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HomeMy WebLinkAbout130469 THE BRENDLE GROUP INC - INSURANCE CERTIFICATE (14)State Farm STATE FARM FIRE AND CASUALTY COMPANY aA STOCK COMPANY WITH HOME OFFICES IN BLOOMINGTON, ILLINOIS DECLARATIONS AMENDED DEC 5 2016 • Raving pn3v tlanta vA 346-21 17 M-20-2359-FAF1 F U 001952 3123 Addl Insured -Section 11 Only CITY OF FORT COLLINS 215 N MASON ST 2ND FLOOR PO BOX 580 FORT COLLINS CO 80522-0580 Office Policy Policy Number 96-CW-8447-1 Policy Period Effective Date Expiration Date 12 Months DEC 3 2016 DEC 3 2017 The policy period begins and ends at 12:01 am standard time at the premises location. Named Insured THE BRENDLE GROUP INC 212 W MULBERRY ST FORT COLLINS CO 80521-2814 Automatic Renewal - If the policy period is shown as 12 months, this policy will be renewed automatically subjectto the premiums, rules and forms in effect for each succeeding policy period. If this policy is terminated, we will give you and the Mortgagee/Lien holder written notice in compliance with the policy provisions or as required by law. Entity: Individual Reason for Declarations: Your policy is amended DEC 5 2016 ADDITIONAL INSURED ADDED PREMIUM ADJUSTMENT FORM CMP-4786 ADDED Endorsement Premium None Discounts Applied: Renewal Year Years in Business Enclosed Building Protective Devices Claim Record Prepared DEC 15 2016 © Copyright, State Farm Mutual Automobile Insurance Company, 2008 CMP-4000 Includes copyrighted material of Insurance Services Office, Inc., with its permission. 015562 290 AI Continued on Reverse Side of Page Page 1 of 6 N DECLARATIONS (CONTINUED) Office Policy for CITY OF FORT COLLINS Policy Number 96-CW-8447-1 SECTION I - PROPERTY SCHEDULE Location Location of Limit of Insurance* Limit of Insurance` Seasonal Number Described Increase - Premises Coverage A - Coverage B - Business Buildings Business Personal Personal Property Property 001 212 W MULBERRY No Coverage $ 219,500 25% FORT COLLINS CO 80521-2814 * As of the effective date of this policy, the Limit of Insurance as shown includes any increase in the limit due to Inflation Coverage. SECTION I - INFLATION COVERAGE INDEXES) Cov A - Inflation Coverage Index: Cov B - Consumer Price Index: SECTION I - DEDUCTIBLES N/A 241.0 Basic Deductible $500 Special Deductibles: Money and Securities $250 Employee Dishonesty $250 Equipment Breakdown $500 Other deductibles may apply - refer to policy. Prepared FEB 14 2017 © Copyright, State Farm Mutual Automobile Insurance Company, 2008 CMP-4000 Includes copyrighted material of Insurance Services Office, Inc., with its permission. 013366 Continued on Next Page Page 2 of 6 StateFarm • • • DECLARATIONS (CONTINUED) Office Policy for CITY OF FORT COLLINS Policy Number 96-CW-8447-1 SECTION I - EXTENSIONS OF COVERAGE - LIMIT OF INSURANCE - EACH DESCRIBED PREMISES The coverages and corresponding limits shown below apply separately to each described premises shown in these Declarations, unless indicated by "See Schedule." If a coverage does not have a corresponding limit shown below, but has "Included" indicated, please refer to that policy provision for an explanation of that coverage. LIMIT OF COVERAGE INSURANCE Accounts Receivable On Premises $50,000 Off Premises $15,000 Arson Reward $5,000 Back -Up Of Sewer Or Drain $15,000 Collapse Included Damage To Non -Owned Buildings From Theft, Burglary Or Robbery Coverage B Limit Debris Removal 25% of covered loss Equipment Breakdown Included Fire Department Service Charge $5,000 Fire Extinguisher Systems Recharge Expense $5,000 Forgery Or Alteration $10,000 Glass Expenses Included Increased Cost Of Construction And Demolition Costs (applies only when buildings are 10% insured on a replacement cost basis) Money And Securities (Off Premises) $5,000 Money And Securities (On Premises) $10,000 Money Orders And Counterfeit Money $1,000 Newly Acquired Business Personal Property (applies only if this policy provides $100,000 Coverage B - Business Personal Property) Newly Acquired Or Constructed Buildings (applies only if this policy provides $250,000 Coverage A - Buildings) Prepared FEB 14 2017 © Copyright, State Farm Mutual Automobile Insurance Company, 2008 CMP-4000 Includes copyrighted material of Insurance Services Office, Inc., with its permission. 