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Home My WebLink AboutTIMBERLINE CHURCH - INSURANCE CERTIFICATE (7)c� �e Brotherhood Mutual' Insurance Companv MinistryFirst" Commercial Multi -Peril Insurance Coverage Summary These are your policy's Declarations. Renewal of 05M5A0358236 TIMBERLINE CHURCH 2908 S Timberline Rd Fort Collins, CO 80525-2402 NAMED INSURED TIMBERLINE CHURCH POLICY NUMBER 05M5A0358236 POLICY PERIOD 7/27/2017 to 7/27/2018 at 12:01 a.m. Policy Number 05M5A0358236 Brotherhood Mutual Insurance Company Print Date: June 16, 2017 Policy Period: 7/27/2017 to 7/27/2018 866-565-6424 Ministry Risk Management LLC 0598-104 PO Box 740670 Arvada, CO 80006-0670 Contact your agent with your customer service questions, including updating your policy or reporting a claim. www.brotherhoodmutual.com/payonline For your convenience, you can make premium payments online. Key Facts About Your Policy These Declarations replace your previous ones. Your policy's Declarations contain a summary of the coverage contained in the insurance policy. Your policy contains a full explanation of your coverage. AGREEMENT: In return for the payment of the premium and subject to all the terms of the policy, we agree to provide the insurance stated in the policy. TYPE OF ORGANIZATION: Church Institution FORM OF ORGANIZATION: Corporation Policy Overview COVERAGE DESCRIPTION DETAILS Property Coverage Page 2 - 6 Inland Marine Coverage Page 7 - 8 Liability Coverage Page 9 -15 Excess Liability Coverage Page 16 -16 COVERAGE DESCRIPTION DETAILS Terrorism Premium $3,266 (See Notice Form BN6025A-D 3.1 for details) Policy Premium Overview This premium is subject to adjustment at each anniversary. This premium is subject to adjustment due to premium audit provision. ANNUAL PREMIUM: $73,718.00 PAYMENT SCHEDULE: See invoice. Common Policy Forms FORM FORM NAME BN2A 1.1 .......................................................................................................................................................................................................................................................... Notice to our Policyholder CL3001.0 ...............................................-............................................................. Amendatory Endorsement ........................................................................................................................................... BCP100 4.0 ................................................-.-.....-......---..............................................................................................................................................................I.................. Commercial Property Coverage Conditions BSEB100 4.1 ........................................................._.........-..-..............-......................................-...._....................................................................................I....-..........-_.....-. Systems/Equipment Breakdown Coverage BN11A 1.1 ......................................... .......-......... ...................................... Customer Notice Value -Added Benefits .................................................................................... .......................................... ........................... BN1B 1.0 .Notice Of Payment -Related Charges G13210 06 ... ............................................... --.................................. ................ Notice To Policyholders ...... ........ ..... ............................................................................................................................................... BN6EX 1.0 Notice - Terrorism -Related Loss FORM FORM NAME CL1001.0 . ........................................................................................................................................................................................................................ Common Policy Conditions . ......................-...............-..-......._.........................................-............................................-.........................-....-........-...........-......... GL1001.0 ............................................................................ Commercial Liability Coverage ...................................... ................................. .... ....................... I ....... - ........... -.......... BCL3011.0 ...-...................................... -._....... _........ Form Number Reference _......... -............................................................. _.......... _............................. -..-..-.... _...- CL0182 0101 .................................................................................................................................................................-..................................................... Amendatory Endorsement Colorado BCL1001.1 ..............................................--........_...................................................................................................................................-......_._..._.... Additional Policy Conditions EX06061.0 ...................................... ...-...-............................... Conditional Terrorism Exclusion ..............................................................................._..........._..._._-..-...._.._.... BN6025A-D 3.1 Notice Terrorism -Related Loss Brotherhood Mutual Insurance Company I www.brotherhoodmutual.com I 800.333.3735 I P.O. Box 2227, Fort Wayne, IN 46801-2227 ............................................................................... . M1 DEC 09/16 'Bear ye one another's burdens and so fulfill the law of Christ"— Galatians 6:2 Page 1 of 16 Brotherhood Mutual" Insurance Company NAMED INSURED TIMBERLINE CHURCH POLICY NUMBER 05M5A0358236 POLICY PERIOD 7/27/2017 to 7/27/2018 Liability Coverage Summary MinistryFirsts' commercial multi -peril policy Declarations continued... The Coverages listed here are provided according to the terms of the designated coverage form and any other applicable forms or endorsements. Only one liability coverage and one medical coverage will apply to an occurrence and any related loss. Any limit which is specifically stated within a coverage form or endorsement represents the most we will pay for the coverage to which such a limit applies. For application of limits, see Liability and Medical Coverage form (BGL11 4.0). Counseling Acts Professional Liability Coverage COVERAGE DESCRIPTIONS COVERAGE LIMIT COVERAGE AGGREGATE LIMIT FORM Counseling Acts Liability Coverage $1,000,000, $3,000,000* BGL63 4.1 �_................................................................................._.._.__..__........................................................................ Outside Counseling Reimbursement Coverage $5,000+ $3,000,000* BGL63 4.1 Cyber Liability Coverage COVERAGE DESCRIPTIONS COVERAGE LIMIT COVERAGE AGGREGATE LIMIT FORM Computer Use Liability Coverage $1,000,000* $3,000,000* BGL87 4.1 ..............................................................................................................................._................................._........._........_......__...................._..............._.................................._..----................._...-••---.........................................._.._...._....__............................_...._.................__.........._............_......_...................._.......................... Electronic Commerce Liability Coverage $1,000,000* $3,000,000* BGL87 4... Data Breach Liability Coverage $1,000,000* $3,000,000* BGL87 4.1 _........................................................................................_..._.__.._........................................................................._.........._..._._._... Outsourced IT Liability Coverage $1,000,000* - ...._..__.......... ........... _........._.._...._....._....------............................... $3,000,000* BGL87 4.1 Special Reimursement Coverage (Data Breach Rectification _...._._........................._...._....._..--_........._._..............................._.._.....__._.._.._._.._...--._-................._....................-_.._..._._..._..._............._..__......_.....--- $250,000 $250,000 BGL87 4.1 Costs) .............................._.....__.......................................__......_......._......................._............_...........................................................................1,. Special Reimbursement Coverage (Electronic Discovery Costs) __. $100,000 $100,000 BGL87 4.1 Special Defense Coverage (Subpoenas, Regulatory Actions and $100,000 $100,000 BGL87 4.1 Injunctive) Defense Reimbursement Coverage COVERAGE DESCRIPTIONS Legal Liability Defense Reimbursement Coverage Directors and Officers Liability Coverage COVERAGE DESCRIPTIONS Directors and Officers (Leadership) Liability Coverage Benefits Administration Liability Coverage COVERAGE LIMIT COVERAGE AGGREGATE LIMIT FORM See Form BGL89 See Form BGL89 BGL89 4.1 COVERAGE LIMIT COVERAGE AGGREGATE LIMIT FORM $1,000,000, $3,000,000' BGL81B 4.1 COVERAGE DESCRIPTIONS COVERAGE LIMIT COVERAGE AGGREGATE LIMIT FORM Employee Benefit Liability Coverage $1,000,000 $3,000,000 BGL83 4.0 __....._......__.._....__............................................__..._..__.........................--.------..............._..---._........._..._...._....._....._...................................................................._...._._._.............._....._._..__.........0','._......._......_.._.. --- _ .._...__..__.._...._..................................._...._._.._...........................0" (Medical Expense Limit) $100,000* $500,000* BGL83 4.0 Employment Practices ("Employment Pract") Liability Coverage COVERAGE DESCRIPTIONS Employment -Related Liability Coverage COVERAGE LIMIT COVERAGE AGGREGATE LIMIT FORM $1,000,00w $3,000,000' BGL85 4.1 * Only a single limit applies to the loss. All coverage limits are subject to the general occurrence limit and all aggregate limits are subject to the general aggregate limit. +per person limit Brotherhood Mutual Insurance Company I www.brotherhoodmutual.com I 800.333.3735 I P.O. Box 2227, Fort Wayne, IN 46801-2227 M1 DEC 09/16 'Bear ye one another's burdens and so fulfill the law of Christ" — Galatians 6:2 Page 10 of 16 Brotherhood Mutual" Insurance Company NAMED INSURED TIMBERLINE CHURCH POLICY NUMBER 05M5A0358236 POLICY PERIOD 7/27/2017 to 7/27/2018 Liability Coverage Summary MinistryFirstsm commercial multi -peril policy Declarations continued... The Coverages listed here are provided according to the terms of the designated coverage form and any other applicable forms or endorsements. Only one liability coverage and one medical coverage will apply to an occurrence and any related loss. Any limit which is specifically stated within a coverage form or endorsement represents the most we will pay for the coverage to which such a limit applies. For application of limits, see Liability and Medical Coverage form (BGLII 4.0). Fire Legal/Nonowned Property Damage Liability Coverage COVERAGE DESCRIPTIONS COVERAGE LIMIT COVERAGE AGGREGATE LIMIT FORM Nonowned Property Damage Liability Coverage $1,000,000* $3,000,000* BGL951 3.0 ..............................._......_..............................................................._-.....__...-..............._...-................................................................_......................................................................._..-.