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HomeMy WebLinkAbout157778 BOBBAR INC DBA SCOTCHIES CLEANERS - INSURANCE CERTIFICATE (5)StateFarm • • • STATE FARM FIRE AND CASUALTY COMPANY A STOCK COMPANY WITH HOME OFFICES IN BLOOMINGTON, ILLINOIS DECLARATIONS AMENDED JUN 2 2015 2702 Ireland Grove Dad Bloomington, IL 61 09-0001 T-20-2339-FA65 F Z 001722 3123 Addl Insured -Section II Only CITY OF FORT COLLINS PURCHASING DIVISION 215 N MASON ST FORT COLLINS CO 80524-4402 Dry Cleaning And Laundering Services Policy Policy Number 96-B5-F824-6 Policy Period Effective Date Expiration Date 12 Months JUL 31 2015 JUL 31 2016 The policy period begins and ends at 12:01 am standard time at the premises location. Named Insured BOBBAR INC DBA SCOTCHIES CLEANERS & ALL -CLEAN -ON -SITE 1827 E MULBERRY ST FORT COLLINS CO 80524-3525 Automatic Renewal - If the policy period is shown as 12 months , this policy will be renewed automatically subjectto the premiums, rules and forms in effect for each succeeding policy period. If this policy is terminated, we will give you and the Mortgagee/Lienholder written notice in compliance with the policy provisions or as required by law. Entity: Corporation Reason for Declarations: Your policy is amended JUN 2 2015 ADDITIONAL INSURED ADDED FORM CMP-4786 ADDED Other items shown are effective with the policy's 2015 renewal Endorsement Premium Increase $ 88.00 Discounts Applied: Claim Record Prepared JUN 17 2015 © Copyright, State Farm Mutual Automobile Insurance Company, 20D8 CMP-4000 Includes copyrighted material of Insurance Services Office, Inc., with its permission. 014903 290 Al Continued on Reverse Side of Page Page 1 of 7 N 96-B5-F824-6 ATTACHING INLAND MARINE SCHEDULE PAGE ATTACHING INLAND MARINE ENDORSEMENT LIMIT OF DEDUCTIBLE ANNUAL NUMBER COVERAGE INSURANCE AMOUNT PREMIUM FE-8743 Inland Marine Computer Prop S 25,000 $ 500 Included Loss of Income and Extra Expense S 25,000 Included OTHER LIMITS AND EXCLUSIONS MAY APPLY - REFER TO YOUR POLICY Prepared JUN 17 2015 © Copyright State Farm Mutual Automobile Insurance Company, 2008 FD-6007 Includes copyrighted material of Insurance Services Office, Inc., with its permission. 014907 530.686 a.2 05-31 2011 WU2330 StateFarm 96-B5-F824-6 014908 CMP-4786 • • • Page 1 of 1 THIS ENDORSEMENT CHANGES THE POLICY PLEASE READ IT CAREFULLY sr.rr s+ar CMP-4786 ADDITIONAL INSURED — OWNERS, LESSEES, OR CONTRACTORS (Scheduled) This endorsement modifies insurance provided under the following: BUSINESSOWNERS COVERAGE FORM SCHEDULE Policy Number: 96-B5-F824-6 Named Insured: BOBBAR INC DBA SCOTCHIES CLEANERS & ALL -CLEAN -ON -SITE 1827 E MULBERRY ST FORT COLLINS CO 80524-3525 Name And Address Of Additional Insured Person Or Organization: CITY OF FORT COLLINS PURCHASING DIVISION 215 N MASON ST FORT COLLINS CO 80524-4402 1. SECTION II — WHO IS AN INSURED of SECTION II — LIABILITY is amended to in- clude, as an additional insured, any person or organization shown in the Schedule, but only with respect to liability for "bodily in- jury", "property damage", or "personal and advertising injury" caused, in whole or in part, by: a. Ongoing Operations (1) Your acts or omissions; or (2) The acts or omissions of those acting on your behalf; in the performance of your ongoing opera- tions for that additional insured; or b. Products -Completed Operations "Your work" performed for that additional insured and included in the "products - completed operations hazard". 2. Any insurance provided to the additional in- sured shall only apply with respect to a claim made or a "suit' brought for damages for which you are provided coverage. 