liability $2,000,000 Coverage M - Medical Expenses (Any One Person) $5,000 Damage To Premises Rented To You $300,000 LIMIT OF AGGREGATE LIMITS INSURANCE Products/Completed Operations Aggregate $4,000,000 General Aggregate $4,000,000 Each paid claim for Liability Coverage reduces the amount of insurance we provide during the applicable annual period. Please refer to Section II - Liability in the Coverage Form and any attached endorsements. Your policy consists of these Declarations,. the BUSINESSOWNERS COVERAGE FORM shown below, and any other forms and endorsements that apply, including those shown below as well as those issued subsequent to the issuance of this policy. CMP-4100 Businessowners Coverage Form CMP-4786 "Addl Insd Owners Lessee Sched CMP-4819.1 Unauthorized Business Card Use FE-6999.2 Terrorism Insurance Coy Notice CMP-4206.1 Amendatory Endorsement FE-3650 Actual Cash Value Endorsement CMP-4561.1 Policy Endorsement CMP-4705.2 Loss of Income & Extra Expnse CMP-4710 Employee Dishonesty CMP-4709 Money and Securities CMP-4706 Back -Up of Sewer or Drain CMP-4704.1 Dependent Prop Loss of Income CMP-4703.1 Utility Interruption Loss Incm Prepared MAR 25 2020 © Cop yrigh't State Farm Mutual Automobile Insurance Company, 2000 CMP-4000 Includes copyrighted material of Insurance Services Office, Inc.; with its permission. 015s48 290 Continued on Reverse Side of Page Page 5 of 6 N DECLARATIONS (CONTINUED) Office Policy for CITY OF FORT COLLINS Policy Number 96-05-B398-8 CMP-4785 Addl Ins Owners Lessee Blkt CMP-4875 Loss Payable CMP-4787 Waiver of Trans Rgt of Recov FD-6007 Inland Marine Attach Dec ' New Form Attached This policy is issued by the State Farm Fire and Casualty Company. Participating Policy You are entitled to participate in a distribution of the earnings of the company as determined by our Board of Directors in accordance with the Company's Articles of Incorporation, as amended. In Witness Whereof, the State Farm Fire and Casualty Company has caused this policy to be signed by its President and Secretary at Bloomington, Illinois, Secretary President Prepared MAR 25 2020 CMP-4000 © Copyright, State Farm Mutual Automobile Insurance Company, 2008 Includes copyrighted material of Insurance Services, Office, Inc., with its permission. 015948 290 N Page 6 of, 6