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HomeMy WebLinkAbout555745 AISLING INC - INSURANCE CERTIFICATE (8)StateFarm • • • STATE FARM FIRE AND CASUALTY COMPANY A STOCK COMPANY WITH HOME OFFICES IN BLOOMINGTON, ILLINOIS DECLARATIONS AMENDED JUN 1 2017 Atlanta rGA 3G346-2117 M-20-1648-FAF1 F Z 002035 3123 Addl Insured -Section II Only Policy Number 96-CB-K216-7 Policy Period Effective Date Exppiration Date 12 Months JUL 22 2017 JLIL 222018 The policy period begins and ends at 12:01 am standard time atthe premises Tocatlon. CITY OF FORT COLLINS Named Insured PURCHASING FINANCIAL SERVICE AISLING INC PURCHASING DIVISION 1827 E MULBERRY ST PO BOX 580 FORT COLLINS CO 80524-3525 FORT COLLINS CO 80522-0580 Dry Cleaning And Laundering Services Policy 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/Lien holder written notice in compliance with the policy provisions or as required by law. Entity: Corporation Reason for Declarations: Your policy is amended JUN 1 2017 ADDITIONAL INSURED ADDED FORM CMP-4802 ADDED Other items shown are effective with the policy's 2017 renewal Endorsement Premium None Discounts Applied: Protective Devices Prepared JUN 21 2017 © Copyright, State Farm Mutual Automobile Insurance Company, 2008 CMP-4000 Includes copyrighted material of Insurance Services Office, Inc., with its permission. 016377 290 Al Continued on Reverse Side of Page Page 1 of 7 N 530 586 a.2 05.31-2011 lot DECLARATIONS (CONTINUED) Dry Cleaning And Laundering Services Policy for CITY OF FORT COLLINS Policy Number 96-CB-K216-7 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 $ 331,900 25% FORT COLLINS CO 80524-3525 002 725 S LEMAY AVE No Coverage $ 20,600 25% FORT COLLINS CO 80524-3245 003 3675 S COLLEGE AVE STE 21 No Coverage $ 20,400 25% FORT COLLINS CO 80525-3044 004 1357 WATER VALLEY PKWY No Coverage $ 20,400 25% UNIT 500 W I N DSOR CO 80550-6250 * As of the effective date of this policy, the Limit of Insurance as shown Includes any Increase In the Ilmlt due to Inflation coverage. SECTION I - INFLATION COVERAGE INDEX(ES) Cov A - Inflation Coverage Index: Cov B - Consumer Price Index: SECTION I - DEDUCTIBLES Basic Deductible $1,000 N/A 243.6 Prepared JUN 21 2017 © Copyright, State Farm Mutual Automobile Insurance Company, 2008 CMP-4000 Includes copyrighted material of Insurance Services Office, Inc., with its permission. 016377 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-CB-K216-7 Special Deductibles: Money and Securities $250 Employee Dishonesty Equipment Breakdown $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 21 2017 © Copyright, State Farm Mutual Automobile Insurance Company, 2008 CMP-4000 Includes copyrighted material of Insurance Services Office, Inc., with its permission. 016378 290 Continued on Reverse Side of Page N 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-CB-K216-7 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 21 2017 © 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 $100,000 $10,000 $5,000 $5,000 016378 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-CB-K216-7 Valuable Papers and Records (On Premises) $10,000 Valuable Papers and Records (Off Premises) $5,000 0002 Signs $2,500 Money And Securities (On Premises) $10,000 Money And Securities (Off Premises) $5,000 Property Of Others (applies only to those premises provided Coverage B - Business $100,000 Personal Property) Accounts Receivable (On Premises) $10,000 Accounts Receivable (Off Premises) $5,000 Outdoor Property $5,000 Valuable Papers and Records (On Premises) $10,000 Valuable Papers and Records (Off Premises) $5,000 0003 Accounts Receivable (On Premises) $10,000 Accounts Receivable (Off Premises) $5,000 Money And Securities (Off Premises) $5,000 Money And Securities (On Premises) $10,000 Outdoor Property $5,000 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 Valuable Papers and Records (Off Premises) $5,000 0004 Accounts Receivable (On Premises) $10,000 Accounts Receivable (Off Premises) $5,000 Money And Securities (Off Premises) $5,000 Money And Securities (On Premises) $10,000 Outdoor Property $5,000 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 Valuable Papers and Records (Off Premises) $5,000 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 Prepared J UN 21 2017 © Copyright, State Farm Mutual Automobile Insurance Company, 2008 CMP-4000 Includes copyrighted material of Insurance Services Office, Inc., with its permission. LIMIT OF INSURANCE $5,000 016379 290 Continued on Reverse Side of Page N Page 5 of 7 DECLARATIONS (CONTINUED) Dry Cleaning And Laundering Services Policy for CITY OF FORT COLLINS Policy Number 96-CB-K216-7 Employee Dishonesty Utility Interruption - Loss Of Income Loss Of Income And Extra Expense SECTION II - LIABILITY $10,000 $10,000 Actual Loss Sustained - 12 Months 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 $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 CMP-4802 'Addl Insd Lessor of Leased Eqp 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 Prepared JUN 21 2017 © Copyright, State Farm Mutual Automobile Insurance Company, 2008 CMP-4000 Includes copyrighted material of Insurance Services Office, Inc., with its permission. 016379 Continued on Next Page Page 6 of 7 StateFarm A DECLARATIONS (CONTINUED) Dry Cleaning And Laundering Services Policy for CITY OF FORT COLLINS Policy Number 96-CB-K216-7 CMP-4704 Dependent Prop Loss of Income CMP-4703 Utility Interruption Loss Incm FE-3650 Actual Cash Value Endorsement 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 * 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 JUN 21 2017 CMP-4000 © Copyright, State Farm Mutual Automobile Insurance Company, 2008 Includes copyrighted material of Insurance Services Office, Inc., with its permission. 016380 290 N Page 7 of 7 Statefarm • • • STATE FARM FIRE AND CASUALTY COMPANY A STOCK COMPANY WITH HOME OFFICES IN BLOOMINGTON, ILLINOIS INLAND MARINE ATTACHING DECLARATIONS 3 Ravini88 r,vQQ Atlanta G 30346-2117 M-20-1648-FAF1 F Z Named Insured AISLING INC 1827 E MULBERRY ST FORT COLLINS CO 80524-3525 ATTACHING INLAND MARINE Policy Number 96-CB-K216-7 Policy Period Effective Date Ex�ppiration Date 12 Months JUL 22 2017 JUL 222018 The policy period beggins 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 Amountis 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 21 2017 © Copyright, State Farm Mutual Automobile Insurance Company, 2008 FD-6007 Includes copyrighted material of Insurance Services Office, Inc., with its permission. 016381 530 686 a.2 05-31.2011 (otf3232c) 96-CB-K216-7 ATTACHING INLAND MARINE SCHEDULE PAGE ATTACHING INLAND MARINE ENDORSEMENT NUMBER COVERAGE FE-8743 Inland Marine Computer Prop Loss of Income and Extra Expense Prepared JUN 21 2017 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 016381 538-686 a.2 85-31-2811 (o W330