3. Primary Insurance. The insurance afforded the additional insured shall be primary insur- ance. Any insurance carried by the additional insured shall be noncontributory with respect to coverage provided by you. There will be no refund of premium in the event this endorsement is cancelled. All other policy provisions apply. CMP-4786 ©, Copyright, State Farm Mutual Automobile Insurance Company, 2008 Includes copyrighted material of Insurance Services Office, Inc., with its permission. DECLARATIONS (CONTINUED) DCleaning And Laundering Services Policy for CITY OF FORT COLLINS Polry icy Number 96-B5-F824-6 SECTION I - PROPERTY SCHEDULE Location Number Location of Described Premises Limit of Insurance* Coverage A - Buildings Limit of Insurance* Coverage B - Business Personal Property Seasonal Increase - Business Personal Property 001 1827 E MULBERRY ST No Coverage $ 225,000 25% FORT COLLINS CO 80524-3525 002 1538 E HARMONY RD UNIT 3 No Coverage $ 25,000 25% FORT COLLINS CO 80525-8006 003 1823 E MULBERRY ST No Coverage $ 25,000 25% FORT COLLINS CO 80524 * 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 - Gov B - Consumer Price Index: SECTION I - DEDUCTIBLES Basic Deductible $1,000 N/A 238.3 Prepared JUN 17 2015 © Copyright, State Farm Mutual Automobile Insurance Company, 2008 CMP-4000 Includes copyrighted material of Insurance Services Office, Inc., with its permission. 014903 Continued on Next Page Page 2 of 7 StateFarm &�, DECLARATIONS (CONTINUED) Dry Cleaning And Laundering Services Policy for CITY OF FORT COLLINS Policy Number 96-65-F824-6 Special Deductibles: Money and Securities Equipment Breakdown $250 Employee Dishonesty $1,000 Other deductibles may apply - refer to policy. $250 SECTION I - EXTENSIONS OF COVERAGE - LIMIT OF INSURANCE - EACH DESCRIBED PREMISES The coverages and corresponding limits shown below apply separately to each described premises shown in these Declarations, unless indicated by "See Schedule." If a coverage does not have a corresponding limit shown below, but has "Included" indicated, please refer to that policy provision for an explanation of that coverage. COVERAGE Accounts Receivable On Premises Off Premises Arson Reward Collapse Damage To Non -Owned Buildings From Theft, Burglary Or Robbery Debris Removal Equipment Breakdown Fire Department Service Charge Fire Extinguisher Systems Recharge Expense Forgery Or Alteration Glass Expenses Increased Cost Of Construction And Demolition Costs (applies only when buildings are insured on a replacement cost basis) Money And Securities (Off Premises) Money And Securities (On Premises) Prepared JUN 17 2015 CMP-4000 014904 290 N © Copyright, State Farm Mutual Automobile Insurance Company, 2008 Includes copyrighted material of Insurance Services Dffice, Inc., with its permission. Continued on Reverse Side of Page LIMIT OF INSURANCE See Schedule See Schedule $5,000 Included Coverage B Limit 25% of covered loss Included $2,500 $5,000 $10,000 Included 10% See Schedule See Schedule Page 3 of 7 DECLARATIONS (CONTINUED) Dry Cleaning And Laundering Services Policy for CITY OF FORT COLLINS Policy Number 96-B5-F824-6 Money Orders And Counterfeit Money $1,000 Newly Acquired Business Personal Property (applies only if this policy provides $100,000 Coverage B - Business Personal Property) Newly Acquired Or Constructed Buildings (applies only if this policy provides $250,000 Coverage A - Buildings) Ordinance Or Law - Equipment Coverage Included Outdoor Property See Schedule Personal 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 $20,000 Preservation Of Property 30 Days Property Of Others (applies only to those premises provided Coverage B - Business See Schedule Personal Property) Signs See Schedule Valuable Papers And Records On Premises See Schedule Off Premises See Schedule Water Damage, Other Liquids, Powder Or Molten Material Damage Included SECTION I - EXTENSIONS OF COVERAGE - LIMIT OF INSURANCE - SCHEDULE The coverages and corresponding limits shown below apply only to the described premises as shown. LOCATION COVERAGE 0001 Signs Money And Securities (On Premises) Money And Securities (Off Premises) Property Of Others (applies only to those premises provided Coverage B - Business Personal Property) Accounts Receivable (On Premises) Accounts Receivable (Off Premises) Outdoor Property Prepared JUN 