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HomeMy WebLinkAbout555745 AISLING INC - INSURANCE CERTIFICATE (6)StateFarm • STATE FARM FIRE AND CASUALTY COMPANY A STOCK COMPANY WITH HOME OFFICES IN BLOOMINGTON, ILLINOIS RENEWAL DECLARATIONS 3 Ravini3 p M346-2117 Atlanta caH Addl Insured -Section II Only AT2 004104 3125 CITY OF FORT COLLINS PURCHASING FINANCIAL PURCHASING DIVISION PO BOX 580 M-20-1648-FAF1 F Z SERVICE FORT COLLINS CO 80522-0580 1IIf1IIII1I11I11111lllll'Illl'III' 11111111111111111Illl"IIIIIIII Dry Cleaning And Laundering Services Policy Policy Number 96-CB-K216-7 Policy Period Effective Date Exppiration Date 12 Months JUL 22 2017 JUL 222018 The policy period begins and ends at 12:01 am standard time atthe premises Tocatlon. Named Insured AISLING INC 1827 E MULBERRY ST FORT COLLINS CO 80524-3525 Automatic Renewal - If the policy period is shown as 12 months, this policy will be renewed automatically subjectto the premiums, rules and forms in effect for each succeeding policy period. If this policy is terminated, we will give you and the Mortgagee/Lienholder written notice in compliance with the policy provisions or as required by law. Entity: Corporation NOTICE: Information concerning changes in your policy language is included. Please call your agent if you have any questions. POLICY PREMIUM Discounts Applied: Protective Devices Prepared APR 10 2017 CMP-4000 $ 5,324.00 C Copyright, State Farm Mutual Automobile Insurance Company, 2008 Includes copyrighted material of Insurance Services Office, Inc., with its permission. 025979 294 Al N Continued on Reverse Side of Page Page 1 of 8 96-CB-K216-7 ATTACHING INLAND MARINE SCHEDULE PAGE ATTACHING INLAND MARINE ENDORSEMENT LIMIT OF DEDUCTIBLE ANNUAL NUMBER COVERAGE INSURANCE AMOUNT PREMIUM FE-8743 Inland Marine Computer Prop S 25,000 S 500 Included Loss of Income and Extra Expense S 25,000 Included Prepared APR 10 2017 FD-6007 025983 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. 530 586 a.2 05 31 2011 lot f3233c StateFarm • • , STATE FARM FIRE AND CASUALTY COMPANY A STOCK COMPANY WITH HOME OFFICES IN BLOOMINGTON, ILLINOIS DECLARATIONS AMENDED OCT 1 2016 9 Raviniaa nve Atlanta G 30346-2117 M-20-1648-FAF1 F Z 001599 3123 Addl Insured -Section II Only Policy Number 96-CB-K216-7 Policy Period Effective Date Expiration Date 12 Months JUL 22 2016 JUL 222017 The policy period beggins and ends at 12:01 am standard time atthe premises Tocation. CITY OF FORT COLLINS Named Insured PURCHASING FINANCIAL SERVICE AISLING INC PURCHASING DIVISION 5412 TAYLOR LN PO BOX 580 FORT COLLINS CO 80528-8803 FORT COLLINS CO 80522-0580 Dry Cleaning And Laundering Services Policy Automatic Renewal - If the policy period is shown as 12 months, this policy will be renewed automatically stibjectto the premiums, rules and forms in effect for each succeeding policy period. If this policy is terminated, we will give you and the Mortgagee/Lienholder written notice in compliance with the policy provisions or as required by law. Entity: Corporation Reason for Declarations: Your policy is amended OCT 1 2016 BUSINESS PERS PROP COVERAGE CHANGED PROTECTIVE DEVICES DISCOUNT CHANGED OPERATIONS EXPOSURE CHANGED Endorsement Premium Increase Discounts Applied: Protective Devices Prepared NOV 08 2016 CMP-4000 359.03 © Copyright, State Farm Mutual Automobile Insurance Company, 2008 Includes copyrighted material of Insurance Services Office, Inc., with its permission. 