__._......................................3'*..0- Additional Incidental Countractual Liability Coverage $1,000,000* $3,000,000* BGL951 3.0 Media Liability Coverage COVERAGE DESCRIPTIONS COVERAGE LIMIT Personal Injury Liability Coverage (Media/Communications $1,000,000* Activity) ........................................................................................................................................................................................................................................................................................ Personal Injury Liability Coverage (Personal Violations) $1,000,000* Injury COVERAGE AGGREGATE LIMIT FORM $3,000,000' BGL411.0 L41 1.0 BGL41 1.0 Posting) .............__......................................................................_......__..._......._........_.............._...............�........._............_____....._..."._.._...-..........._...-...._..__...- - -...................................- Special Defense Coverage (Alleged Intentional Acts) $1,000,000* $3,000,000_...._*...BGL4..1..1...0 Medical Coverage COVERAGE DESCRIPTIONS COVERAGE LIMIT COVERAGE AGGREGATE LIMIT FORM Student/Day Care Medical $5,000*+ $3,000,000* BGL93A 4.0 _......................._...._....-....._..---..—...__...-....-.._..._.... - ............................-�_....---............-...._._..-....---.......--.--..................................................................._....._......................._-...-.........._................._....__......................................4"..0. Religious Athletic Medical Coverage $10,000 + $3,000,000* BGL91 4.0 Nonowned Vehicle Coverage COVERAGE DESCRIPTIONS Nonowned Vehicle Liability C mage Nurse Liability Coverage COVERAGE DESCRIPTIONS Nurses' Professional Liability Coverage COVERAGE LIMIT COVERAGE AGGREGATE LIMIT FORM $1,000,00.0* $3,000,000* BGL71 4.0 ...........................----.... ....... ..----.......................................................--...-...__-._................................. ............................................. deductible COVERAGE LIMIT COVERAGE AGGREGATE LIMIT FORM $1,000,000' $3,000,000' BGL234 4.1 ' Only a single limit applies to the loss. All coverage limits are subject to the general occurrence limit and all aggregate limits are subject to the general aggregate limit. + per person limit Brotherhood Mutual Insurance Company I www.brotherhoodmutual.com I 800.333.3735 I P.O. Box 2227, Fort Wayne, IN 46801-2227 M1 DEC 09/16 "Bear ye one another's burdens and so fulfill the law of Christ" — Galatians 6:2 Page 11 of 16 NAMED INSURED TIMBERLINE CHURCH POLICY NUMBER 05M5A0358236 Brotherhood Mutual' POLICY PERIOD 7/27/2017 to 7/27/2018 Insurance Company Liability Coverage Summary MinistryFirstsrt' commercial multi -peril policy Declarations continued... The Coverages listed here are provided according to the terms of the designated coverage form and any other applicable forms or endorsements. Only one liability coverage and one medical coverage will apply to an occurrence and any related loss. Any limit which is specifically stated within a coverage form or endorsement represents the most we will pay for the coverage to which such a limit applies. For application of limits, see Liability and Medical Coverage form (BGLII 4.0). Other Liability Coverage COVERAGE DESCRIPTIONS Terrorism Liability Coverage Relief Activity Additional Coverages COVERAGE DESCRIPTIONS Emotional Injury and Financial Additional Medical Expense C Damage to Relief Worker's Tools and Equiprr .................................................................................................................................................... Primary Liability Coverage for Relief Workers Religious Freedom Protection Coverage COVERAGE DESCRIPTIONS Religious Communication Lia Religious Activity Liability Co COVERAGE LIMIT COVERAGE AGGREGATE LIMIT FORM $1,000,000 $3,000,000 BGL0250 3.1 COVERAGE LIMIT COVERAGE AGGREGATE LIMIT FORM $1,000,000- $3,000,000* BGL9941.0 _.................................................................................._ $50,000+ ...........,................................................................................._..._._.............__....................................................................... $250,000 per occurrence BGL9941.0 _...._..._...-----...._-._...-------.._ $10,000+ ................."0-.........................._...__.._..................................................................................................._....._.._.._..._...... $50,000 per occurrence BGL9941.0 ...._......__..__..............._..............._........_...._....._.....,_................................e"'r.............._.._..........._.._...._ $2,500+ ................._............................................................................... $10,000 per occurrence BGL9941.0 $1,000,000* $3,000,000* BGL9941.0 COVERAGE LIMIT COVERAGE AGGREGATE LIMIT FORD $1,000,000* $3,000,00W BGL661. $1,000,000* - ......-- ....-- — ....................-. _. $3,000,000* BGL661.1 __................... _...._ — $1,000,000* —_....................._...__........................................................................-................................... $3,000,000* BGL661.1 Tax Exempt Challenge: Reimbursement Coverage $25,000* $25,000* BGL661.1 ....:........... ...................................................... ...................................................................................................................................... _......,...................... _..---...._......_..._......._...._....._.... — .._._.._ _._.....__..._..._.._...._--.--..--.—.--...._..._..._...__.._..._..............................._............._........_. Litigation Activity: Legal Defense Reimbursement Coverage .... .. .. See form See form BGL661.1 ........................................................................................................................................................................................................... . Liti..gation Activity: Declaratory Action Reimbursement Coverage See form See form BGL661.1 Security Operations Coverage COVERAGE DESCRIPTIONS COVERAGE LIMIT COVERAGE AGGREGATE LIMIT FORM Additional Medical Expense Coverage $50,000*+ $50,000, BGL993 4.0 Broadened Wage Loss Reimbursement Coverage (Emotional $10,000*+ $50,000* BGL993 4.0 Inlurv) Damage to Security -Related Equipment $2,500*+ Primary Coverage for Specified Individuals $1,000,000* _........................................................................................................................................_.._......._...._---..._.. ___._......... __...................................... Enforcement of Security Policy or Weapons Policy $1,000,000* ..................................................................................................................................................................................................................................................................... Negligent Infliction of Emotional Distress Arising from Security $1,000,000* Operations * Only a single limit applies to the loss. All coverage limits are subject to the general occurrence limit and all aggregate limits are subject to the general aggregate limit. + per person limit BGL993 4.0 BGL993 4.0 Brotherhood Mutual Insurance Company I www.brotherhoodmutual.com I 800.333.3735 I P.O. Box 2227, Fort Wayne, IN 46801-2227 .................... .... ............................................................ --....... _............ _... _..................... ...... ....................... _.... _.._..................... _........ _.._............... ......................................................... _....... __... _............. ............_ .....I ........... Ml DEC 09/16 'Bear ye one another's burdens and so fulfill the law of Christ." — Galatians 6:2 Page 12 of 16 Brotherhood Mutual® Insurance Company NAMED INSURED TIMBERLINE CHURCH POLICY NUMBER 05M5A0358236 POLICY PERIOD 7/27/2017 to 7/27/2018 Liability Coverage Summary MinistryFirstsm commercial multi -peril policy Declarations continued... The Coverages listed here are provided according to the terms of the designated coverage form and any other applicable forms or endorsements. Only one liability coverage and one medical coverage will apply to an occurrence and any related loss. Any limit which is specifically stated within a coverage form or endorsement represents the most we will pay for the coverage to which such a limit applies. For application of limits, see Liability and Medical Coverage form (BGL11 4.0). Sexual Acts Liability Coverage COVERAGE DESCRIPTIONS COVERAGE LIMIT COVERAGE AGGREGATE LIMIT FORM Sexual Acts Liability Coverage With Screening $1,000,000* $1,000,000* BGL61 4.1 ............................................................................................................................................................................................................................................................................................................................... . Sexual Harassment Liability Coverage (other than your $1,000,000* $1,000,000* BGL61 4.1 Improper Supervision of Convicted Sexual Offenders Coverage Outside Counseling Reimbursement Coverage Sexual Acts Medical Payment Extension ...... ................ .................... ..............................................................._....., Image Restoration Extension Redemptive Employment/Appointment Traumatic Incident Response Coverage Liability $1,000,000* 0,000* Le BGL61 4.1 BGL61 4.1 ....B......L..........61 ........... G4.1 COVERAGE DESCRIPTIONS COVERAGE LIMIT COVERAGE AGGREGATE LIMIT FORM Additional Medical Expense Coverage $50,000*+ $300,000* BGL991B 4.1 .................................................................................................................................................... . Broadened Wage Loss Reimbursement Coverage (Including See form $300,000' BGL991B 4.1 Emotional Injury) .. ..... .. ........................................................................................ ..vidual ..................................................................................................................... IndiCounseling Coverage ................................................................................................................................................................................................................................................................................................................ $5,000*+ $300,000* BGL991B 4.1 ................................................................................................................................... .............................................................................................................................................................................................................................................................................................................................................................................................. Additional Organizational Expense $100,000* $300,000* BGL9916 4.1 Wage Reimbursement Coverage COVERAGE DESCRIPTIONS Wage Loss Reimbursement Coverage Worldwide Liability Extension Coverage COVERAGE DESCRIPTIONS Limited Worldwide Kidnap and Extortion Expense Reimbursement Coverage ......................................................................................................................................................................................... Expanded Medical Coverage for Short -Term Foreign Trip Participants Schedule of Liability Exposures COVERAGE LIMIT COVERAGE AGGREGATE LIMIT FORM $3,500+ $35,000 per occurrence BGL99 4.0 COVERAGE LIMIT COVERAGE AGGREGATE LIMIT FORM See form See form BGL111T 1.2 11 ...................................................................................................................................................................................................................................................................................................... See form See form BGL111T 1.2 In issuing this policy, we have relied on material information provided to us by the Named Insured. The following schedule discloses all of the insured's insurable exposures (as conveyed by the Named Insured) known to exist at the policy inception date. Declared premises must be owned, occupied, or rented by you or your scheduled related organizations. * Only a single limit applies to the loss. All coverage limits are subject to the general occurrence limit and all aggregate limits are subject to the general aggregate limit. + per person limit Brotherhood Mutual Insurance Company I www.brotherhoodmutual.com I 800.333.3735 I P.O. Box 2227, Fort Wayne, IN 46801-2227 M1 DEC 09/16 "Bear ye one another's burdens and so fulfill the law of Christ."