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HomeMy WebLinkAbout157778 BOBBAR INC DBA SCOTCHIES CLEANERS - INSURANCE CERTIFICATE (7)State Farm STATE FARM FIRE AND CASUALTY COMPANY #� s A STOCK COMPANY WITH HOME OFFICES IN BLOOMINGTON, ILLINOIS DECLARATIONS AMENDED SEP 11 2015 7021reland Grove Road Bloomington, IL 61709-0001 T-20-2339-FA65 F Z 002465 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 96-135-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 atthe premises location. Named Insured BOBBAR INC DBA SCOTCHIES CLEANERS 985 W IOTH ST APT E4 LOVELAND CO 80537-4565 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 Reason for Declarations: Your policy is amended SEP 11 2015 ADDITIONAL INSURED ADDED FORM CMP-4788 ADDED Endorsement Premium None Discounts Applied: Years in Business Protective Devices Claim Record Prepared OCT 12 2015 © Copyright, State Farm Mutual Automobile Insurance Company, 2008 CMP-4000 Includes copyrighted material of Insurance Services Office, Inc., with its permission. 020236 290 Al Continued on Reverse Side of Page Page 1 of 6 N DECLARATIONS (CONTINUED) Dry Cleaning And Laundering Services Policy for CITY OF FORT COLLINS Policy Number 96-135-F824-6 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 002 1538 E HARMONY RD UNIT 3 No Coverage $ 25,000 25% FORT COLLINS CO 80525-8006 * As of the effective date of this policy, the Limit of Insurance as shown includes any Increase in the limit clue to Inflation Coverage. SECTION I - INFLATION COVERAGE INDEX(ES) Cov A - Inflation Coverage Index: Cov B - Consumer Price Index: SECTION I - DEDUCTIBLES N/A 238.3 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 OCT re 2015 © Copyright, State Farm Mutual Automobile Insurance Company, 2008 CMP-4000 Includes copyrighted material of Insurance Services Office, Inc., with its permission. 020236 Continued on Next Page Page 2 of 6 StateFarm • • • DECLARATIONS (CONTINUED) Dry Cleaning And Laundering Services Policy for CITY OF FORT COLLINS Policy Number 96-135-F824-6 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) $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 OCT 12 2015 © Copyright, State Farm Mutual Automobile Insurance Company, 2008 CMP-4000 Includes copyrighted material of Insurance Services Office, Inc., with its permission. 020237 290 Continued on Reverse Side of Page Page 3 of 6 N DECLARATIONS (CONTINUED) Dry Cleaning And Laundering Services Policy for CITY OF FORT COLLINS Policy Number 96-65-F824-6 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 $20,000 Preservation Of Property 30 Days Property Of Others (applies only to those premises provided Coverage B - Business $50,000 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. 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 © OCT re 2015 Copyright, State Farm Mutual Automobile Insurance Company, 2008 OMP-4000 Includes copyrighted material of Insurance Services Office, Inc., with its permission. 020237 Continued on Next Page Page 4 of 6 StateFarm • 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-4788 *Addl Insd Mgrs Lessor of Prem 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 CMP-4786 Addl Insd Owners Lessee Sched FD-6007 Inland Marine Attach Dec * New Form Attached Prepared OCT 12 2015 © Copyright, State Farm Mutual Automobile Insurance Company, 2008 CMP-4000 Includes copyrighted material of Insurance Services Office, Inc., with its permission. 020238 290 Continued on Reverse Side of Page N Page 5 of 6 DECLARATIONS (CONTINUED) Dry Cleaning And Laundering Services Policy for CITY OF FORT COLLINS Policy Number 96-B5-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 OCT 12 2015 CMP-4000 © Copyright, State Farm Mutual Automobile Insurance Company, 2008 Includes copyrighted material of Insurance Services Office, Inc., with its permission. 020238 290 N Page 6 of 6 State Farm • • 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 61709-0001 T-20-2339-FA65 F Z Named Insured BOBBAR INC DBA SCOTCHIES CLEANERS 985 W IOTH ST APT E4 LOVELAND CO 80537-4565 ATTACHING INLAND MARINE Policy Number 96-B5-F824-6 Policy Period Effective Date Expiration Date 12 Months JUL 31 2015 JUL 31 2016 The policy period be?ins and ends at 12:01 am standard time atthe premises ocation. 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. 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 OCT 12 2015 Copyright, State Farm Mutual Automobile Insurance Company, 2000 FD-6007 Includes copyrighted material of Insurance Services Office, Inc., with its permission. 020239 538 686 a2 05 31 2011 Io1P32320 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 Prepared OCT 12 2015 FD-6007 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. 020239 630 666 a.2 OS 31 2011 1olf3233cl