014192 290 N Al Continued on Reverse Side of Page Page 1 of 7 DECLARATIONS (CONTINUED) Dry Cleaning And Laundering Services Policy for CITY OF FORT COLLINS Policy Number 96-CB-K216-7 SECTION 1 - PROPERTY SCHEDULE Location Number Location of Described Premises Limit of Insurance* Coverage A - Buildings Limit of Insurance* Coverage B - Business Personal Property Seasonal Increase - Business Personal Property 001 1827 E MULBERRY ST No Coverage $ 326,000 25% FORT COLLINS CO 80524-3525 002 725 S LEMAY AVE No Coverage $ 20,100 25% FORT COLLINS CO 80524-3245 003 3675 S COLLEGE AVE STE 21 No Coverage $ 20,100 25% FORT COLLINS CO 80525-3044 004 1357 WATER VALLEY PKWY No Coverage $ 20,100 25% UNIT 500 WINDSOR CO 80550-6250 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 Basic Deductible $1,000 N/A 239.3 Prepared NOV 08 2016 © Copyright, State Farm Mutual Automobile Insurance Company, 2000 CMP-4000 Includes copyrighted material of Insurance Services Office, Inc., with its permission. 014192 Continued on Next Page Page 2 of 7 StateFarm • • • DECLARATIONS (CONTINUED) Dry Cleaning And Laundering Services Policy for CITY OF FORT COLLINS Policy Number 96-CB-K216-7 Special Deductibles: Money and Securities $250 Employee Dishonesty Equipment Breakdown $1,000 Other deductibles may apply - refer to policy. $250 SECTION I - EXTENSIQNS 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 Off Premises Arson Reward Collapse Damage To Non -Owned Buildings From Theft, Burglary Or Robbery Debris Removal Equipment Breakdown Fire Department Service Charge Fire Extinguisher Systems Recharge Expense Forgery Or Alteration Glass Expenses Increased Cost Of Construction And Demolition Costs (applies only when buildings are insured on a replacement cost basis) Money And Securities (Off Premises) Money And Securities (On Premises) Prepared NOV 08 2016 CMP-4000 014193 290 N © Copyright, State Farm Mutual Automobile Insurance Company, 2008 Includes copyrighted material of Insurance Services Office, Inc., with its permission. Continued on Reverse Side of Page See Schedule See Schedule $5,000 Included Coverage B Limit 25% of covered loss Included $2,500 $5,000 $10,000 Included 10% See Schedule See Schedule Page 3 of 7 DECLARATIONS (CONTINUED) Dry Cleaning And Laundering Services Policy for CITY OF FORT COLLINS Policy Number 96-CB-K216-7 Money Orders And Counterfeit Money $1,000 Newly Acquired Business Personal Property (applies only if this policy provides $100,000 Coverage B - Business Personal Property) Newly Acquired Or Constructed Buildings (applies only if this policy provides $250,000 Coverage A - Buildings) Ordinance Or Law - Equipment Coverage Included Outdoor Property See Schedule Personal Effects (applies only to those premises provided Coverage B - Business $2,500 Personal Property) Personal Property Off Premises $15,000 Pollutant Clean Up And Removal $20,000 Preservation Of Property 30 Days Property Of Others (applies only to those premises provided Coverage B - Business See Schedule Personal Property) Signs See Schedule Valuable Papers And Records On Premises See Schedule Off Premises See Schedule Water Damage, Other Liquids, Powder Or Molten Material Damage Included SECTION I - EXTENSIONS OF COVERAGE - LIMIT OF INSURANCE - SCHEDULE The coverages and corresponding limits shown below apply only to the described premises as shown. LOCATION COVERAGE LIMIT OF INSURANCE 0001 Signs $2,500 Money And Securities (On Premises) $10,000 Money And Securities (Off Premises) $5,000 Property Of Others (applies only to those premises provided Coverage B - Business $100,000 Personal Property) Accounts Receivable (On Premises) $10,000 Accounts Receivable (Off Premises) $5,000 Outdoor Property $5,000 Prepared NOV 08 2016 © Copyright, State Farm Mutual Automobile Insurance Company, 2008 CMP-4000 Includes copyrighted material of Insurance Services Office, Inc., with its permission. 