013367 290 Continued on Reverse Side of Page Page 3 of 6 N DECLARATIONS (CONTINUED) Office Policy for CITY OF FORT COLLINS Policy Number 96-CW-8447-1 Ordinance Or Law - Equipment Coverage Included Outdoor Property $5,000 Personal Effects (applies only to those premises provided Coverage B - Business $5,000 Personal Property) Personal Property Off Premises $15,000 Pollutant Clean Up And Removal $10,000 Preservation Of Property 30 Days Property Of Others (applies only to those premises provided Coverage B - Business $2,500 Personal Property) Signs $2,500 Unauthorized Business Card Use $5,000 Valuable Papers And Records On Premises $50,000 Off Premises $15,000 Water Damage, Other Liquids, Powder Or Molten Material Damage Included SECTION I - EXTENSIONS OF COVERAGE - LIMIT OF INSURANCE - PER POLICY The coverages and corresponding limits shown below are the most we will pay regardless of the number of described premises shown in these Declarations. COVERAGE Dependent Property - Loss Of Income Employee Dishonesty Utility Interruption - Loss Of Income Loss Of Income And Extra Expense LIMIT OF INSURANCE $5,000 $10,000 $10,000 Actual Loss Sustained - 12 Months Prepared FEB 14 2017 © Copyright, State Farm Mutual Automobile Insurance Company, 2008 CMP-4000 Includes copyrighted material of Insurance Services Office, Inc., with its permission. 013367 Continued on Next Page Page 4 of 6 rStateFarm • •• DECLARATIONS (CONTINUED) Office Policy for CITY OF FORT COLLINS Policy Number 96-CW-8447-1 SECTION II - LIABILITY LIMIT OF COVERAGE INSURANCE Coverage L - Business Liability $2,000,000 Coverage M - Medical Expenses (Any One Person) $5,000 Damage To Premises Rented To You $500,000 LIMIT OF AGGREGATE LIMITS INSURANCE Products/Completed Operations Aggregate Excluded General Aggregate $4,000,000 Each paid claim for Liability Coverage reduces the amount of insurance we provide during the applicable annual period. Please refer to Section II - Liability in the Coverage Form and any attached endorsements. Your policy consists of these Declarations, the BUSINESSOWNERS COVERAGE FORM shown below, and any other forms and endorsements that apply, including those shown below as well as those issued subsequent to the issuance of this policy. FORMS AND ENDORSEMENTS CMP-4100 Businessowners Coverage Form CMP-4206.1 Amendatory Endorsement CMP-4845 Excl Product Comp Operatn Liab FE-6999.2 Terrorism Insurance Cov Notice CMP-4713 Excl Testing Consulting E&O CMP-4787 Waiver of Trans Rgt of Recov CMP-4819.1 Unauthorized Business Card Use CMP-4706 Back -Up of Sewer or Drain CMP-4704 Dependent Prop Loss of Income CMP-4710 Employee Dishonesty CMP-4709 Money and Securities CMP-4703 Utility Interruption Loss Incm CMP-4705 Loss of Income & Extra Expnse Prepared FEB 14 2017 © Copyright, State Farm Mutual Automobile Insurance Company, 2008 CMP-4000 Includes copyrighted material of Insurance Services Office, Inc., with its permission. 013368 290 Continued on Reverse Side of Page Page 5 of 6 N DECLARATIONS (CONTINUED) Office Policy for CITY OF FORT COLLINS Policy Number 96-CW-8447-1 CMP-4746 Hired Auto Liability CMP-4786 Addl Insd Owners Lessee Sched CMP-4785 Addl Ins Owners Lessee Blkt FE-3650 Actual Cash Value Endorsement CMP-4860 Al Design Person Org CMP-4793 Al State Political Perm Prem CMP-4788 Addl Insd Mgrs Lessor of Prem FD-6007 Inland Marine Attach Dec This policy is issued by the State Farm Fire and Casualty Company. Participating Policy You are entitled to participate in a distribution of the earnings of the company as determined by our Board of Directors in accordance with the Company's Articles of Incorporation, as amended. In Witness Whereof, the State Farm Fire and Casualty Company has caused this policy to be signed by its President and Secretary at Bloomington, Illinois. Secretary President Prepared FEB 14 2017 CMP-4000 © Copyright, State Farm Mutual Automobile Insurance Company, 2008 Includes copyrighted material of Insurance Services Office, Inc., with its permission. 