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HomeMy WebLinkAbout130469 THE BRENDLE GROUP INC - INSURANCE CERTIFICATE (10)StateFarm STATE FARM FIRE AND CASUALTY COMPANY A STOCK COMPANY WITH HOME OFFICES IN BLOOMINGTON, ILLINOIS DECLARATIONS COVERAGE SUMMARY JAN 13 2016 T T 3 Ravinia Oriv Atlanta GA 3rT346-2117 M-20-2359-FAF1 F U 001289 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 poll y period beggins and ends at 12:01 am standard time at a premises Tocatlon. 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 Requested By: Policyholder Policy Premium Discounts Applied: Renewal Year Years in Business Enclosed Building Protective Devices Claim Record Prepared JAN 13 2016 CMP-4000 $ 1,026.00 © Copyright, State Farm Mutual Automobile Insurance Company, 2008 Includes copyrighted material of Insurance Services Office, Inc., with its permission. 010592 290 AI N Continued on Reverse Side of Page Page 1 of 6 530-686 a.2 05-31.7011 I o 1 i3231 c l 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 Inflation Coverage. SECTION I - INFLATION COVERAGE INDEX(ES) Cov A - Inflation Coverage Index: Cov B - Consumer Price Index: SECTION I - DEDUCTIBLES N/A 2387 Basic Deductible $500 Special Deductibles: Money and Securities $250 Employee Dishonesty $250 Equipment Breakdown $500 Other deductibles may apply - refer to policy. Prepared JAN 13 2016 © Copyright, State Farm Mutual Automobile Insurance Company, 2008 CMP-4000 Includes copyrighted material of Insurance Services Office, Inc., with its permission. 010592 Continued on Next Page Page 2 of 6 StateFarm • ®400 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. COVERAGE Accounts Receivable On Premises Off Premises Arson Reward Back -Up Of Sewer Or Drain 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) Money Orders And Counterfeit Money Newly Acquired Business Personal Property (applies only if this policy provides Coverage B - Business Personal Property) Newly Acquired Or Constructed Buildings (applies only if this policy provides Coverage A - Buildings) Prepared JAN 13 2016 CMP-4000 010593 290 N © 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 LIMIT OF INSURANCE $50,000 $15,000 $5,000 $15,000 Included Coverage B Limit 25% of covered loss Included $5,000 $5,000 $10,000 Included 10% $5,000 $10,000 $1,000 $100,000 $250,000 Page 3 of 6 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 JAN 13 2016 © Copyright, State Farm Mutual Automobile Insurance Company, 2008 CMP-4000 Includes copyrighted material of Insurance Services Office, Inc., with its permission. 010593 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 II - LIABILITY LIMIT OF COVERAGE INSURANCE Coverage L - Business Liability $2,000,000 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 $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 CMP-4705 Loss of Income & Extra Expnse CMP-4206.1 Amendatory Endorsement CMP-4785 Addl Ins Owners Lessee Blkt CMP-4710 Employee Dishonesty CMP-4746 Hired Auto Liability CMP-4819.1 Unauthorized Business Card Use CMP-4704 Dependent Prop Loss of Income CMP-4709 Money and Securities CMP-4706 Back -Up of Sewer or Drain CMP-4703 Utility Interruption Loss Incur FE-6999.2 Terrorism Insurance Cov Notice CMP-4845 Exci Product Comp Operatn Liab Prepared JAN 13 2016 (D Copyright, State Farm Mutual Automobile Insurance Company, 2008 CMP-4000 Includes copyrighted material of Insurance Services Office, Inc., with its permission. 010594 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-4713 Excl Testing Consulting E&O CMP-4786 Addl Insd Owners Lessee Sched CMP-4787 Waiver of Trans Rgt of Recov CMP-4788 Addl Insd Mgrs Lessor of Prem FD-6007 Inland Marine Attach Dec 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 JAN 13 2016 CMP-4000 © Copyright, State Farm Mutual Automobile Insurance Company, 2008 Includes copyrighted material of Insurance Services Office, Inc., with its permission. 010594 290 N Page 6 of 6 SfatefarM STATE FARM FIRE AND CASUALTY COMPANY • A STOCK COMPANY WITH HOME OFFICES IN BLOOMINGTON, ILLINOIS INLAND MARINE ATTACHING DECLARATIONS 3 Ravinia Dnve Atlanta GA 30346-2117 M-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 Tocation. 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-8743 Inland Marine Computer Prop FE-8739 Inland Marine Conditions See Reverse for Schedule Page with Limits Prepared JAN 13 2016 © Copyright, State Farm Mutual Automobile Insurance Company, 2008 FD-6007 Includes copyrighted material of Insurance Services Office, Inc., with its permission. 010595 538-686 a.2 05 312911 (oIf3232c) 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 $ 25,000 5 500 Included Loss of Income and Extra Expense $ 25,000 Included Prepared JAN 13 2016 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. 010595 530 686a.2 05 31L2011 (o1Q2330 StateFarm 96-CW-8447-1 010596 CMP-4786 i • Page 1 of 1 THIS ENDORSEMENT CHANGES THE POLICY PLEASE READ IT CAREFULLY S tTC i1hN CMP-4786 ADDITIONAL INSURED — OWNERS, LESSEES, OR CONTRACTORS (Scheduled) This endorsement modifies insurance provided under the following: BUSINESSOWNERS COVERAGE FORM SCHEDULE Policy Number: 96-CW-8447-1 Named Insured: THE BRENDLE GROUP INC 212 W MULBERRY ST FORT COLLINS CO 80521-2814 Name And Address Of Additional Insured Person Or Organization: CITY OF FORT COLLINS 215 N MASON ST 2ND FLOOR PO BOX 580 FORT COLLINS CO 80522-0580 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 CMP-4786 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. ©, Copyright, State Farm Mutual Automobile Insurance Company, 2008 Includes copyrighted material of Insurance Services Office, Inc., with its permission.