— Galatians 6:2 Page 13 of 16 Brotherhood Mutual® Insurance Company NAMED INSURED TIMBERLINE CHURCH POLICY NUMBER 05M5A0358236 POLICY PERIOD 7/27/2017 to 7/27/2018 Liability Coverage Summary MinistryFirstsm commercial multi -peril policy Declarations continued... The Coverages listed here are provided according to the terms of the designated coverage form and any other applicable forms or endorsements. Only one liability coverage and one medical coverage will apply to an occurrence and any related loss. Any limit which is specifically stated within a coverage form or endorsement represents the most we will pay for the coverage to which such a limit applies. For application of limits, see Liability and Medical Coverage form (BGL114.0). EXPOSURE DESCRIPTIONS ADDRESS / BUILDING DESCRIPTION CODE RATING BASIS Offices - NOC . ............ ................................... ......... _...... _.... ..... ....... _..... ........................... .............. ..................... Location 4 Building 1 Office .... ,............. _................................................................ _........... __........ _.......... __._._.._....- -_.__................. 04504 _.......... _...... _............... .......... _---.......... 5,000 Square Feet .... _.......... __... _._.._................................................................ Food & Clothing Pantry ................ ......................................................... ._..._...... ....... _.......... _............ ..... ... ......._....__._.._................. Location 1 Building 1 Church _................ _............................................ _.................................... __... ......................... _..__........ _... ---........ 05813 _.......................................... _........................ 2,000 Square Feet _.................. _._... ._._.._.............................................. _................ Book/Magazines/Stationery Stores - Small Location 1 Building 1 Church 05813 2,000 Square Feet Retail .......................................................................................... _...... _. _..... Thrift Shop ..... ............................._........ _................. _.................. _............................... _.... _..... _................................................................................................... Location 1 Building 1 Church _.......................... .......... _.... _.__.............___..._............. _... _..-- 05813 ........... ....... _... ....... ...__...._.._. 1,000 Square Feet ........ _....... ...................__.... .............. _...... ............. ---.... ....... Thrift Shop . ... _...... _................................__........ ..... ...... ....._. .... ..._...... .._._......._...... ....... ................... Location 2 Building 1 Other ................................................................................ ........................._._... _... ..... ... _............... ...... ...... _..... - .... 05813 ---........_......._.._..___........ __...... 1,000 Square Feet ............ .--_..._..... ............................................ _.................. Coffee Shop .................................................... _........... _.... _...__..._... -_.._-........................ Location 2 Building 1 Other --_....... _............................................. _....... _.... _..... _.._..................... _..................... _................................................... _... 06501 _................................................................ ......................... 4,800 Square Feet ................................. _.......................... _.................... After School Ministry 2908 S Timberline Rd Fort Collins CO 80525-2402 07900 30 Students Medical Including Students ........... ........................ .................................................... _...... _... _...... _............. _...... __................... _.... _............... _.... _..................... _............................... _................. ........ _............... _......................... _._..... _._...._........... _ ............ _......... _.......... _...... _........ ---...... _ ......... ........................ _............... _...__........ _.... __... ..... ..... _. Church Location 1 Building 1 Church 08101 115,068 Square Feet ____.._.__....___ ....... .....__..._._..._...__.......... Location 2 Building 1 Other _.... -l..Church__._e_..... _........ _............... ____.._____......___............ .................... ....... ................ ..... _........ . 4,800 Square Feet ...... _.__..._.... ......... -2,500 Mission Church............__.._ ............._.._...._...................................._...._...._.._................._..__.__..............................._......._................................................................................................................_..............._............................._...._................._..............................................................___._..............................__......_....._.... Location......Building 08101 Square Feet ...._...._.........._......................... Church ...._...................................... _..................... _... _................................ ......... .................. ............................................................................................................... Location 6 Building 1 Church ........... ............................................................... _.................................. 08101 ............................................. _... 13,342 Square Feet ....._....- ........__......_....-._......_.. Golf Cart ........... 2908 S Timberline Rd Fort Collins CO 80525-2402 .,...................................................... _............. __............................... _._...._......... _... _........ _.......... ....... .......... ...... 15002 _.... _....... ...... _..... ........... ...... _.............. 3 Each _....._.. - - ..._..._.._._.... ...._..... Grounds - Excess of Five Acres 2908 S Timberline Rd Fort Collins CO 80525-2402 15100 33 Acres ............. ............. _......................... _..................................... Bleachers or Grandstands 2908 S Timberline Rd Fort Collins CO 80525-2402 30035 1 Each .................... .-............. ............ .............. .............................................. ._..._...__......_................._........_............._............_..............................................................._......................................................................................................................._._............__....._................_._._................_........_.............__........_.......... Outreach Ministry ............................................ ..._..................... _.... _.._.......................................... _..---..... __..... _. 2908 S Timberline Rd Fort Collins CO 80525-2402 ........................ _.._.................................................................................................................._....._........ _.._. ... _..... __... _.._..__...__...- 30130 1 # items/activitie ___._.._.._.... ._......_... ._._._..._. Bicycle Trip ........................ .............. ...... .......... .... ....... .... ..... ..... 2908 S Timberline Rd Fort Collins CO 80525-2402 ....................... .... .... ............. ... .............. .................... .......... ................................................... ......... ------ 30130 ...... ..... ........ .......................... 1 # items . .... .............................. Playgrounds ................ ........ ..................................................................................... _.................................... 2908 S Timberline Rd Fort Collins CO 80525-2402 _......................... _.._........................................... .................... ................. .................................................................... _........................... 30320 __.._........................... __.._..__.....__.._........__.._..---- 1 Each .... ...... .......... ........ Softball Field Rated As Playground ............................................... ....................... .................................................. _........_.._.....__._.._ 2908 S Timberline Rd Fort Collins CO 80525-2402 .... _........................... ..............._................................................................................. __.._...... _....- .._._...-_-- 30320 ....... ...................... ...................... _...._...__.... 1 Each ...... - ...._............---............................................. Books, Magazines and Stationery Stores Location 6 Building 1 Church 34113 50,000 Receipts ........................................................................................................................_............._._...................._........................................................................................................_.................._._................._......_-_..........__..._..._.......-........._............_.....__..._.......---......_.._....................._____.................................................................. Food or Drink - Retail Stores - NOC Location 1 Building 1 Church 83800 58,000 Sales .. .............. ........................ ............................_............_...... ___........__..... .... .......... ..................... Location 2 Building 1 Other __................................................................................. _............... ............. ..... _.... _.... ......_....---__...___---- _.__.._. ..._...__...... ......... ._...... --........................... 50,000 Sales _._......_...__..........................._.._...... Pastoral Counseling ................................................. ............................... .......................... _.................................._............_........................................................ _.................................................... 17 Pastor(s) Special Events High Hazard Activities For details regarding how these coverage limits will apply, see the How Much We Pay section of the High Hazard Activities Coverage Limits Form (BGL-21). ACTIVITY DESCRIPTION MEDICAL LIMIT OCCURRENCE LIMIT COVERAGE AGGREGATE LIMIT FORM Skate Park Operations ...... ................................................................................._._................................................................