013368 290 N Page 6 of 6 StateFarm • • STATE FARM FIRE AND CASUALTY COMPANY A STOCK COMPANY WITH HOME OFFICES IN BLOOMINGTON, ILLINOIS INLAND MARINE ATTACHING DECLARATIONS 9Rnvta p3 Atlanta 6A 31,46-21 i7 M-20-2359-FAF1 F U Named Insured THE BRENDLE GROUP INC 212 W MULBERRY ST FORT COLLINS CO 80521-2814 ATTACHING INLAND MARINE Policy Number 96-CW-8447-1 Policy Period Effective Date Expiration Date 12 Months DEC 3 2016 DEC 3 2017 The policy period begins and ends at 12:01 am standard time atthe premises Tocation. Automatic Renewal - If the policy period is shown as 12 months, this policy will be renewed automatically subjectto the premiums, rules and forms in effectfor each succeeding policy period. If this policy is terminated, we will give you and the Mortgagee/Lienholder written notice in compliance with the policy provisions or as required by law. Annual Policy Premium Included The above Premium Amount is included in the Policy Premium shown on the Declarations. Your policy consists of these Declarations, the INLAND MARINE CONDITIONS shown below, and any other forms and endorsements that apply, including those shown below as well as those issued subsequentto the issuance of this policy. Forms, Options, and Endorsements FE-8739 Inland Marine Conditions FE-8743 Inland Marine Computer Prop See Reverse for Schedule Page with Limits Prepared FEB 14 2017 © Copyright, State Farm Mutual Automobile Insurance Company, 2008 FD-6007 Includes copyrighted material of Insurance Services Dffice, Inc., with its permission. 013369 530 686 a.2 05 31 2011 WIQ232c1 96-CW-8447-1 ATTACHING INLAND MARINE SCHEDULE PAGE ATTACHING INLAND MARINE ENDORSEMENT NUMBER COVERAGE FE-8743 Inland Marine Computer Prop Loss of Income and Extra Expense Prepared FEB 14 2017 FD-6007 013369 LIMIT OF INSURANCE $ 25,000 $ 25,000 DEDUCTIBLE AMOUNT $ 500 OTHER LIMITS AND EXCLUSIONS MAY APPLY - REFER TO YOUR POLICY © Copyright, State Farm Mutual Automobile Insurance Company, 2008 Includes copyrighted material of Insurance Services Office, Inc., with its permission. ANNUAL PREMIUM Included Included 530-686 a.2 05.31-2011 WN7330 DECLARATIONS (CONTINUED) Office Policy for CITY OF FORT COLLINS Policy Number 96-CW-8447-1 SECTION I - PROPERTY SCHEDULE Location Location of Limit of Insurance* Limit of Insurance* Seasonal Number Described Increase - Premises Coverage A - Coverage B - Business Buildings Business Personal Personal Property Property 001 212 W MULBERRY No Coverage $ 219,500 25% FORT COLLINS CO 80521-2814 As of the effective date of this policy, the Limit of Insurance as shown includes any increase in the limit due to Inflation coverage. SECTION I - INFLATION COVERAGE INDEXES) Cov A - Inflation Coverage Index: Cov B - Consumer Price Index: SECTION I - DEDUCTIBLES N/A 241.0 Basic Deductible $500 Special Deductibles: Money and Securities $250 Employee Dishonesty $250 Equipment Breakdown $500 Other deductibles may apply - refer to policy. Prepared DEC re 2016 © Copyright, State Farm Mutual Automobile Insurance Company, 2008 CMP-4000 Includes copyrighted material of Insurance Services Office, Inc., with its permission. 015562 Continued on Next Page Page 2 of 6 StateFarm • • • . DECLARATIONS (CONTINUED) Office Policy for CITY OF FORT COLLINS Policy Number 96-CW-8447-1 SECTION I - EXTENSIONS OF COVERAGE - LIMIT OF INSURANCE - EACH DESCRIBED PREMISES The coverages and corresponding limits shown below apply separately to each described premises shown in these Declarations, unless indicated by "See Schedule." If a coverage does not have a corresponding limit shown below, but has "Included" indicated, please refer to that policy provision for an explanation of that coverage. LIMIT OF COVERAGE INSURANCE Accounts Receivable On Premises $50,000 Off Premises $15,000 Arson Reward $5,000 Back -Up Of Sewer Or Drain $15,000 Collapse Included Damage To Non -Owned Buildings From Theft, Burglary Or Robbery Coverage B Limit Debris Removal 25% of covered loss Equipment Breakdown Included Fire Department Service Charge $5,000 Fire Extinguisher Systems Recharge Expense $5,000 Forgery Or Alteration $10,000 Glass Expenses