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HomeMy WebLinkAbout111 N COLLEGE LLC - INSURANCE CERTIFICATE (3)STATE FARM FIRE AND CASUALTY COMPANY A STOCK COMPANY WITH HOME OFFICES IN BLOOMINGTON, ILLINOIS RENEWAL DECLARATIONS I o 0 0 0 0 G 702 Ireland Grove oa loomington. IL 61 09- Of Loss Payee AT1 T-20-2359-FAF1 F Z 002920 3125 THE CITY OF FORT COLLINS PO BOX 580 FORT COLLINS CO 80522-0580 Businessowners Policy Policy Number 96-J9-2084-8 Policy Period Effective Date Expiration Date 12 Months JUN 15 2015 JUN 15 2016 The policy period begins and ends at 12:01 am standard time atthe premises Tocanon. Named Insured 111 N COLLEGE LLC 111 N COLLEGE AVE FORT COLLINS CO 80524-2443 Automatic Renewal - If the policy period is shown as 12 months , this policy will be renewed automatically subjectto the premiums, rules and forms in effectfor each succeeding policy period. If this policy is terminated, we will give you and the Mortgagee/Lienholder written notice in compliance with the policy provisions or as required by law. Entity: LLC NOTICE: Information concerning changes in your policy language is included. Please call your agent if you have any questions. POLICY PREMIUM Discounts Applied: Renewal Year Years in Business Claim Record Prepared APR 22 2015 CMP-4000 $ 3,602.00 © Copyright State Farm Mutual Automobile Insurance Company, 2008 Includes copyrighted material of Insurance Services Office, Inc., with its permission. 017792 294 Al N Continued on Reverse Side of Page Page 1 of 6 530-506 a.2 05-31-2011 10113231c1 RENEWAL DECLARATIONS (CONTINUED) Businessowners Policy for THE CITY OF FORT COLLINS Policy Number 96-J9-2084-8 SECTION I - PROPERTY SCHEDULE Location Location of Limit of Insurance* Limit of Insurance* Seasonal Number Described Increase - Premises Coverage A - Coverage B - Business Buildings Business Personal Personal Property Property 001 111 N COLLEGE AVE $ 1,492,600 No Coverage N/A FORT COLLINS CO 80524-2443 * 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 INDEX(ES) Cov A - Inflation Coverage Index: Cov B - Consumer Price Index: SECTION I - DEDUCTIBLES 164.5 N/A Basic Deductible $5,000 Special Deductibles: Money and Securities $250 Equipment Breakdown $2,500 Other deductibles may apply - refer to policy. Prepared APR 22 2015 © Copyright, State Farm Mutual Automobile Insurance Company, 2008 CMP-4000 Includes copyrighted material of Insurance Services Office, Inc., with its permission. 017792 Continued on Next Page Page 2 of 6 RENEWAL DECLARATIONS (CONTINUED) Businessowners Policy for THE CITY OF FORT COLLINS Policy Number 96-J9-2084-8 SECTION I - EXTENSIONS OF COVERAGE - LIMIT OF INSURANCE - EACH DESCRIBED PREMISES The coverages and corresponding limits shown below apply separately to each described premises shown in these Declarations, unless indicated by "See Schedule." If a coverage does not have a corresponding limit shown below, but has 'Included" indicated, please refer to that policy provision for an explanation of that coverage. LIMIT OF COVERAGE INSURANCE Accounts Receivable On Premises $10,000 Off Premises $5,000 Arson Reward $5,000 Collapse Included Damage To Non -Owned Buildings From Theft, Burglary Or Robbery Coverage B Limit Debris Removal 25% of covered loss Equipment Breakdown Included Fire Department Service Charge $2 500 Fire Extinguisher Systems Recharge Expense $5,000 Forgery Or Alteration $10,000 Glass Expenses Included Increased Cost Of Construction And Demolition Costs (applies only when buildings are 10% insured on a replacement cost basis) Money And Securities (Off Premises) $2,000 Money And Securities (On Premises) $5,000 Money Orders And Counterfeit Money $1,000 Newly Acquired Business Personal Property (applies only if this policy provides $100,000 Coverage B - Business Personal Property) Newly Acquired Or Constructed Buildings (applies only if this policy provides $250,000 Coverage A - Buildings) Prepared APR 22 2015 © Copyright, State Farm Mutual Automobile Insurance Company, 20DO CMP-4000 Includes copyrighted material of Insurance Services Office, Inc., with its permission. 017793 294 Continued on Reverse Side of Page Page 3 of 6 N RENEWAL DECLARATIONS (CONTINUED) Businessowners Policy for THE CITY OF FORT COLLINS Policy Number 96-J9-2084-8 Ordinance Or Law - Equipment Coverage Included Outdoor Property $5,000 Personal Effects (applies only to those premises provided Coverage B - Business $2,500 Personal Property) Personal Property Off Premises $15,000 Pollutant Clean Up And Removal $10,000 Preservation Of Property 30 Days Property Of Others (applies only to those premises provided Coverage B - Business $2,500 Personal Property) Signs $2,500 Valuable Papers And Records On Premises $10,000 Off Premises $5,000 Water Damage, Other Liquids, Powder Or Molten Material Damage Included SECTION I - EXTENSIONS OF COVERAGE - LIMIT OF INSURANCE - PER POLICY The coverages and corresponding limits shown below are the most we will pay regardless of the number of described premises shown in these Declarations. CK�I9�.L•[� Loss Of Income And Extra Expense LIMIT OF INSURANCE Actual Loss Sustained - 12 Months SECTION II - LIABILITY LIMIT OF COVERAGE INSURANCE Coverage L - Business Liability $2,000,000 Prepared APR 22 2015 © Copyright State Farm Mutual Automobile Insurance Company, 2008 CMP-4000 Includes copyrighted material of Insurance Services Office, Inc., with its permission. 