__._..._..._._................................................................... $0 per person $100,000 .......... .... _....__................................................_................._......---._....._...-----..._..._..._....__.._ $300,000 ... .............................. BGL21 4.1 ............. ............................ Fireworks Sales ..........................................................................................__.._...._........................._........................................................._.................................................._............._.......................................__........_....._............................................._..--..---_.-...._..__.._....._..._._...__...._........_..__.._................................................................. $0 per person $100,000 $300,000 BGL214.1 Fireworks Display ... ......................................................... _.._..---......... $0 per person _................................................ $100,000 -....... $300,000 _... -.............. ... _...... ............ .... .... -----.... .......... ................. __.._.._...._......_..._.._..__.._...__........ BGL214.1 _..... _...... _.................... I ........ ... _..._.._..__._............... Construction Oversight _._._. $0 per person ................ ...................................... __._..... _....... _...... $100,000 $300,000 BGL214.1 * Only a single limit applies to the loss. All coverage limits ore subject to the general occurrence limit and all aggregate limits are subject to the general aggregate limit. + per person limit Brotherhood Mutual Insurance Company I www.brotherhoodmutual.com I 800.333.3735 I P.O. Box 2227, Fort Wayne, IN 46801-2227 M1 DEC 09/16 "Bear ye one another's burdens and so fulfill the law of Christ." — Galatians 6:2 Page 14 of 16 Brotherhood Mutual' Insurance Company NAMED INSURED TIMBERLINE CHURCH POLICY NUMBER 05M5A0358236 POLICY PERIOD 7/27/2017 to 7/27/2018 Liability Coverage Summary MinistryFirsts' commercial multi -peril policy Declarations continued... The Coverages listed here are provided according to the terms of the designated coverage form and any other applicable forms or endorsements. Only one liability coverage and one medical coverage will apply to an occurrence and any related loss. Any limit which is specifically stated within a coverage form or endorsement represents the most we will pay for the coverage to which such a limit applies. For application of limits, see Liability and Medical Coverage form (BGL114.0). Other Liability and Medical Forms FORM FORM NAME BCL966CO 1.0 .... ......................................... .....__....... ....... Additional Policy Definition _...................................................................... .... ............................ ............................................................................ BGL114.0 ................................... I ............. _..._..__.—... Liability And Medical Coverage Form ........ __.......................................... _.__..-..._............ ....._._...- — _.. _ ..__ _.... EX9091.0 ...._......_...._. __.. _....... Asbestos Exposure Exclusion ..............................._....._._.._.-..__......_........---._ GL095012 99 ... ........................................................ _........... Known Injury or Damage Amendments _....... .11. ................... BGL939AISP 1.0 ......................................................... ......................... Provision Modification -Excess Liability _._......... _......... -.... .................. ................_.._........ .............. _........................... _- ... _................ ........ EX0281 2.4 NBC Terrorism Exclusion Additional Insureds NAME LOAN/REFERENCE NUMBER City of Fort Collins, Additional Insured Schedule of Additional Covered Ministries FORM FORM NAME BGL100A1 2.2 ... Commercial Liability Endorsement ........ BGL1521.0 _.................. __............ _.......................................................................... Additional Insured Endorsement -.......................... I ........... _.... _..... ..... --..._............ GLO163 0108 ......... ..........._...-----._........................_........... ... Exclusion War and Military Action .... _........................................._..................._.............. _....................... _...... _..... --.- GL8901.0 ..................................................... ._....... Lead Liability Exclusion _............................................. -............................................... _...... _..... _............ _.... _........... .......................... ..... EX939ESP 4.0 ......................................_................................................ Additional Exclusions ................ _._............ _.... _....................... _..... _ GL1270 06 06 .... _..... _... __............................... _... ....... _ ._.. Conditional Terrorism Exclusion INTEREST ADDRESS Loc 02 Outdoor area 215 N Mason St Fort Collins, CO 80524 -4402 The operations listed herein are covered as a ministry of the Named Insured, subject to all of the terms of the policy. No separate limit of coverage applies to the listed ministry operation(s). NAME ADDRESS None None Only a single limit applies to the loss. All coverage limits are subject to the general occurrence limit and all aggregate limits are subject to the general aggregate limit. + per person limit Brotherhood Mutual Insurance Company I www.brotherhoodmutual.com I 800.333.3735 I P.O. Box 2227, Fort Wayne, IN 46801-2227 M1 DEC 09/16 "Bear ye one another's burdens and so fulfill the law of Christ" — Galatians 6:2 Page 15 of 16 NAMED INSURED TIMBERLINE CHURCH POLICY NUMBER OSMSA0 Brotherhood Mutual' 7to7/2 POLICY PERIOD 7/27/2017 to 7/27/2018 Insurance Company Commercial Excess Liability Supplemental Coverage Summary MinistryFirsts' commercial multi -peril policy Declarations continued... In return for the payment of the premium, and subject to all the terms of the policy, we agree with you to provide the insurance as stated in the Excess/Umbrella Liability Coverage endorsement BGL939 4.0. Key Excess Liability Coverage Facts NAME OF INSURED TIMBERLINE CHURCH ADDRESS 2908 S Timberline Rd, Fort Collins, CO 80525-2402 EXCESS LIABILITY POLICY PERIOD 7/27/2017 to 7/27/2018 at 12:01 a.m. at the location listed above EXCESS LIABILITY ANNUAL PREMIUM $2,488 Excess Liability Coverage - Limit of Insurance Coverage Limit (per Occurrence) $4,000,000 Coverage Aggregate Limit $4,000,000 Deductible/Retention N/A Optional Excess Coverage Information COVERAGE STATUS LIMIT Directors and Officers Included $4,000,00 Sexual Acts Excluded N/A Employment Practices Excluded N/A Optional Coverage Limits are the some as the Excess Liability "per Occurrence" and Aggregate limits shown above, unless otherwise specified. Schedule of Underlying Insurance TYPE INSURER POLICY PERIOD POLICY NUMBER LIMITS OF LIABILITY General Liability Brotherhood Mutual Insurance Company 07/27/2017 - 07/27/2018 05M5AO358236 $1,000,000 Occ/$3,000,000 Agg _.._......_.......__....._..__............__.-...__...._...---.._...._...._..__..._....._...._....__.............................................................................................................................................--- ------.._..__._.......-- ——...._.__............ -.----..__.....................................................__...................... Automobile Liability Brotherhood Mutual Insurance Company See applicable declarations page. 05AO358237 $1,000,000 CSL ........................ _......_..............................__................................._.........._.._......................................_................................................ ............................................................... ....... .................. ............................ ,..... ... _...... _.... ..... ......_.......... _....... _.._............. .... .... _.._.__._........_..._.._._..._..._..._._..._..._............................ Employer's Liability Brotherhood Mutual Insurance Company See applicable declarations page. 05WO358238 $100,000/$500,000/$100,000 Brotherhood Mutual Insurance Company I www.brotherhoodmutual.com I 800.333.3735 I P.O. Box 2227, Fort Wayne, IN 46801-2227 M1 DEC 09/16 "Bear ye one another's burdens and so fulfill the law of Christ." — Galatians 6:2 Page 16 of 16 05M5A0358236 i he following is a reproduction of the mortgage provisions contained in the Commercial Lines Policy of the insured indicted on the attached Declarations Page. These are reproduced for your review and for your convenience are being sent in lieu of the complete policy. -Please read this carefully - NOTICE TO MORTGAGEE NOTICE The following represent the applicable mortgage provisions in the Building and Personal Property Coverage form (BCP-12). CONDITIONS Mortgage Provisions - If a mortgagee (mortgage holder) is named in this policy, loss to buildings shall be paid to the mortgagee and you as their interest appears. If more than one mortgagee is named, they shall be paid in order of precedence. The insurance for the mortgagee continues in effect even when your insurance may be void because of your acts, neglect, or failure to comply with the coverage terms. The insurance for the mortgagee does not continue in effect if the mortgagee is aware of changes in ownership or substantial increase in risk and does not notify us. If we cancel this policy, we notify the mortgagee at least 10 days before the effective date of cancellation if we cancel for your nonpayment of premium, or 30 days before the effective date of cancellation if we cancel for any other reason. We may request payment of the premium from the mortgagee, if you fail to pay the premium. If we pay the mortgagee for a loss where your insurance may be void, the mortgagee's rights to collect that portion of the mortgage debt from you then belongs to us. This does not affect the mortgagee's right to collect the remainder of the mortgage debt from you. As an alterna- tive, we may pay the mortgagee the remaining principal and accrued interest in return for a full assignment of the mortgagee's interest and any instruments given as secu- rity for the mortgage debt. If we choose not to renew this policy, we give written notice to the mortgagee at least 10 days before the expiration date of this policy. BN-15 (1.0) BROTHERHOOD MUTUAL INSURANCE COMPANY Page 1 of 1 NAMED INSURED TIMBERLINE CHURCH POLICY NUMBER 05M5A0 Brotherhood Mutual' 7to7/2 POLICY PERIOD 7/27/2017 to 7/27/2018 Insurance Company Property Coverage Summary MinistryFirsts" commercial multi -peril policy Declarations continued... We provide the Commercial Property coverage at the declared premise(s) for the coverage and limits indicated. The Coverages listed here are provided according to the terms of the designated coverage form and any other applicable forms or endorsements. Property Coverage Details PROPERTY DEDUCTIBLE $1,000 GLASS DEDUCTIBLE $1,000 Schedule of Locations LOCATION # DESCRIPTION ADDRESS 0101 Church 2908 S Timberline Rd Fort Collins, CO 80525-2402 ............... _........................ __............. _...... _... ... -........... _........ .......... ... _ ..._.... _ ...._..__-_----.-----..................._......................_....... _.._..__._..__....................................... _..............................................................................................................................