17 2015 © Copyright, State Farm Mutual Automobile Insurance Company, 2008 CMP-4000 Includes copyrighted material of Insurance Services Office, Inc., with its permission. LIMIT OF INSURANCE $2,500 $10,000 $5,000 $80,000 $10,000 $5,000 $5,000 014904 Continued on Next Page Page 4 of 7 StateFarm • ••. DECLARATIONS (CONTINUED) Dry Cleaning And Laundering Services Policy for CITY OF FORT COLLINS Policy Number 96-65-F824-6 Valuable Papers and Records (On Premises) Valuable Papers and Records (Off Premises) 0002 Signs Money And Securities (On Premises) Money And Securities (Off Premises) Property Of Others (applies only to those premises provided Coverage B - Business Personal Property) Accounts Receivable (On Premises) Accounts Receivable (Off Premises) Outdoor Property Valuable Papers and Records (On Premises) Valuable Papers and Records (Off Premises) 0003 Signs Money And Securities (On Premises) Money And Securities (Off Premises) Property Of Others (applies only to those premises provided Coverage B - Business Personal Property) Accounts Receivable (On Premises) Accounts Receivable (Off Premises) Outdoor Property Valuable Papers and Records (On Premises) Valuable Papers and Records (Off Premises) SECTION I - EXTENSIONS OF COVERAGE - LIMIT OF INSURANCE - PER POLICY $10,000 $5,000 $2,500 $10,000 $5,000 $50,000 $10,000 $5,000 $5,000 $10,000 $5,000 $2,500 $10,000 $5,000 $50,000 $10,000 $5,000 $5,000 $10,000 $5,000 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 JUN 17 2015 © Copyright, State Farm Mutual Automobile Insurance Company, 2008 CMP-4000 Includes copyrighted material of Insurance Services Office, Inc., with its permission. 014905 290 Continued on Reverse Side of Page Page 5 of 7 N DECLARATIONS (CONTINUED) Dry Cleaning And Laundering Services Policy for CITY OF FORT COLLINS Policy Number 96-B5-F824-6 SECTION II - LIABILITY LIMIT OF COVERAGE INSURANCE Coverage L - Business Liability $3,000,000 Coverage M - Medical Expenses (Any One Person) $5,000 Damage To Premises Rented To You $1,000,000 LIMIT OF AGGREGATE LIMITS INSURANCE Products/Completed Operations Aggregate $6,000,000 General Aggregate $6,000,000 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 CMP-4786 "Addl Insd Owners Lessee Sched FE-6999.2 Terrorism Insurance Cov Notice CMP-4206.1 Amendatory Endorsement CMP-4705 Loss of Income & Extra Expnse CMP-4710 Employee Dishonesty CMP-4709 Money and Securities CMP-4704 Dependent Prop Loss of Income CMP-4703 Utility Interruption Loss Incm FD-6007 Inland Marine Attach Dec New Form Attached Prepared JUN 17 2015 © Copyright, State Farm Mutual Automobile Insurance Company, 2008 CMP-4000 Includes copyrighted material of Insurance Services Office, Inc., with its permission. 014905 Continued on Next Page Page 6 of 7 StateFarm • •• DECLARATIONS (CONTINUED) Dry Cleaning And Laundering Services Policy for CITY OF FORT COLLINS Policy Number 96-135-F824-6 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 JUN 17 2015 CMP-4000 © Copyright, State Farm Mutual Automobile Insurance Company, 2008 Includes copyrighted material of Insurance Services Office, Inc., with its permission. 014906 290 N Page 7 of 7 96-B5-F824-6 014906 StateFarm • ••, STATE FARM FIRE AND CASUALTY COMPANY ASTOCK COMPANY WITH HOME OFFICES INBLOOMINGTON,ILLINOIS INLAND MARINE ATTACHING DECLARATIONS p702 Ireland Grove Road Bloomington, IL 61709-0001 T-20-2339-FA65 F Z Named Insured BOBBAR INC DBA SCOTCHIES CLEANERS & ALL -CLEAN -ON -SITE 1827 E MULBERRY ST FORT COLLINS CO 80524-3525 ATTACHING INLAND MARINE Policy Number 96-B5-F824-6 Policy Period Effective Date Ex�ppiration Date 12 Months JUL 31 2015 JUL 31 2016 The policy period begins and ends at 12:01 am standard time atthe premises Tocatlon. 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 JUN 17 2015 © Copyright, State Farm Mutual Automobile Insurance Company, 2008 FD-6007 Includes copyrighted material of Insurance Services Office, Inc., with its permission. 014907 530 686 a.2 Oh 31 2011 MQ7320