014193 Continued on Next Page Page 4 of 7 DECLARATIONS (CONTINUED) Dry Cleaning And Laundering Services Policy for CITY OF FORT COLLINS Policy Number 96-CB-K216-7 Valuable Papers and Records (On Premises) $10,000 Valuable Papers and Records (Off Premises) $5,000 0002 Signs $2,500 Money And Securities (On Premises) $10,000 Money And Securities (Off Premises) $5,000 Property Of Others (applies only to those premises provided Coverage B - Business $100,000 Personal Property) Accounts Receivable (On Premises) $10,000 Accounts Receivable (Off Premises) $5,000 Outdoor Property $5,000 Valuable Papers and Records (On Premises) $10,000 Valuable Papers and Records (Off Premises) $5,000 0003 Accounts Receivable (On Premises) $10,000 Accounts Receivable (Off Premises) $5,000 Money And Securities (Off Premises) $5,000 Money And Securities (On Premises) $10,000 Outdoor Property $5,000 Property Of Others (applies only to those premises provided Coverage B - Business $50,000 Personal Property) Signs $2,500 Valuable Papers and Records (On Premises) $10,000 Valuable Papers and Records (Off Premises) $5,000 0004 Accounts Receivable (On Premises) $10,000 Accounts Receivable (Off Premises) $5,000 Money And Securities (Off Premises) $5,000 Money And Securities (On Premises) $10,000 Outdoor Property $5,000 Property Of Others (applies only to those premises provided Coverage B - Business $50,000 Personal Property) Signs $2,500 Valuable Papers and Records (On Premises) $10,000 Valuable Papers and Records (Off Premises) $5,000 SECTION I - EXTENSIONS OF COVERAGE - LIMIT OF INSURANCE - PER POLICY The coverages and corresponding limits shown below are the most we will pay regardless of the number of described premises shown in these Declarations. COVERAGE Dependent Property - Loss Of Income Prepared NOV 08 2016 CMP-4000 © Copyright, State Farm Mutual Automobile Insurance Company, 2008 Includes copyrighted material of Insurance Services Office, Inc., with its permission. LIMIT OF INSURANCE $5,000 014194 290 Continued on Reverse Side of Page Page 5 of 7 N DECLARATIONS (CONTINUED) Dry Cleaning And Laundering Services Policy for CITY OF FORT COLLINS Policy Number 96-CB-K216-7 Employee Dishonesty Utility Interruption - Loss Of Income Loss Of Income And Extra Expense SECTION II - LIABILITY $10,000 $10,000 Actual Loss Sustained - 12 Months LIMIT OF COVERAGE INSURANCE Coverage L - Business Liability $1,000,000 Coverage M - Medical Expenses (Any One Person) $5,000 Damage To Premises Rented To You $300,000 LIMIT OF AGGREGATE LIMITS INSURANCE Products/Completed Operations Aggregate $2,000,000 General Aggregate $2,000,000 Each paid claim for Liability Coverage reduces the amount of insurance we provide during the applicable annual period. Please refer to Section II - Liability in the Coverage Form and any attached endorsements. Your policy consists of these Declarations, the BUSINESSOWNERS COVERAGE FORM shown below, and any other forms and endorsements that apply, including those shown below as well as those issued subsequent to the issuance of this policy. FORMS AND ENDORSEMENTS CMP-4100 Businessowners Coverage Form FE-6999.2 Terrorism Insurance Cov Notice CMP-4206.1 Amendatory Endorsement CMP-4705 Loss of Income & Extra Expnse CMP-4710 Employee Dishonesty CMP-4709 Money and Securities CMP-4704 Dependent Prop Loss of Income Prepared NOV 08 2016 © Copyright, State Farm Mutual Automobile Insurance Company, 2008 CMP-4000 Includes copyrighted material of Insurance Services Office, Inc., with its permission. 