017793 Continued on Next Page Page 4 of 6 RENEWAL DECLARATIONS (CONTINUED) Businessowners Policy for THE CITY OF FORT COLLINS Policy Number 96-J9-2084-8 Coverage M - Medical Expenses (Any One Person) $5,000 Damage To Premises Rented To You $300,000 Im LIMIT OF 0 AGGREGATE LIMITS INSURANCE 0 0 N Products/Completed Operations Aggregate $4,000,000 v 0 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. FORMS AND ENDORSEMENTS CMP-4100 Businessowners Coverage Form FE-6999.2 'Terrorism Insurance Cov Notice CMP-4206.1 Amendatory Endorsement CMP-4839 Loss Payable CMP-4709 Money and Securities CMP-4705 Loss of Income & Extra Expnse FD-6007 Inland Marine Attach Dec New Form Attached Prepared APR 22 2015 CMP-4000 © Copyright, State Farm Mutual Automobile Insurance Company, 2tm8 Includes copyrighted material of Insurance Services Office, Inc., with its permission. of rrs4 294 Continued on Reverse Side of Page Page 5 of 6 N RENEWAL DECLARATIONS (CONTINUED) Businessowners Policy for THE CITY OF FORT COLLINS Policy Number 96-J9-2084-8 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 NOTICE TO POLICYHOLDER: For a comprehensive description of coverages and forms, please refer to your policy. Policy changes requested before the "Date Prepared", which appear on this notice, are effective on the Renewal Date of this policy unless otherwise indicated by a separate endorsement, binder, or amended declarations. Any coverage forms attached to this notice are also effective on the Renewal Date of this policy. Policy changes requested after the "Date Prepared" will be sent to you as an amended declarations or as an endorsement to your policy. Billing for any additional premium for such changes will be mailed at a later date. If, during the past year, you've acquired any valuable property items, made any improvements to insured property, or have any questions about your insurance coverage, contact your State Farm agent. Please keep this with your policy. Prepared APR 22 2015 © Copyright State Farm Mutual Automobile Insurance Company, 2008 CMP-4000 Includes copyrighted material of Insurance Services Office, Inc., with its permission. 017794 294 Page 6 of 6 N STATE FARM FIRE AND CASUALTY COMPANY A STOCK COMPANY WITH HOME OFFICES IN BLOOMINGTON, ILLINOIS INLAND MARINE ATTACHING DECLARATIONS 702 Ireland Grove Road loomington, IL 61 09-0001 T-20-2359-FAFI F Z Named Insured III N COLLEGE LLC 111 N COLLEGE AVE FORT COLLINS CO 80524-2443 0 0 G O N d 0 ATTACHING INLAND MARINE Policy Number 96-J9-2084-8 Policy Period Effective Date Exppiration Date 12 Months JUN 15 2015 JUN 15 2016 The policy period beggins and ends at 12:01 am standard time at the premisesTocation. Automatic Renewal - If the policy period is shown as 12 months , this policy will be renewed automatically subjectto the premiums, rules and forms in effectfor each succeeding policy period. If this policy is terminated, we will give you and the Mortgagee/Lienholder written notice in compliance with the policy provisions or as required by law. Annual Policy Premium Included The above Premium Amount is included in the Policy Premium shown on the Declarations. Your policy consists of these Declarations, the INLAND MARINE CONDITIONS shown below, and any other forms and endorsements that apply, including those shown below as well as those issued subsequentto the issuance of this policy. Forms, Options, and Endorsements FE-8739 Inland Marine Conditions FE-8743 Inland Marine Computer Prop See Reverse for Schedule Page with Limits Prepared APR 22 2015 © Copyright, State Farm Mutual Automobile Insurance Company, 2008 FD-6007 Includes copyrighted material of Insurance Services Office, Inc., with its permission. 017795 530 6116 a.2 05 312011 1032320 1 96-J9-2084-8 ATTACHING INLAND MARINE SCHEDULE PAGE ATTACHING INLAND MARINE ENDORSEMENT NUMBER FE-8743 Prepared APR 22 2015 FD-6007 COVERAGE Inland Marine Computer Prop Loss of Income and Extra Expense LIMIT OF INSURANCE S 25,000 S 25,000 DEDUCTIBLE AMOUNT $ 500 OTHER LIMITS AND EXCLUSIONS MAY APPLY - REFER TO YOUR POLICY © Copyright State Farm Mutual Automobile Insurance Company, 2008 Includes copyrighted material of Insurance Services Office, Inc., with its permission. ANNUAL PREMIUM Included Included 017795 530 fiefi u.2 05 31.2011 1 o 1 N23%I