Included Increased Cost Of Construction And Demolition Costs (applies only when buildings are 10% insured on a replacement cost basis) Money And Securities (Off Premises) $5,000 Money And Securities (On Premises) $10,000 Money Orders And Counterfeit Money $1,000 Newly Acquired Business Personal Property (applies only if this policy provides $100,000 Coverage B - Business Personal Property) Newly Acquired Or Constructed Buildings (applies only if this policy provides $250,000 Coverage A - Buildings) Prepared DEC 15 2016 © Copyright, State Farm Mutual Automobile Insurance Company, 2008 CMP-4000 Includes copyrighted material of Insurance Services Office, Inc., with its permission. 015563 290 Continued on Reverse Side of Page Page 3 of 6 N DECLARATIONS (CONTINUED) Office Policy for CITY OF FORT COLLINS Policy Number 96-CW-8447-1 Ordinance Or Law - Equipment Coverage Included Outdoor Property $5,000 Personal Effects (applies only to those premises provided Coverage B - Business $5,000 Personal Property) Personal Property Off Premises $15,000 Pollutant Clean Up And Removal $10,000 Preservation Of Property 30 Days Property Of Others (applies only to those premises provided Coverage B - Business $2,500 Personal Property) Signs $2,500 Unauthorized Business Card Use $5,000 Valuable Papers And Records On Premises $50,000 Off Premises $15,000 Water Damage, Other Liquids, Powder Or Molten Material Damage Included SECTION I - EXTENSIONS OF COVERAGE - LIMIT OF INSURANCE - PER POLICY The coverages and corresponding limits shown below are the most we will pay regardless of the number of described premises shown in these Declarations. COVERAGE Dependent Property - Loss Of Income Employee Dishonesty Utility Interruption - Loss Of Income Loss Of Income And Extra Expense LIMIT OF INSURANCE $5,000 $10,000 $10,000 Actual Loss Sustained - 12 Months Prepared DEC 15 2016 © Copyright, State Farm Mutual Automobile Insurance Company, 2008 CMP-4000 Includes copyrighted material of Insurance Services Office, Inc., with its permission. 015563 Continued on Next Page Page 4 of 6 StateFarm • •• DECLARATIONS (CONTINUED) Office Policy for CITY OF FORT COLLINS Policy Number 96-CW-8447-1 SECTION II - LIABILITY LIMIT OF COVERAGE INSURANCE Coverage L - Business Liability $2,000,000 Coverage M - Medical Expenses (Any One Person) $5,000 Damage To Premises Rented To You $500,000 LIMIT OF AGGREGATE LIMITS INSURANCE Products/Completed Operations Aggregate Excluded General Aggregate $4,000,000 Each paid claim for Liability Coverage reduces the amount of insurance we provide during the applicable annual period. Please refer to Section II - Liability in the Coverage Form and any attached endorsements. Your policy consists of these Declarations, the BUSINESSOWNERS COVERAGE FORM shown below, and any other forms and endorsements that apply, including those shown below as well as those issued subsequent to the issuance of this policy. FORMS AND ENDORSEMENTS CMP-4100 Businessowners Coverage Form CMP-4786 'Addl Insd Owners Lessee Sched CMP-4206.1 Amendatory Endorsement CMP-4845 Excl Product Comp Operatn Liab FE-6999.2 Terrorism Insurance Cov Notice CMP-4713 Excl Testing Consulting E&O CMP-4787 Waiver of Trans Rgt of Recov CMP-4819.1 Unauthorized Business Card Use CMP-4706 Back -Up of Sewer or Drain CMP-4704 Dependent Prop Loss of Income CMP-4710 Employee Dishonesty CMP-4709 Money and Securities CMP-4703 Utility Interruption Loss Incm Prepared DEC 15 2016 © Copyright, State Farm Mutual Automobile Insurance Company, 2008 CMP-4000 Includes copyrighted material of Insurance Services Office, Inc., with its permission. 