014194 Continued on Next Page Page 6 of 7 StateFarm • •• DECLARATIONS (CONTINUED) Dry Cleaning And Laundering Services Policy for CITY OF FORT COLLINS Policy Number 96-CB-K216-7 CMP-4703 Utility Interruption Loss Incm FE-3650 Actual Cash Value Endorsement CMP-4786 Add] Insd Owners Lessee Sched CMP-4787 Waiver of Trans Rgt of Recov CMP-4788 Addl Insd Mgrs Lessor of Prem FD-6007 Inland Marine Attach Dec This policy is issued by the State Farm Fire and Casualty Company. Participating Policy You are entitled to participate in a distribution of the earnings of the company as determined by our Board of Directors in accordance with the Company's Articles of Incorporation, as amended. In Witness Whereof, the State Farm Fire and Casualty Company has caused this policy to be signed by its President and Secretary at Bloomington, Illinois. Secretary President Prepared NOV 08 2016 CMP-4000 © Copyright, State Farm Mutual Automobile Insurance Company, 2008 Includes copyrighted material of Insurance Services Office, Inc., with its permission. 014195 290 N Page 7 of 7 State Farm STATE FARM FIRE AND CASUALTY COMPANY •n4b A STOCK COMPANY WITH HOME OFFICES IN BLOOMINGTON, ILLINOIS INLAND MARINE ATTACHING DECLARATIONS 33 Ravinaa r vQg Atlanfa G 30346-2117 Named Insured AISLING INC 5412 TAYLOR LN FORT COLLINS CO M-20-1648-FAF1 F Z 80528-8803 ATTACHING INLAND MARINE Policy Number 96-CB-K216-7 Policy Period Effective Date Expiration Date 12 Months JUL 22 2016 JUL 222017 The policy period begins and ends at 12:01 am standard time atthe premises ocation. Automatic Renewal - If the policy period is shown as 12 months, this policy will be renewed automatically subjectto the premiums, rules and forms in effectfor each succeeding policy period. If this policy is terminated, we will give you and the Mortgagee/Lienholder written notice in compliance with the policy provisions or as required by law. Annual Policy Premium Included The above Premium Amount is included in the Policy Premium shown on the Declarations. Your policy consists of these Declarations, the INLAND MARINE CONDITIONS shown below, and any other forms and endorsements that apply, including those shown below as well as those issued subsequentto the issuance of this policy. Forms, Options, and Endorsements FE-8739 Inland Marine Conditions FE-8743 Inland Marine Computer Prop See Reverse for Schedule Page with Limits Prepared NOV 08 2016 © Copyright, State Farm Mutual Automobile Insurance Company, 2008 FD-6007 Includes copyrighted material of Insurance Services Office, Inc., with its permission. 014196 530 685 a.2 05-31-2811 1022320 96-CB-K216-7 ATTACHING INLAND MARINE SCHEDULE PAGE ATTACHING INLAND MARINE ENDORSEMENT NUMBER FE-8743 Prepared NOV 08 2016 FD-6007 COVERAGE Inland Marine Computer Prop Loss of Income and Extra Expense LIMIT OF INSURANCE 25,000 25,000 DEDUCTIBLE AMOUNT OTHER LIMITS AND EXCLUSIONS MAY APPLY - REFER TO YOUR POLICY © Copyright, State Farm Mutual Automobile Insurance Company, 2008 Includes copyrighted material of Insurance Services Office, Inc., with its permission. 500 ANNUAL PREMIUM Included Included 014196 539 586 a.2 05 31 2011 (.M2330 RENEWAL DECLARATIONS (CONTINUED) Dry Cleaning And Laundering Services Policy for CITY OF FORT COLLINS Policy Number 96-CB-K216-7 SECTION I - PROPERTY SCHEDULE Location Number Location of Described Premises Limit of Insurance` Coverage A - Buildings Limit of Insurance* Coverage B - Business Personal Property Seasonal Increase - Business Personal Property 001 1827 E MULBERRY ST No Coverage $ 331,900 25% FORT COLLINS CO 80524-3525 002 725 S LEMAY AVE No Coverage $ 20,600 25% FORT COLLINS CO 80524-3245 003 3675 S COLLEGE AVE STE 21 No Coverage $ 20,400 25% FORT COLLINS CO 80525-3044 004 1357 WATER VALLEY PKWY No Coverage $ 20,400 25% UNIT 500 WINDSOR CO 80550-6250 * As of the effective date of this policy, the Limit of Insurance as shown includes any increase in the limit due to Inflation Coverage. SECTION I - INFLATION COVERAGE INDEX(ES) Cov A - Inflation Coverage Index: Cov B - Consumer Price Index: SECTION I - DEDUCTIBLES Basic Deductible $1,000 N/A 243.6 Prepared APR 10 2017 C Copyright, State Farm Mutual Automobile Insurance Company, 2008 CMP-4000 Includes copyrighted material of Insurance Services Office, Inc., with its permission. 