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HomeMy WebLinkAbout128365 NATIONAL RESEARCH CENTER INC - INSURANCE CERTIFICATE (21)StateFarm • STATE FARM FIRE AND CASUALTY COMPANY A STOCK COMPANY WITH HOME OFFICES IN BLOOMINGTON, ILLINOIS 2702Ireland Grove Road Bloomington, IL 61709-0001 Addl Insured -Section II Only AT2 T-20-2388-FA65 F U 001584 3125 CITY OF FORT COLLINS, CITY HALL WEST 300 LAPORTE AVE FORT COLLINS CO 80521-2719 Office Policy RENEWAL DECLARATIONS Policy Number 96-BU-3823-8 Policy Period Effective Date Expiration Date 12 Months NOV 16 2015 NOV 16 2016 The policy period beggins and ends at12:01 am standard time atthe premisesTocatlon. Named Insured NATIONAL RESEARCH CENTER INC 2955 VALMONT RD STE 300 BOULDER CO 80301-1360 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: Corporation 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 Sprinkler Claim Record Prepared SEP 23 2015 CMP-4000 009820 294 AI N $ 674.00 © Copyright, State Farm Mutual Automobile Insurance Company, 2008 Includes copyrighted material of Insurance Services Office, Inc., with its permission. Continued on Reverse Side of Page Page 1 of 7 ATTACHING INLAND MARINE SCHEDULE PAGE ATTACHING INLAND MARINE ENDORSEMENT NUMBER COVERAGE FE-8743 Inland Marine Computer Prop S Loss of Income and Extra Expense S Prepared SEP 23 2015 FD-6007 LIMIT OF INSURANCE 25,000 25,000 DEDUCTIBLE AMOUNT 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. 500 ANNUAL PREMIUM Included Included 009824 530-585 a.2 05-31-2011 lotf3233c1 RENEWAL DECLARATIONS (CONTINUED) Office Policy for CITY OF FORT COLLINS, Policy Number 96-BU-3823-8 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 2955 VALMONT RD STE 300 No Coverage $ 79,400 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 INDEX(ES) Cov A - Inflation Coverage Index: Cov B - Consumer Price Index: SECTION I - DEDUCTIBLES NIA 238.7 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 SEP 23 2015 © Copyright, State Farm Mutual Automobile Insurance Company, 2008 CMP-4000 Includes copyrighted material of Insurance Services Office, Inc., with its permission. 009820 Continued on Next Page Page 2 of 7 StateFarm • • • RENEWAL DECLARATIONS (CONTINUED) Office Policy for CITY OF FORT COLLINS, Policy Number 96-BU-3823-8 a 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, tn but has "Included" indicated, please refer to that policy provision for an explanation of that coverage. 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 $5,000 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 SEP 23 2015 (D Copyright, State Farm Mutual Automobile Insurance Company, 2008 CMP-4000 Includes copyrighted material of Insurance Services Office, Inc., with its permission. 009821 294 Continued on Reverse Side of Page Page 3 of 7 N RENEWAL DECLARATIONS (CONTINUED) Office Policy for CITY OF FORT COLLINS, Policy Number 96-BU-3823-8 Ordinance Or Law - Equipment Coverage Outdoor Property Personal Effects (applies only to those premises provided Coverage B - Business Personal Property) Personal Property Off Premises Pollutant Clean Up And Removal Preservation Of Property Property Of Others (applies only to those premises provided Coverage B - Business Personal Property) Signs Unauthorized Business Card Use Valuable Papers And Records On Premises Off Premises Water Damage, Other Liquids, Powder Or Molten Material Damage Included $5,000 $5,000 $15,000 $10,000 30 Days $2,500 $2,500 $5,000 $100,000 $15,000 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 SEP 23 2015 © Copyright, State Farm Mutual Automobile Insurance Company, 2008 CMP-4000 Includes copyrighted material of Insurance Services Office, Inc., with its permission. 009821 Continued on Next Page Page 4 of 7 StateFarm • •• RENEWAL DECLARATIONS (CONTINUED) .W. Office Policy for CITY OF FORT COLLINS, Policy Number 96-BU-3823-8 SECTION II - LIABILITY 0 4 LIMIT OF COVERAGE INSURANCE 0 Coverage L - Business Liability $1,000,000 Coverage M - Medical Expenses (Any One Person) $10,000 Damage To Premises Rented To You $300,000 LIMIT OF AGGREGATE LIMITS INSURANCE Products/Completed Operations Aggregate $2,000,000 General Aggregate $2,000,000 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-4746 Hired Auto Liability CMP-4787 Waiver of Trans Rgt of Recov CMP-4713 Excl Testing Consulting E&O CMP-4819.1 Unauthorized Business Card Use CMP-4706 Back -Up of Sewer or Drain CMP-4704 Dependent Prop Loss of Income CMP-4710 Employee Dishonesty CMP-4709 Money and Securities CMP-4703 Utility Interruption Loss Incm CMP-4705 Loss of Income & Extra Expnse Prepared SEP 23 2015 © Copyright, State Farm Mutual Automobile Insurance Company, 2008 CMP-4000 Includes copyrighted material of Insurance Services Office, Inc., with its permission. 009822 294 Continued on Reverse Side of Page N Page 5 of 7 RENEWAL DECLARATIONS (CONTINUED) Office Policy for CITY OF FORT COLLINS, Policy Number 96-BU-3823-8 CMP-4788 Addl Insd Mgrs Lessor of Prem CMP-4785 Addl Ins Owners Lessee Blkt CMP-4786 Addl Insd Owners Lessee Sched CMP-4860 Al Design Person Org 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 SEP 23 2015 OO Copyright, State Farm Mutual Automobile Insurance Company, 2008 CMP-4000 Includes copyrighted material of Insurance Services Office, Inc., with its permission. 009822 Continued on Next Page Page 6 of 7 StateFarm •• RENEWAL DECLARATIONS (CONTINUED) Office Policy for CITY OF FORT COLLINS, Policy Number 96-BU-3823-8 N 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 SEP 23 2015 CMP-4000 © Copyright, State Farm Mutual Automobile Insurance Company, 2008 Includes copyrighted material of Insurance Services Office, Inc., with its permission. 009823 294 N Page 7 of 7 96-B U-3823-8 009823 StateFarm • • • STATE FARM FIRE AND CASUALTY COMPANY A STOCK COMPANY WITH HOME OFFICES IN BLOOMINGTON, ILLINOIS INLAND MARINE ATTACHING DECLARATIONS Bloomington, ILro6i709 r 01 Named Insured T-20-2388-FA65 F U nnik NATIONAL RESEARCH CENTER INC 2955 VALMONT RD STE 300 BOULDER CO 80301-1360 0 0 0 0 ATTACHING INLAND MARINE Policy Number 96-BU-3823-8 Policy Period Effective Date Exppiration Date 12 Months NOV 16 2015 NOV 16 2016 The policy period begins and ends at 12:01 am standard time at the premises iocatton. 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-8743 Inland Marine Computer Prop FE-8739 Inland Marine Conditions See Reverse for Schedule Page with Limits Prepared SEP 23 2015 © Copyright, State Farm Mutual Automobile Insurance Company, 2000 FD-6007 Includes copyrighted material of Insurance Services Office, Inc., with its permission. 009824 530-666 a.2 05 31-2011 WM2320