-........................... 0102 Playground Equipment 2908 S Timberline Rd Fort Collins, CO 80525-2402 ---.._..........._......................................................................................_.... ................._...................._............................................................................................................................................................................................................ 0201 Coffee House 144 S Mason St Fort Collins, CO 80524-2812 ............................ _... - .......... ... _.._........ _ - _ .._... - ____-----.-... ---.... _.... ........................................................... ...... ........................... ...... ...... _..... ... _.__.._._.._.---_................... _.._.......... _............................ _............. ....................................................... _.............. 0401 Office 1136 E Stuart St Fort Collins, CO 80525-1195 ............ _......... ----.......... -.......... _....... ....... ... --.... .................. --.......................... _.......... ... _...................... ............. _......... _.. ...-- -... _ __._._.._.._—..__._....._.......---......._............................................................................................................................. 0601 Church 360 Crossroads Blvd Windsor, CO 80550-7264 Schedule of Buildings and Personal Property CHURCH 2908 S Timberline Rd Fort Collins, CO 8OS25-2402 LOCATION 0101 Mortgagee Firstbank Isaoa Loan#8755590 8755620 ..............................................._................__......................................................_.................................................................................................................._....................._.................................................................................... 10403 W Colfax Ave Lakewood, CO 80215-38, COVERAGE DESCRIPTION COVERAGE LIMIT COINSURANCE EQ DED VALUATION TYPE AUTO INCR PERIL TYPE FORM (INCL. TYPE OF PROPERTY) Building $27,085,000 Agreed Amount N/A ..... Replacement Cost . ............................._.....-........._........................... 0% ... Special with Theft BCP85 4.0_ . ........................-._......._.................._--.................................... Building Ordinance & $27,085,000 N/A N/A N/A N/A N/A Law Increased Building Loss Building Ordinance & $300,000 N/A N/A N/A N/A N/A Law Increased Debris Removal - ........__._...—_._..__....._...._------- ...... Building Ordinance _..... _.... _.... ---- - _ $300,000 _._.._......_.. - _ _ .._..._..._.._...._.. N/A N/A —_ __-------- _..._.__.._.................... N/A ...... _............ _.... -- N/A - __ — N/A & Law Cost of Construction ...................................................................._....................................................__-._....._-......_.....-- Personal Property $2,015,000 ..................... ....................... .......................................................... Agreed Amount N/A ..........._............................._...._.............................o..._...... Replacement Cost .............. .......... .... _........ 4 /o _._.......-:-........ _..........---..._.........._......_... ...................................................... Special with Theft — BCP85 4:0 Personal Property of Others _-- $3,000 .................._..._..............................................................._................ Agreed Amount N/A Replacement Cost 0% Special with Theft BCP85 4.0 PLAYGROUND EQUIPMENT 2908 S Timberline Rd Fort Collins, CO 80525-2402 LOCATION 0102 COVERAGE DESCRIPTION COVERAGE LIMIT COINSURANCE EQ DED VALUATION TYPE AUTO INCR PERIL TYPE FORM (INCL. TYPE OF PROPERTY) Property -in -the -Open $133,000 Agreed Amount N/A Replacement Cost 0% Special with Theft BCP85 4.0 Brotherhood Mutual Insurance Company I www.brotherhoodmutual.com I 800.333.3735 I P.O. Box 2227, Fort Wayne, IN 46801-2227 M1 DEC 09/16 'Bear ye one another's burdens and so fulfill the law of Christ" — Galatians 6:2 Page 2 of 16 NAMED INSURED TIMBERLINE CHURCH 36 Brotherhood Mutual' POLICY NUMBER 0 27/2 07 to 7/2 POLICY PERIOD 7/27/2017 to 7/27/2018 Insurance Company Property Coverage Summary MinistryFirstsm commercial multi -peril policy Declarations continued... We provide the Commercial Property coverage at the declared premise(s) for the coverage and limits indicated. The Coverages listed here are provided according to the terms of the designated coverage form and any other applicable forms or endorsements. COFFEE HOUSE 144 S Mason St Fort Collins, CO 80524-2812 LOCATION 0201 COVERAGE DESCRIPTION COVERAGE LIMIT COINSURANCE EQ DED VALUATION TYPE AUTO INCR PERIL TYPE FORM (INCL. TYPE OF PROPERTY) Personal Property $175,240 Agreed Amount N/A Replacement Cost 4% Special with Theft BCP85 4.0 OFFICE 1136 E Stuart St Fort Collins, CO 80525-1195 LOCATION 0401 COVERAGE DESCRIPTION COVERAGE LIMIT COINSURANCE EQ DED VALUATION TYPE AUTO INCR PERIL TYPE FORM (INCL. TYPE OF PROPERTY) Personal Property $47,840 Agreed Amount N/A Replacement Cost 4% Special with Theft BCP85 4.0 CHURCH 360 Crossroads Blvd Windsor, CO 80550-7264 LOCATION 0601 Mortgagee Firstbank Isaoa Loan#8755590 87SS620 10403 W Colfax Ave Lakewood, CO 80215-3811 COVERAGE DESCRIPTION COVERAGE LIMIT COINSURANCE EQ DED VALUATION TYPE AUTO INCR PERIL TYPE FORM (INCL. TYPE OF PROPERTY) Building $2,796,000 Agreed Amount N/A Replacement Cost 0% Special with Theft BCP85 4.0 ....................................._...._........_.........._..._...._................................................... Personal Property $._....._.._..._...... 92,000 Agreed Amount N/A Replacement Cost 4% Special with Theft BCP85 4.0 Brotherhood Mutual Insurance Company I www.brotherhoodmutual.com I 800.333.3735 I P.O. Box 2227, Fort Wayne, IN 46801-2227 ...................................................................................................................................................................I I......................................._ .......... ..... ........... M1 DEC 09/16 "Bear ye one another's burdens and so fulfill the law of Christ." — Galatians 6:2 Page 3 of 16 A NAMED INSURED TIMBERLINE CHURCH POLICY NUMBER 05M5A0358236 Brotherhood Mutual' POLICY PERIOD 7/27/2017 to 7/27/2018 Insurance Company Property Coverage Summary MinistryFirstsm commercial multi -peril policy Declarations continued... We provide the Commercial Property coverage at the declared premise(s) for the coverage and limits indicated. The Coverages listed here are provided according to the terms of the designated coverage form and any other applicable forms or endorsements. Schedule of Additional Coverages: All Locations The policy's property deductible applies to each of these coverages. Details are found on the Commercial Property Coverages BCP12 4.1 form. COVERAGE DESCRIPTION COVERAGE LIMIT DEDUCTIBLE FORM Property Off Premises $25,000+ $1,000 - -..._...._...._...._._.......-...----•-_---........-- BCP12 4.1 _...._......_._._......................................................._.._.. ....__.........._....-..._...._..----.............................._.._..._................_............................................................................................_......_..........._...._...._.._..._._.................._..._.................._.. Inter-Continent $2,500/Item, $25,000 total+ $1,000 BCP12 4.1 Owned Personal Property Parsonage . _............. _... _..._........................................................................................................................................................... ................................................................................................................................................ $2,500 $1,000 BCP12 4.1 Building/Personal Property - Newly Acquired/Constructed $2,000,000++ $1,000 -..-.------.............0......................-_--_..._... BCP12 4.1 _..__......_.................._......_._...__....__............._............_...-..............................................................................................................._................................... Outside Objects/Structures $15,000/category, $20,000 Total.............._......._._._....__.............-__...._...._$.._c..._0�..............................................................................1 BC 4.1 ...................................................................................... ....................................................................................................... ....._..... For any one tree, shrub, or plant ........_...._........................... _ ........... . ___..__...__ $1,000 $1,000 _.. ...__.... BCP12 4.1 .._...__...._....__.............._....__.._......_........._.._.........._................._........._........................................................_........_.._....._....__._..._...__... Each loss caused by wind $2,500 $1,000 BCP12 4.1 — -- - ..............................................................._...__.._._....._......._......._.__...._....._.._...._......_.......---............_.._...._...__...._.._.... Detached Structures and their Contents (Unscheduled) ..__....._......__.._......._................................................................................................................._....................._...................._..........................................................- $10,000 for structures, $10,000 for Contents $1,000 BCP12 4.1 Owned Personal Property Dwellings - .._.... 5% of dwelling value $1,000 ...._............_...................... BCP12 4.1 Contents - Buildings and Structures Described on the $10,000+++ $1,000 BCP12 4.1 Declarations .................................................................................................__......................... _ ..........---......_.._....---..........__......_..........._..................................-................._......_..._...__...._.._._........_......__...._.-......................._..........$," Trailers $10,000 i......._........................._......................._............__._..2. $1,000 _..... BCP12 4.1 VehicleEquipment and Accessories --..........._........_............_.._.._.............._................._..._........_...._.......----....._....._........_.. . ...._ ._. Money and Securities .........._........................................................................ $5,000 (Loss from specified perils only. Doubled on specified $1,000 BCP12 4.1 Damage to Buildings and Personal Property fr.......... ............ ......... ................_............ _._.