025979 Continued on Next Page Page 2 of 8 StateFarm • • • RENEWAL DECLARATIONS (CONTINUED) Dry Cleaning And Laundering Services Policy for CITY OF FORT COLLINS Policy Number 96-CB-K216-7 Special Deductibles: •�; Money and Securities $250 Equipment Breakdown $1,000 0 4 Other deductibles may apply - refer to policy. 0 N O Employee Dishonesty $250 SECTION I - EXTENSIONS OF COVERAGE - LIMIT OF INSURANCE - EACH DESCRIBED PREMISES The coverages and corresponding limits shown below apply separately to each described premises shown in these Declarations, unless indicated by "See Schedule." If a coverage does not have a corresponding limit shown below, but has "Included" indicated, please refer to that policy provision for an explanation of that coverage. COVERAGE Accounts Receivable On Premises Off Premises Arson Reward Collapse Damage To Non -Owned Buildings From Theft, Burglary Or Robbery Debris Removal Equipment Breakdown Fire Department Service Charge Fire Extinguisher Systems Recharge Expense Forgery Or Alteration Glass Expenses Increased Cost Of Construction And Demolition Costs (applies only when buildings are insured on a replacement cost basis) Money And Securities (Off Premises) Money And Securities (On Premises) Prepared APR 10 2017 Copyright, State Farm Mutual Automobile Insurance Company, 2008 CMP-4000 Includes copyrighted material of Insurance Services Office, Inc., with its permission. 025980 294 Continued on Reverse Side of Page N LIMIT OF INSURANCE See Schedule See Schedule $5,000 Included Coverage B Limit 25% of covered loss Included $2,500 $5,000 $10,000 Included 10% See Schedule See Schedule Page 3 of 8 RENEWAL DECLARATIONS (CONTINUED) Dry Cleaning And Laundering Services Policy for CITY OF FORT COLLINS Policy Number 96-CB-K216-7 Money Orders And Counterfeit Money Newly Acquired Business Personal Property (applies only if this policy provides Coverage B - Business Personal Property) Newly Acquired Or Constructed Buildings (applies only if this policy provides Coverage A - Buildings) Ordinance Or Law - Equipment Coverage Outdoor Property Personal Effects (applies only to those premises provided Coverage B - Business Personal Property) Personal Property Off Premises Pollutant Clean Up And Removal Preservation Of Property Property Of Others (applies only to those premises provided Coverage B - Business Personal Property) Signs Valuable Papers And Records On Premises Off Premises Water Damage, Other Liquids, Powder Or Molten Material Damage SECTION I - EXTENSIONS OF COVERAGE - LIMIT OF INSURANCE - SCHEDULE $1,000 $100,000 $250,000 Included See Schedule $2,500 $15,000 $20,000 30 Days See Schedule See Schedule See Schedule See Schedule Included The coverages and corresponding limits shown below apply only to the described premises as shown. LOCATION COVERAGE LIMIT OF INSURANCE 0001 Signs $2,500 Money And Securities (On Premises) $10,000 Money And Securities (Off Premises) $5,000 Property Of Others (applies only to those premises provided Coverage B - Business $100,000 Personal Property) Accounts Receivable (On Premises) $10,000 Accounts Receivable (Off Premises) $5,000 Outdoor Property $5,000 Prepared APR 10 2017 Copyright, State Farm Mutual Automobile Insurance Company, 2008 CMP-4000 Includes copyrighted material of Insurance Services Office, Inc., with its permission. 