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HomeMy WebLinkAbout130469 THE BRENDLE GROUP INC - INSURANCE CERTIFICATE (11)StateFarm STATE FARM FIRE AND CASUALTY COMPANY A STOCK COMPANY WITH HOME OFFICES IN BLOOMINGTON, ILLINOIS DECLARATIONS AMENDED SEP 18 2015 P_702Ireland Grove Road Bloomington, IL 61709-0001 T-20-2359-FAF1 F U 001189 3123 Addl Insured -Section II Only CITY OF FORT COLLINS 215 N MASON ST 2ND FLOOR PO BOX 580 FORT COLLINS CO 80522-0580 Office Policy Policy Number 96-CW-8447-1 Policy Period Effective Date Expiration Date 12 Months DEC 3 2015 DEC 3 2016 The policy period begins and ends at 12:01 am standard time atthe premises location. Named Insured THE BRENDLE GROUP INC 212 W MULBERRY ST FORT COLLINS CO 80521-2814 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: Individual Reason for Declarations: Your policy is amended SEP 18 2015 ADDITIONAL INSURED ADDED PREMIUM ADJUSTMENT FORM CMP-4786 ADDED Other items shown are effective with the policy's 2015 renewal Endorsement Premium None Discounts Applied: Renewal Year Years in Business Enclosed Building Protective Devices Claim Record Prepared OCT 14 2015 © Copyright, State Farm Mutual Automobile Insurance Company, 2008 CMP-4000 Includes copyrighted material of Insurance Services Office, Inc., with its permission. 011010 290 Al Continued on Reverse Side of Page Page 1 of 6 N 530-686 a.2 05-31-7011 1olt3231cl DECLARATIONS (CONTINUED) Office Policy for CITY OF FORT COLLINS Policy Number 96-CW-8447-1 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 001 212 W MULBERRY No Coverage $ 217,300 25% FORT COLLINS CO 80521-2814 * As of the effective date of this policy, the Limit of Insurance as shown includes any increase in the limit due to Intlation Coverage. SECTION I - INFLATION COVERAGE INDEX(ES) Cov A - Inflation Coverage Index: Cov B - Consumer Price Index: SECTION I - DEDUCTIBLES N/A 238.7 Basic Deductible $500 Special Deductibles: Money and Securities 250 Employee Dishonesty $250 Equipment Breakdown 1500 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. 011010 Continued on Next Page Page 2 of 6 StateFarm • • • DECLARATIONS (CONTINUED) Office Policy for CITY OF FORT COLLINS Policy Number 96-CW-8447-1 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 $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 OCT 14 2015 © Copyright, State Farm Mutual Automobile Insurance Company, 2008 CMP-4000 Includes copyrighted material of Insurance Services Office, Inc., with its permission. 011011 290 Continued on Reverse Side of Page Page 3 of 6 N DECLARATIONS (CONTINUED) Office Policy for CITY OF FORT COLLINS Policy Number 96-CW-8447-1 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 OCT 14 2015 C Copyright, State Farm Mutual Automobile Insurance Company, 2008 CMP-4000 Includes copyrighted material of Insurance Services Office, Inc., with its permission. 011011 Continued on Next Page Page 4 of 6 StateFarm • •• DECLARATIONS (CONTINUED) Office Policy for CITY OF FORT COLLINS Policy Number 96-CW-8447-1 SECTION 11 - LIABILITY LIMIT OF COVERAGE INSURANCE Coverage L - Business Liability $1 000 000 Coverage M - Medical Expenses (Any One Person) $5,000 Damage To Premises Rented To You $500 000 LIMIT OF AGGREGATE LIMITS INSURANCE Products/Completed Operations Aggregate Excluded 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 CMP-4786 *Addl Insd Owners Lessee Sched CMP-4787 *Waiver of Trans Rgt of Recov CMP-4206.1 Amendatory Endorsement CMP-4845 Excl Product Comp Operatn Liab FE-6999.2 Terrorism Insurance Cov Notice 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 Prepared OCT 14 2015 © Copyright, State Farm Mutual Automobile Insurance Company, 2008 CMP-4000 Includes copyrighted material of Insurance Services Office, Inc., with its permission. 011012 290 Continued on Reverse Side of Page N Page 5 of 6 DECLARATIONS (CONTINUED) Office Policy for CITY OF FORT COLLINS Policy Number 96-CW-8447-1 CMP-4705 Loss of Income & Extra Expnse CMP-4746 Hired Auto Liability CMP-4785 Addl Ins Owners Lessee Blkt CMP-4788 Addl Insd Mgrs Lessor of Prem FD-6007 Inland Marine Attach Dec NOTICE: INFORMATION CONCERNING CHANGES IN YOUR POLICY LANGUAGE IS INCLUDED. PLEASE CALL YOUR AGENT IF YOU HAVE ANY QUESTIONS. * 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 OCT re 2015 © Copyright, State Farm Mutual Automobile Insurance Company, 2008 CMP-4000 Includes copyrighted material of Insurance Services Office, Inc., with its permission. 011012 290 Page 6 of 6 N StateFarm STATE FARM FIRE AND CASUALTY COMPANY 4010) A STOCK COMPANY WITH HOME OFFICES IN BLOOMINGTON, ILLINOIS INLAND MARINE ATTACHING DECLARATIONS 702Ireland Grove -Road Bloomington, IL 6109-0001 T-20-2359-FAF1 F U Named Insured THE BRENDLE GROUP INC 212 W MULBERRY ST FORT COLLINS CO 80521-2814 ATTACHING INLAND MARINE Policy Number 96-CW-8447-1 Policy Period Effective Date Expiration Date 12 Months DEC 3 2015 DEC 3 2016 The policy period begins 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 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 OCT 14 2015 © Copyright, State Farm Mutual Automobile Insurance Company, 2008 FD-6007 Includes copyrighted material of Insurance Services Office, Inc., with its permission. 011013 530-686 a.2 05 31 2911 (o1r32320 96-CW-8447-1 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 OCT 14 2015 © Copyright, State Farm Mutual Automobile Insurance Company, 2008 FD-6007 Includes copyrighted material of Insurance Services Office, Inc., with its permission. 011013 530 686 a.2 05 31 2011 (olf32330