__....._......... _. .. ..... Building Glass Included; no per pane or per plate limits $1,000 BCP12 4.1 + If the loss resulted from a covered peril and the property is off premises for no longer than 180 days. ++ Coverage applies for 780 days from the time construction begins or the new property is acquired. +++ Only applies if the limit of insurance shown for the structure is no more than $10,000 and there is no limit of Organizational Personal Property shown on the declarations for the structure. The policy's property deductible does not apply to the following coverages. Details are found on the Commercial Property Coverages BCP12 4.1 form. COVERAGE DESCRIPTION COVERAGE LIMIT Debris Removal Expense - Partial or Total Loss Partial Loss: Remaining Limit for Covered Property - Total Loss: $10,000 Personal Property Owned by Others Theft or Vandalism Reward $5,000'" * If the loss resulted from a covered peril and was reported within 180 days. Or the amount paid to the insured as a result of the direct loss, if less than the limit stated above. "" Additional limits are available maximum FORM BCP12 4.1 Ell Brotherhood Mutual Insurance Company I www.brotherhoodmutual.com I 800.333.3735 I P.O. Box 2227, Fort Wayne, IN 46801-2227 Ml DEC 09/16 "Bear ye one another's burdens and so fulfill the law of Christ" — Galatians 6:2 Page 4 of 16 Brotherhood Mutual' Ins u ran e e C o ra pen y NAMED INSURED TIMBERLINE CHURCH POLICY NUMBER 05M5A0358236 POLICY PERIOD 7/27/2017 to 7/27/2018 Property Coverage Summary MinistryFirst" commercial multi -peril policy Declarations continued... We provide the Commercial Property coverage at the declared premise(s) for the coverage and limits indicated. The Coverages listed here are provided according to the terms of the designated coverage form and any other applicable forms or endorsements. Optional Coverages: All Locations Combined Ordinance or Law Enforcement Coverage COVERAGE DESCRIPTION COVERAGE LIMIT DEDUCTIBLE FORM Increased Building Loss (Ord & Law A) $500,000 $1,000 BCP138B 1.1 Increased Debris Removal (Ord &Law B) ........................... ............. ....... ............. ... �250,000 .... ... $1,000 ............................................................ BCP13861.1 ....._....................._.._..._............................_................__..._ ....... .........__..._............................................................ Increased Cost of Construction (Ord & Law C) $250,000 ............ _.. - ._._.._...._.. _ $1,000 ...._...._--.................... .. BCP138B 1.1 Organizational Optional Theft Coverage COVERAGE DESCRIPTION COVERAGE LIMIT DEDUCTIBLE FORM Theft of Money & Securities (Thft M & S) $10,000 $250 BCP36 4.1 ........................................................._.........................................................._............................,....................................................................................................................................................................................................._.. Theft of Building Materials (Thf..t Bldg..Mtls..) $5,000.....$250.......................... _...... ................... .......BCF36 4.1 Ministry Personnel Dishonesty Coverage COVERAGE DESCRIPTION Personnel Dishonesty Coverage COVERAGE LIMIT $100,000 Income, Extra Expense, and Donations Coverage Part DEDUCTIBLE FORM N/A BCP37A 4.0 COVERAGE DESCRIPTION COVERAGE LIMIT DEDUCTIBLE FORM Earnings and Expenses $25,000 N/A BCP71 1.1 _...._._.... ........__._.._ _ _.._......__.._.................................................._---............................_..............._......... _.................__--_.._._.................................._........_....._......._........... Extra Expense $100,000 N/A BCP71 1.1 Water Damage Coverage Part COVERAGE DESCRIPTION Water Damage Sewer and Drain Backup Extension COVERAGE DESCRIPTION Sewer/Drain Backup Extension Systems / Equipment Breakdown Coverage COVERAGE DESCRIPTION Systems/Equipment Breakdown Coverage COVERAGE LIMIT DEDUCTIBLE FORM $10,000 $1,000 BCP27 4.1 COVERAGE LIMIT DEDUCTIBLE FORM See Building/Personal Property Limit $1,000 BCP135 4.1 COVERAGE LIMIT DEDUCTIBLE FORM Building/Personal Property Limit $1,000 BSEB100 4.1 Brotherhood Mutual Insurance Company I www.brotherhoodmutual.com I 800.333.3735 I P.O. Box 2227, Fort Wayne, IN 46801-2227 --- ................. _... _..._...................................................................................................................................................................................... ............................... . ....................................................... M1 DEC 09/16 'Bear ye one another's burdens and so fulfill the law of Christ." — Galatians 6:2 Page 5 of 16 Brotherhood Mutual' Insurance Company NAMED INSURED TIMBERLINE CHURCH POLICY NUMBER 05M5A0358236 POLICY PERIOD 7/27/2017 to 7/27/2018 Property Coverage Summary MinistryFirstsm commercial multi -peril policy Declarations continued... We provide the Commercial Property coverage at the declared premise(s) for the coverage and limits indicated. The Coverages listed here are provided according to the terms of the designated coverage form and any other applicable forms or endorsements. Other Optional Coverages COVERAGE DESCRIPTION COVERAGE LIMIT DEDUCTIBLE FORM Certified and Non -Certified Terrorism Loss $32,347,080 $1,000 BCL0600 3.0 _ _... _.._......................................................... Interior Building Damage Coverage Including Gutters/ _._............................................ $32,347,080 _......................._................................................. . $1,000 BCP49 4.0 Downspouts Coverage ..._._._._..__.._..._..._......................._.._-..........._.._........__...._.......__......_........................._......_..B..._... _......---4.1- Rented Personal Property of Others ...._... ......... ..... ......._.. — _ — — _ ._.._............ .._... $10,000 _ $1,000 CP12 Additional Property Forms FORM FORM NAME BCP0643 0108 Exclusion - War and Military Action ............._..............._............................._......................_......_.....__.._....__..................._....._....... BCP88 4.0 _....__...._.................... Earth Movement &Volcanic Eruption Excl BN151.0 Notice To Mortgagee ..._........................................................................................._..__.............................-..............._..-......_........................ C01321.0 Loss Payable Options CP1111.0 Automatic Increase ................._--_...._...._......_._...........__..........._......._......e................P._............_...... BN1001.0 ......... _................... ...................................... ............ Notice Boiler Ins ections _..--_....._.......__.._..__........._ EX0651 2.3 ...................................................................._....._....__._...__.._..__...................................... NBC Terrorism Exclusion Additional Interests NAME TYPE LOAN NUMBER Konica Minolta Premier Loss Payee Finance FORM FORM NAME BCP500 4.0 Loss -Free Ded Reduction Endorsement .... ..... BN12V 1.0 ...................... .......... _.......................... _....._...-. __._.._._.. Notice Regarding Building Valuation .... _..... I .......................................................... CP017110 08 _... . .................................................................................... . ............................ _........ Exclusion Water Damage ......................._...................................__.......................................................... BCP138 4.0 ...... . .............................. ........... ........... _...... __....... ... --._...._...._......._.... Ordinance Or Law Extension ...... ----... _...................................................................................................................................................._ BN25671.0 -- — -- Notice Water Damage/Flood Coverage CL1630 06 06 _..._........__._...__.._—_..._........__...._...__.._.........._.................. _.... _........................ Conditional Terrorism Exclusion INTEREST Copier ADDRESS PO Box 5000 Johnston, IA 50131 -5000 Brotherhood Mutual Insurance Company I www.brotherhoodmutual.com I 800.333.3735 I P.O. Box 2227, Fort Wayne, IN 46801-2227 M1 DEC 09/16 "Bear ye one another's burdens and so fulfill the law of Christ:' — Galatians 6:2 Page 6 of 16 NAMED INSURED TIMBERLINE CHURCH Brotherhood Mutual' POLICY NUMBER 05M5A0358236 POLICY PERIOD 7/27/2017 to 7/27/2018 Insurance Companv Inland Marine Coverage Summary MinistryFirsts' commercial multi -peril policy Declarations continued... Schedule of Inland Marine Coverages: All Locations COVERAGE DESCRIPTION COVERAGE LIMIT DEDUCTIBLE FORM Computer Hardware $34,633 $500 BIM72014.0 .... Actual Cash Value ....... ..... ..........................._..... _.. _. _._._. _. _._. _..._._.__.._............. _-_...._.._._.... ._........... ..__......_............._...._._._..............._ TOSHIBA PA 5254U A 59693704A .......... __.................................................. _._..............__....... _.-- .................. — _ ._._.._..—-......_.._..__....— _ _ _...__.._... $1,300 412AKTIM ..__.............._........._.............................................._............6...... $1,680 ......................................... _................ ................................................... _...._..._........... IBM 2611412 AADFVN6 _-_____............................. ......................... _...... _........ __............. .............. _..............._.........................__........_......................... _.................................. _._.................. $1,410 N.J5 F680 4 650-186-11 SKD -_..... _.............. ..._...._....._ $2,278 ...........................................__....._..................S._..—_—._-._._-.__---_._.........._...._.__...._.._....—___....._....__.._.._...__..._ TOSHIBA SATELLITE 1800-5203 X7071541PU ...... .... -............................... ...... _........_--....._.......... ...... $1,154 __. _._........._..............__...._...._......_.._......-.............................._._.....................9-......................................................................._..........._...................................................................... SONY PCG EX370 28332430 3531019 ... ........ .... _............ -.... _...... ....... .........__...__....__............... _....__.... __...... _....... .... . $1,978 SONY 992E 992E 28332430-3530806 — $1,978 __._. _. _ .. ... _..................................................... __............ -_-.......................................................................................... COMPAQ PRESARIO 4784 TWO1211698 _.._ _..__._._.._�._ _-_ _... _ _ ..__._..— _._...._.._._.... _... ---.............. ............ -- .......... $450 ............._......_....................................__.... —.:_............_...................._..............................................................._.............__.._.._..................................... SONY PCG GR300K 6CTTAI 35533-M5- ................................... ...._.................. __..................... __.............. ....... -...... __..._.. —--........ _........__...._ .. $1,885 ....... .................(..................................................................................................................................................__........_._.............._....................._..............................................._.._......_......._..._._....._............_............._..._.........................................._................................_.................................... BM THINKPAD A30 78 DL595 ......... ..... $2,362 SONY SUPERSLIIv1 R508 PCGR505GCK $1,900 _ .._.........._...BONY GRS 700 A2224MGB.......... .................... ............ ................... ...... .................... __. ._...._......................................................................................._............................................................................................ ..__..._ — -._...__.........._......_.__........_._._........_..---........._.._.._..._..............................._......._. ........... ..... _...._......_...._...._............._........................._.........................................................................................__...........................................__..__..............._......................