025980 Continued on Next Page Page 4 of 8 StateFarm • :, RENEWAL DECLARATIONS (CONTINUED) Dry Cleaning And Laundering Services Policy for CITY OF FORT COLLINS Policy Number 96-CB-K216-7 ._•• ' Valuable Papers and Records (On Premises) $10,000 Valuable Papers and Records (Off Premises) $5,000 0002 Signs $2,500 o Money And Securities (On Premises) $10,000 $ Money And Securities (Off Premises) $5,000 Property Of Others (applies only to those premises provided Coverage B - Business $100,000 Personal Property) Accounts Receivable (On Premises) $10,000 Accounts Receivable (Off Premises) $5,000 Outdoor Property $5,000 Valuable Papers and Records (On Premises) $10,000 Valuable Papers and Records (Off Premises) $5,000 0003 Accounts Receivable (On Premises) $10,000 Accounts Receivable (Off Premises) $5,000 Money And Securities (Off Premises) $5,000 Money And Securities (On Premises) $10,000 Outdoor Property $5,000 Property Of Others (applies only to those premises provided Coverage B - Business $50,000 Personal Property) Signs $2,500 Valuable Papers and Records (On Premises) $10,000 Valuable Papers and Records (Off Premises) $5,000 0004 Accounts Receivable (On Premises) $10,000 Accounts Receivable (Off Premises) $5,000 Money And Securities (Off Premises) $5,000 Money And Securities (On Premises) $10,000 Outdoor Property $5,000 Property Of Others (applies only to those premises provided Coverage B - Business $50,000 Personal Property) Signs $2,500 Valuable Papers and Records (On Premises) $10,000 Valuable Papers and Records (Off Premises) $5,000 SECTION I - EXTENSIONS OF COVERAGE - LIMIT OF INSURANCE - PER POLICY The coverages and corresponding limits shown below are the most we will pay regardless of the number of described premises shown in these Declarations. COVERAGE Dependent Property - Loss Of Income Prepared APR 10 2017 CMP-4000 C; Copyright, State Farm Mutual Automobile Insurance Company, 2008 Includes copyrighted material of Insurance Services Office, Inc., with its permission. LIMIT OF INSURANCE $5,000 025981 294 N Continued on Reverse Side of Page Page 5 of 8 RENEWAL DECLARATIONS (CONTINUED) Dry Cleaning And Laundering Services Policy for CITY OF FORT COLLINS Policy Number 96-CB-K216-7 Employee Dishonesty Utility Interruption - Loss Of Income Loss Of Income And Extra Expense SECTION II - LIABILITY $10,000 $10,000 Actual Loss Sustained - 12 Months LIMIT OF COVERAGE INSURANCE Coverage L - Business Liability $1,000,000 Coverage M - Medical Expenses (Any One Person) $5,000 Damage To Premises Rented To You $300,000 LIMIT OF AGGREGATE LIMITS INSURANCE Products/Completed Operations Aggregate $2,000,000 General Aggregate $2,000,000 Each paid claim for Liability Coverage reduces the amount of insurance we provide during the applicable annual period. Please refer to Section II - Liability in the Coverage Form and any attached endorsements. Your policy consists of these Declarations, the BUSINESSOWNERS COVERAGE FORM shown below, and any other forms and endorsements that apply, including those shown below as well as those issued subsequent to the issuance of this policy. FORMS AND ENDORSEMENTS CMP-4100 Businessowners Coverage Form FE-6999.2 'Terrorism Insurance Cov Notice CMP-4206.1 Amendatory Endorsement CMP-4705 Loss of Income & Extra Expnse CMP-4710 Employee Dishonesty CMP-4709 Money and Securities CMP-4704 Dependent Prop Loss of Income Prepared APR 10 2017 Copyright, State Farm Mutual Automobile Insurance Company, 2008 CMP-4000 Includes copyrighted material of Insurance Services Office, Inc., with its permission. 