015564 290 Continued on Reverse Side of Page Page 5 of 6 N DECLARATIONS (CONTINUED) Office Policy for CITY OF FORT COLLINS Policy Number 96-CW-8447-1 CMP-4705 Loss of Income & Extra Expnse CMP-4746 Hired Auto Liability CMP-4785 Addl Ins Owners Lessee Blkt FE-3650 Actual Cash Value Endorsement CMP-4860 Al Design Person Org CMP-4793 Al State Political Perm Prem CMP-4788 Addl Insd Mgrs Lessor of Prem FD-6007 Inland Marine Attach Dec New Form Attached This policy is issued by the State Farm Fire and Casualty Company. Participating Policy You are entitled to participate in a distribution of the earnings of the company as determined by our Board of Directors in accordance with the Company's Articles of Incorporation, as amended. In Witness Whereof, the State Farm Fire and Casualty Company has caused this policy to be signed by its President and Secretary at Bloomington, Illinois. Secretary President Prepared DEC 15 2016 CMP-4000 © Copyright, State Farm Mutual Automobile Insurance Company, 2008 Includes copyrighted material of Insurance Services Office, Inc., with its permission. 015564 290 N Page 6 of 6 StateFarm STATE FARM FIRE AND CASUALTY COMPANY • A STOCK COMPANY WITH HOME OFFICES IN BLOOMINGTON, ILLINOIS INLAND MARINE ATTACHING DECLARATIONS • A Ravinnta c�Vr9V1346-21 I7 tla M-20-2359-FAF1 F U Named Insured THE BRENDLE GROUP INC 212 W MULBERRY ST FORT COLLINS CO 80521-2814 ATTACHING INLAND MARINE Policy Number 96-CW-8447-1 Policy Period Effective Data Expiration Date 12 Months DEC 3 2016 DEC 3 2017 The policy period begins and ends at 12:01 am standard time atthe premises Tocation. Automatic Renewal - If the policy period is shown as 12 months, this policy will be renewed automatically subjectto the premiums, rules and forms in effectfor each succeeding policy period. If this policy is terminated, we will give you and the Mortgagee/Lienholder written notice in compliance with the policy provisions or as required by law. Annual Policy Premium Included The above Premium Amount is included in the Policy Premium shown on the Declarations. Your policy consists of these Declarations, the INLAND MARINE CONDITIONS shown below, and any other forms and endorsements that apply, including those shown below as well as those issued subsequentto the issuance of this policy. Forms, Options, and Endorsements FE-8739 Inland Marine Conditions FE-8743 Inland Marine Computer Prop See Reverse for Schedule Page with Limits Prepared DEC 15 2016 © Copyright, State Farm Mutual Automobile Insurance Company, 2008 FD-6007 Includes copyrighted material of Insurance Services Office, Inc., with its permission. 015565 530-686a.2 05 31 2011 Io1f3232G 96-CW-8447-1 ATTACHING INLAND MARINE SCHEDULE PAGE ATTACHING INLAND MARINE ENDORSEMENT LIMIT OF DEDUCTIBLE NUMBER COVERAGE INSURANCE AMOUNT FE-8743 Inland Marine Computer Prop S 25,000 S 500 Loss of Income and Extra Expense S 25,000 Prepared DEC 15 2016 FD-6007 OTHER LIMITS AND EXCLUSIONS MAY APPLY - REFER TO YOUR POLICY © Copyright, State Farm Mutual Automobile Insurance Company, 2008 Includes copyrighted material of Insurance Services Office, Inc., with its permission. ANNUAL PREMIUM Included Included 015565 530 586 a2 05 31 2011 MQ2330 StateFarm STATE FARM FIRE AND CASUALTY COMPANY A A STOCK COMPANY WITH HOME OFFICES IN BLOOMINGTON, ILLINOIS DECLARATIONS AMENDED DEC 15 2016 Atlanta �C�A r31346-2117 M-20-2359-FAF1 F U 001624 3123 Addl Insured -Section II Only CITY OF FORT 215 N MASON PO BOX 580 FORT COLLINS Office Policy COLLINS ST 2ND FLOOR CO 80522-0580 Policy Number 96-CW-8447-1 Policy Period Effective Date Expiration Date 12 Months DEC 3 2016 DEC 3 2017 The policy period begins and ends at 1201 am standard time at the premisesTocatlon. Named Insured THE BRENDLE GROUP INC 212 W MULBERRY ST FORT COLLINS CO 80521-2814 Automatic Renewal - If the policy period is shown as 12 months, this policy will be renewed automatically subjectto the premiums, rules and forms in effectfor each succeeding policy period. If this policy is terminated, we will give you and the Mortgagee/Lienholder written notice in compliance with the policy provisions or as required by law. Entity: Individual Reason for Declarations: Your policy is amended DEC 15 2016 ADDITIONAL INSURED DELETED PREMIUM ADJUSTMENT FORM CMP-4786 DELETED Endorsement Premium None Discounts Applied: Renewal Year Years in Business Enclosed Building Protective Devices Claim Record Prepared FEB 14 2017 © Copyright, State Farm Mutual Automobile Insurance Company, 2008 CMP-4000 Includes copyrighted material of Insurance Services Office, Inc., with its permission. 013366 290 Al Continued on Reverse Side of Page Page 1 of 6 N