_ SONY VAIO PCG GR5700K 600215413000006 .............. __......._........._..................... $1,670 SOIVY PCG GRZ660 3112766 $1,600 DELL MFG LATITUDE D500 DRV8831 $1,436 ............_..._._...._.............. .........................__...__........_....__........._......_......................................._...._...............__........_.................._........__.............__..............._........................_._......................_................_..........._.. SONY PCG ZIR 2.814363032E+014 $2,200 DELL MFG LATITUDE C600 CN09C748481551A _...._....................._....._....................._..._...._._........._._...._...._..__..-_..._..._._.._.._._...._._..----.._._......__.......__......_................... $505 .........................................................................................._....__.........................................._..............................................................._......_......._.._._.__._....._.. COMPAQ CPQR 303OUS CND407OGlK $1,500 _.._...._..............._..._..._.._............_...__._..........................._.......................---........_................_..........................._......_..__......_....._.........._................................_................._....................._..........._..._................................_................... DEEL MFG INSPIRON 5150 ..........................._........................................................................................................................ $1,127 ............................ _.........._. SOIVY VGN A170P 142621943000001 _.._._......_...._........_............ _...._........._.._.... _-.... ............. ..... ............ ........ -.......... ............._........__....._...._................._....--._..--•- ..... _.----...._........... $2,150 _. _..................._... _._.. _.. _ _ _ _ _...._......................................................_....................._......_.........._........................................-....._..__._....._..........._..__...._....._...._..__.........._....--__.._._....__..___....__._ DELL MFG INSPIRION 5150 CN-OW0940-12961 �.—..—.... $1,274 ......_....................._.._............._ .. _.__. _._..__......................................... DELL MFG 5150........_._. _...........__.... ......... _............_.._.._......._....._..._..__..........._._..__......_..._....._.............__......__..__............... $1,126 .._......_._...................................................................................................... ...... ........................................................................................................................... CONGAS -MATADOR CUSTOM W/STANDS .............................. _.............._......__........................... _......................._......_.............................................__.......... _..----......... $375 .........................................................................................................................__..._._........... ---..__...._.....- _._._._....__..__.._.......__.._...._........................._.__..................._....._._.._...._......_..__.._..__............_..._...__...................................................__.._...._.....-- SPEAKER MN MPA5500 SN-81110077 $400 _EXTREMEPOWERED ......................................................_........................_......._..._..._._..._..._._...._....._........._....._........._...._.._......................... EXTREME COMPANION SPEAKER MN-MP5601 SN-H24949 .... .............. ........ .... _.............. __........ ...... .... ................... ..............__.......................................... _........ _.. $300 ...... _. I ........... ..........................................................................._.........._....._........_.._...._......_...._.._.___.._...._...._..._............._................. 2 ULTIMATE SPEAKER STANDS MN-TS80B @ $75 EACH i.................._.........__................. ............ ............................................................................................. _.................................................... $150 ..........................................................._..................................................................................................................-_ 100 FOOT SPEAKER CONNECTING CABLE ... ...... ............. _........ ........................ ..... ._......... ..._._._......... -...... ---............. _._. $50 NIACKIE MISER IvIN-1202 VLZ PRO SN-BU102560 $200 ..................................._................_.__..........._........__......_....._...._...._...._..._.._...._...........__..........................._............._................._......................................_............................................................._...................................._..................................._.......................__.................__......_...._.............................................. FENDER PASSPORT MN P250 WHOLE SYSTEM SN N10362000 PN 069 1002 $1,100 ....................................................................................................................................................................................................................................................................................................................................._..._._......_..........._......---....._.........._._........_........................._._...................._............................................................ 2 ULTIMATE SPEAKER STANDS MN T5806 @ $75 EACH ..... .......................f.FENDERMICROPHONE $150 ................................................... __........ _...- --...._........__$65......._....._..__..__....__..__..._ W/XLR CABEE ... _... ............. _........ _.._............................ ................................. .,........ . .......... ..................... ................................._.................................................................................................................................._..._....._...._...__....---............._...._.............._......_...._..._.......................... 1�FENDER PASSPORT MN-PD-250 WHOLE SYSTEM SN-GD82806FM ............... ........ _ $1,100 ............................ ...........................................................t......._......................................................................................................................................._........_................................................_... 2 FENDER SPEAKER STANDS @ $50 EACH i.................._...._....__.......__...................._...................._...._........._....._.................._.........__..._--.._..........................._................... $100 _....._........ _...._FENDER MICROPHONE W/XLR CABLE..I.N..CASE.................... .............. ........ ...... _.................__....___..........__.._..._.$65 ......... .... _4�ELVORE .. _..._.... _ ... _..__..._... .............. ...................._.... _.......... _....... __..__...... .__.. POTABLE MUSIC STANDS NOSNORMN@ ... .... .................. ...... .._......... ....... ........... .._.......... ....... ..... ............... .... ...... ............... _..... _.... _.......... _ ..... ._._._. ..$2.60 Brotherhood Mutual Insurance Company I www.brotherhoodmutual.com I 800.333.3735 I P.O. Box 2227, Fort Wayne, IN 46801-2227 M1 DEC 09/16 'Bear ye one another's burdens and so fulfill the law of Christ" — Galatians 6:2 Page 7 of 16 Brotherhood Mutual' Insurance Company NAMED INSURED TIMBERLINE CHURCH POLICY NUMBER 05M5A0358236 POLICY PERIOD 7/27/2017 to 7/27/2018 Inland Marine Coverage Summary MinistryFirst" commercial multi -peril policy Declarations continued... COVERAGE DESCRIPTION COVERAGE LIMIT DEDUCTIBLE FORM ........... .............................................................................................................................................................._.................................................._. WHIRLWIND 24 CHANNEL SNAKE (BLUE) NO MN OR SN .... .......................... ... _....... ................................. ............................................ .................................................. .......................... _.__._..__... - _........... ___._._....._----- $300 ...... RAPCO 12 CHANNEL SNAKE NO MN OR SN $150 _................................................. ......._...._...._...._......._..--.. PEAVEY . BASS AMP MN 300CH5 SN CK250376 .._...._...-._.._...__...._.............._.----............................................................_...... _...._...___...--.._..._ $350 .............................................._-_..._................................................................._......_..._.—_..__...- BASS SPEAKER ENCLOSER MN 210TX SN 00124250/JHA23 $200 j 6 .ty 2 GREY PLASTIC TUBS MISC CABLES/MICS 2-SHORE CORDED MICS $130 212 XLR CABLES 20 EACH $40 ........... ......................................................... _................................_.............................. _...........-. ._...- 1 LARGE GREEN PLASTIC TUB -POWER CORDS 2-YELLOW 50' CORDS - ..._............_........_._.._....__.._................................................... _..---........................ _._..__._._...._......_._...___......._....._. $230 ........................... 2 YAMAHA SPEAKERS (MONITOR TYPE) MN-SM121V SN-07717877 & ........................................................................................................... .................._................................. ._......_..... _....--- ....... ......_......... $800 _.._............._........._...._._..._........_...._.... FENDER GUITAR AMPLIFIER MN CHAMP 25 PR201 300 SN-LO 319980 ..._.............._....__.._............................................... _... _ .._.. ----- ----- $300 _..._........................................................................................._..._..._...._...__....................---._._._._._............_.__.._..._....__....-.---......._...................................__........_................._......_..__..............__.._..__.. .. .... . 2 SOUNDTECH SPEAKERS CX4C MN-SMZ SN-951204121 & 941002749 $900 2 ULTIMATE SPEAKER STANDS SN 282582 & 282600 $150 ..... ._...._............................................................ ......................................................................................................................................._....._.._._.........._......_.............__........................... SOUNDTECH AMP MN-PL502 ENCLOSED IN A BLACK TRAVEL CASE _..........................._....................._.......... ........................... _................................_........................................ _...................._....._..............._.... $300 -.......... PEAVEY AMP MN-PV4C ENCLOSED IN A BLACK TRAVEL CASE $400 PEAVEY AMP MN-PV8.5C ENCLOSED IN A BLACK TRAVEL CASE ............................................................_.... $600 ._..........................JVC VHS PLAYER/RECORDER MN-HR535000 SN024J0786 ENCLOSED IN,q_.__....$200..._......_....._..............._._._..__ ................ _.._.... _.__...-__....._.............._.._----..._..___...__.._..___ _--......_...__._....................._....._..............._................................._._............._.........._........._........_._...................._..._............_........_......._......_._................._..............._..._.._........................ TASCAM CD/CASs PLAYER MN-CD-A500 SN-0120716 ENCLOSED IN A ... .......... ............. --_ $200 _..._...._......................................................................._.............................................................................................................................................................................................._._.................................................................._........_............................................_..........._..................................................._..................._...._.... 2 ALESIS REVERE UNITS ENCLOSED IN A SKB TRAVEL CASE @ $250 $500 ALESIS COMPRESSOR ENCLOSED IN A SKB TRAVEL CASE $200 ......................................_............__........__..........._.................................................._.................................................._.._..........._................._......_..- - -- ALESIS EQ UNIT MN-MEQ230 SN-Q51606611 ENCLOSED IN A SKB ...._.............- -._........ _........ —._..----...--------- ........... _-._.._.... ............. —..... __.............. ..... _.......... ..... $150 ...._....._.................................................................................................................................................................................................................................................................................. SOUNDTECH EQ UNIT MN Q150 ENCLOSED IN A SKB TRAVEL CASE ............................ -................................................................_... ...... .................. _.... ............... _.._........_..............._....._._..._.... _--.. $150 MACKIE MIXER CONSOLE MN T36459 $600 2 EV LARGE STAGE SPEAKERS (WITH COVERS) MN-1512ER $1,000 ....__................................................................................................................................................................................................................................................................................................. KURZEWIL KEYBOARD W/TRAVEL CASE MN K2000 SN 499603050354 .........-- ._.__.... _ _._...._.. - .._.._..- - ......_.....---...._..__.. _._.... ............. ..................................... $1,000... .................. ...... ROLAND KEYBOARD (NO CASE) MN-A90EX SN-ZJ96360 ..................................... .._................................................... $750 ROLAND PIANO AMP MN KC500 SN CP16045 ......... $500 ........................................................................................................................................................._._.._..---........._........_._...._..__........_.._........................._..._..._.._..... ROLAND V DRUMS CLUB SERIES (ELECTRONIC) MN-TD6 SN-AQ46183 ......._--...................__...._.._...............--_...........................__._.._......................................................... $1,100 ........ ............................................................................................................................................................................................................................................................................................................................................._....._......_.............................._._.........._.......__......._....._..._........ YAMAHA CLAVINOVA KEYBOARD MN CLP123 SN 046858 --...._..............................................._...... $400 _._..._..._........._........._................_........................._.................................................._................................................_...._....................................................................................................................................................._..__._.._...._......_...._...----...._....--.--..__....................-............................................................_.. BASS AMP W/ONBOARD MIXER MN-SW65 SN-S011205842 $499 AKAI DVD PLAYER (STORED IN CABINET) MN-DVPS760 SN-02040 74364 SONY CD PLAYER (STORED IN CABINET) MN-CDP390 SN-867914 $250 ......................................................................................_............................_.._....._.._......_...._...._.... YELLOW TOOL BOX W/MISC PATCH CABLES, ORANGE 50' POWER CORD, ---..... ....-.-.... -............... -----..... ................................................................................... 2-ULTIMATE SPEAKER STANDS MN-TS80B @ $75 EACH _...._ MACKIr MISER CONSOLE MN CR1604 SN A34942 $700 ROLAND 88 KEY BLACK KEYBOARD MODEL RD 7005X S#ZT01521 . $1,450 ROLAND 88 KEY BLACK KEYBOARD MODEL RD 700SX SXZT01371 $1,450 __..._.....__._._......._......_.._.._. Photographic Equipment ..................................._............._... _.............. ,............................ ....................................... _.... _.......... _......................... ........................ $10,900 $500 IM1350 0105 ................................................................................................................................................................................................................................................................---_.................................................................................................._............._........__......................._._..._......._.........._..._......._._................................................. 1 CANON XL1 3CCD DIGITAL VIDEO CAMCORDER NTSC (MODEL $2,500 #2610201783) .................................................................................................................................................................................................................................. 1 CANON XL1 3CCD DIGITAL VIDEO CAMCORDER NTSC (MODEL #2720700128) ................ .... ....1..OLYNIPUS CAWIEDIA E 10 CMODEL#E-10............................................................._.._....__._....._.........................._...400..._..__.._.._........ _..__.._._...__._.....---............. ........... ..... ...... .......... _.......... .__............. ........................................ _._.._. _. _... .. _... _....._._................_.........._......_................_...._..._........_........_.........._... - - -- _ --- - - -- .... .............. ... -- -_ _ -- ..._.__..._........... ............. .-_..----_...... .............. _... .... ... ...... 1 SONY LCD DATA PROJECTOR (MODEL #VLP-PX20) $2,000 ............................_...---................._......__................._... 1 LIBEC TRIPOD T57 (NO MODEL 3) $500 .............. 1 CHRISTIE LX25 PROJECTOR (MODEL #38VIV208-01 SERIAL #20815626) $3,000 REPLACEMENT Brotherhood Mutual Insurance Company I www.brotherhoodmutual.com I 800.333.3735 I P.O. Box 2227, Fort Wayne, IN 46801-2227 MI DEC 09/16 "Bear ye one another's burdens and so fulfill the law of Christ"— Galatians 6:2 Page 8 of 16 NAMED INSURED TIMBERLINE CHURCH Brotherhood Mutual' POLICYNUMBER OSMSA0358236 7to7/2 POLICY PERIOD 7/27/2017 to 7/27/2018 Insurance Company Liability Coverage Summary MinistryFirst" commercial multi -peril policy Declarations continued... The Coverages listed here are provided according to the terms of the designated coverage form and any other applicable forms or endorsements. Only one liability coverage and one medical coverage will apply to an occurrence and any related loss. Any limit which is specifically stated within a coverage form or endorsement represents the most we will pay for the coverage to which such a limit applies. For application of limits, see Liability and Medical Coverage form (BGL114.0). Key Liability Coverage Facts: Schedule of Limits GENERAL OCCURRENCE LIMIT GENERAL AGGREGATE LIMIT Principal Liability Coverages COVERAGE DESCRIPTIONS Bodily Injury/Property Damage Liability (L) Medical Payments (M) Fire Legal Liability (0) Supplemental Coverages $1,000,000 $3,000,000 COVERAGE LIMIT $1,000,000* ......................................... I ..................... . $10,000*+ COVERAGE AGGREGATE LIMIT FORM $3,000,000* GL1001.0 GL1001.0 COVERAGE DESCRIPTIONS COVERAGE LIMIT COVERAGE AGGREGATE LIMIT FORM Incidental Contractual Liability $1,000,000' $3,000,000' GL1001.0 ................---_._..__.._................................ Incidental Medical Malpractice _.........,._ _ ..... .........,. ....,......................................................... $1,000,000* ........ ................... ........ $3,000,000* .. ........... .....,.... GL1001.0 Mobile Equipment $1,000,000* $3,000,000* GL1001.0 Additional Coverages COVERAGE DESCRIPTIONS COVERAGE LIMIT COVERAGE AGGREGATE LIMIT FORM Membership Emotional Injury Liability Coverage $1,000,000* $3,000,000* BGL514.0 Nursery/Child Care Corporal Punishment Liability $1,000,000` $3,000,000* BGL514.0 ................................. ........._...._......_..........................................................................................................__..—.__..-.__...........................................__..........__...__._.___.._....---....-................................................._.....__.._..-_-....___...._-___.._.._..__......._.._...---..................._..5.1' Supervision -Related Emotional Injury Liability Coverage $1,000,000* $3,000,000* ....._...... BGL514.0 ......................................................_..._..._...._..._...__.._........................................................._..__._...._.........._.........._.._..........,..................................................._........--_..............-..........._..---....._......__......_........_..._........................................0" Food Preparation Liability Coverage $1,000,000* $3,000,000* BGL51 4.0 Privacy Violation Liability Coverage $1,000,000` $3,000,000* .., BGL514.0 Damage To Property Of Others Coverage ..................................................__._.._..._._....---.._..---......................................................._...._ $1,000,000* --..__..._......_....._... .._..--._...__..._..._......................................... $3,000,000* BGL51 4.0 Not in Your Con' trol.....__._._..__.._....................................... .... ...... ___........... ._..__.__...._............$1,000*+................._.._..----._........._..__..----.........................................................._....--.._..__._........_..__-_-.....__...._.__.._...._.._..._..._......................................... $3*,000,000* BGL514.0 In Your Control $2,500*+ $3,000,000* B6L51 4.0 ..........................................................................._..__........_............................,.............................................-_..._._..__............................................,................................................................._..._._............---...._-_......_..._...._.._............._...............................5'*1'.........0 Prosthetic Devices $500*+ $3,000,000* BGL51 4.0 Incidental Camper Medical Coverage $10,000* $3,000,000* ... ..................................... *4' *..** '0 B...G.L51 4.0 Additional Incidental Contractual Liability Coverage $1,000,000` $3,000,000* .... BGL51 4.0 Defense Coverage Applies in addition to the liability limit unless otherwise specifically stated in an applicable coverage form. ` Only a single limit applies to the loss. All coverage limits are subject to the general occurrence limit and all aggregate limits are subject to the general aggregate limit. + per person limit Brotherhood Mutual Insurance Company I www.brotherhoodmutual.com I 800.333.3735 I P.O. Box 2227, Fort Wayne, IN 46801-2227 M1 DEC 09/16 "Bear ye one another's burdens and so fulfill the law of Christ:' — Galatians 6:2 Page 9 of 16