025981 Continued on Next Page Page 6 of 8 StateFarm • •• RENEWAL DECLARATIONS (CONTINUED) 9 Dry Cleaning And Laundering Services Policy for CITY OF FORT COLLINS Policy Number 96-CB-K216-7 CMP-4703 Utility Interruption Loss Incm FE-3650 Actual Cash Value Endorsement CMP-4786 Addl Insd Owners Lessee Sched CMP-4787 Waiver of Trans Rgt of Recov CMP-4788 Addl Insd Mgrs Lessor of Prem FD-6007 Inland Marine Attach Dec New Form Attached This policy is issued by the State Farm Fire and Casualty Company. Participating Policy You are entitled to participate in a distribution of the earnings of the company as determined by our Board of Directors in accordance with the Company's Articles of Incorporation, as amended. In Witness Whereof, the State Farm Fire and Casualty Company has caused this policy to be signed by its President and Secretary at Bloomington, Illinois. Secretary President Prepared APR 10 2017 © Copyright, State Farm Mutual Automobile Insurance Company, 2008 CMP-4000 Includes copyrighted material of Insurance Services Office, Inc., with its permission. 025982 294 Continued on Reverse Side of Page N Page 7 of 8 RENEWAL DECLARATIONS (CONTINUED) Dry Cleaning And Laundering Services Policy for CITY OF FORT COLLINS Policy Number 96-CB-K216-7 NOTICE TO POLICYHOLDER: For a comprehensive description of coverages and forms, please refer to your policy. Policy changes requested before the "Date Prepared", which appear on this notice, are effective on the Renewal Date of this policy unless otherwise indicated by a separate endorsement, binder, or amended declarations. Any coverage forms attached to this notice are also effective on the Renewal Date of this policy. Policy changes requested after the "Date Prepared" will be sent to you as an amended declarations or as an endorsement to your policy. Billing for any additional premium for such changes will be mailed at a later date. If, during the past year, you've acquired any valuable property items, made any improvements to insured property, or have any questions about your insurance coverage, contact your State Farm agent. Please keep this with your policy. Prepared APR 10 2017 ^ Copyright, State Farm Mutual Automobile Insurance Company, 2008 CMP-4000 Includes copyrighted material of Insurance Services Office, Inc., with its permission. 025982 294 N Page 8 of 8 StateFarm • • • STATE FARM FIRE AND CASUALTY COMPANY A STOCK COMPANY WITH HOME OFFICES IN BLOOMINGTON, ILLINOIS INLAND MARINE ATTACHING DECLARATIONS A tlaRavinnta C��ia�Jr30346-2117 Named Insured M-20-1648-FAF1 F Z AISLING INC 1827 E MULBERRY ST FORT COLLINS CO 80524-3525 0 0 g Ls 0 0 ATTACHING INLAND MARINE Policy Number 96-CB-K216-7 Policy Period Effective Date Expiration Date 12 Months JUL 22 2017 JUL 222018 The policy period begins and ends at 12:01 am standard time at the premises locabon. Automatic Renewal - If the policy period is shown as 12 months, this policy will be renewed automatically subjectto the premiums, rules and forms in effect for each succeeding policy period. If this policy is terminated, we will give you and the Mortgagee/Lienholder written notice in comoliance with the Policv provisions or as reauired by law. Annual Policy Premium Included The above Premium Amountis included in the Policy Premium shown on the Declarations. Your policy consists of these Declarations, the INLAND MARINE CONDITIONS shown below, and any other forms and endorsements that apply, including those shown below as well as those issued subsequentto the issuance of this policy. Forms, Options, and Endorsements FE-8739 Inland Marine Conditions FE-8743 Inland Marine Computer Prop See Reverse for Schedule Page with Limits Prepared APR 10 2017 © Copyright, State Farm Mutual Automobile Insurance Company, 2008 FD-6007 Includes copyrighted material of Insurance Services Office, Inc., with its permission. 025983 530 585 a.2 05-31-2011 1oIQ232cI