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HomeMy WebLinkAboutLLOYDS BARBER SHOP LLC - INSURANCE CERTIFICATE (6)STATE FARM FIRE AND CASUALTY COMPANY A STOCK COMPANY WITH HOME OFFICES IN BLOOMINGTON, ILLINOIS RENEWAL DECLARATIONS StateFarm • • • 0 0 0 0 0 tlantaRaviniiVr30346-2117 Addl Insured -Section II Only AT2 M-20-2644-FAF1 F Z 006416 3125 CITY OF FORT COLLINS PO BOX 580 FORT COLLINS CO 80522-0580 I�IIIIIII�I�III�III�I��llll�ll�lllllllllrl�llllllllllllll1�ll�l�l Policy Number 96-138-1<105-4 Policy Period Effective Date Expiration Date 12 Months JAN 12 2017 JAN 122018 The poll y period beggins and ends at 12:01 am standard time at e premises Tocation. Named Insured LLOYDS BARBER SHOP LLC 226 S COLLEGE AVE FORT COLLINS CO 80524-2811 Hair Salon, Day Spa and Barber Policy Automatic Renewal - If the policy period is shown as 12 months, this policy will be renewed automatically subjectto the premiums, rules and forms in effect for each succeeding policy period. If this policy is terminated, we will give you and the Mortgagee/Lienholder written notice in compliance with the policy provisions or as required by law. Entity: Limited Liability Company NOTICE: Information concerning changes in your policy language is included. Please call your agent if you have any questions. POLICY PREMIUM Minimum Premium Discounts Applied: Renewal Year Claim Record $ 475.00 Prepared FEB 16 2017 C Copyright, State Farm Mutual Automobile Insurance Company, 2008 CMP-4000 Includes copyrighted material of Insurance Services Office, Inc., with its permission. 039686 294 Al Continued on Reverse Side of Page N Page 1 of 7 RENEWAL DECLARATIONS (CONTINUED) Hair Salon, Day Spa and Barber Policy for CITY OF FORT COLLINS Policy Number 96-B8-K105-4 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 001 226 S COLLEGE AVE No Coverage $ 23,400 25% FORT COLLINS CO 80524-2811 . 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 1- DEDUCTIBLES N/A 241.7 Basic Deductible $500 Special Deductibles: Money and Securities $250 Employee Dishonesty $250 Equipment Breakdown $500 Other deductibles may apply - refer to policy. Prepared FEB 16 2017 C Copyright, State Farm Mutual Automobile Insurance Company, 2008 CMP-4000 Includes copyrighted material of Insurance Services Office, Inc., with its permission. 039686 Continued on Next Page Page 2 of 7 StateFarm • • • RENEWAL DECLARATIONS (CONTINUED) Hair Salon, Day Spa and Barber Policy for CITY OF FORT COLLINS Policy Number 96-138-1<105-4 SECTION I - EXTENSIONS OF COVERAGE - LIMIT OF INSURANCE - EACH DESCRIBED PREMISES �o 0 s 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, N but has "Included" indicated, please refer to that policy provision for an explanation of that coverage. 0 COVERAGE Accounts Receivable On Premises Off Premises Arson Reward Back -Up Of Sewer Or Drain Brands And Labels Collapse Damage To Non -Owned Buildings From Theft, Burglary Or Robbery Debris Removal Employee Equipment - Off Premises (applies only to those premises provided Coverage B - Business Personal Property) Per Occurrence Per Employee Per Piece Employee Equipment - On Premises (applies only to those premises provided Coverage B - Business Personal Property) Per Occurrence Per Employee Per Piece Equipment Breakdown Fire Department Service Charge Fire Extinguisher Systems Recharge Expense Forgery Or Alteration Glass Expenses Prepared FEB 16 2017 C Copyright, State Farm Mutual Automobile Insurance Company, 2008 CMP-4000 Includes copyrighted material of Insurance Services Office, Inc., with its permission. 039687 294 Continued on Reverse Side of Page N LIMIT OF INSURANCE $10,000 $5,000 $5,000 $10,000 $25,000 Included Coverage B Limit 25% of covered loss $2,500 $1,000 $500 $5,000 $1,000 $500 Included $2,500 $5,000 $10,000 Included Page 3 of 7 RENEWAL DECLARATIONS (CONTINUED) Hair Salon, Day Spa and Barber Policy for CITY OF FORT COLLINS Policy Number 96-68-K105-4 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) Ordinance Or Law - Equipment Coverage Included Outdoor Property $5,000 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 $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 Valuable Papers And Records On Premises $10,000 Off Premises $5,000 Water Damage, Other Liquids, Powder Or Molten Material Damage Included Prepared FEB 16 2017 'D Copyright, State Farm Mutual Automobile Insurance Company, 2008 CMP-4000 Includes copyrighted material of Insurance Services Office, Inc., with its permission. 039687 Continued on Next Page Page 4 of 7 StateFarm • • • RENEWAL DECLARATIONS (CONTINUED) Hair Salon, Day Spa and Barber Policy for CITY OF FORT COLLINS Policy Number 96-138-K105-4 1`W S 8 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 SECTION II - LIABILITY LIMIT OF COVERAGE INSURANCE Coverage L - Business Liability $1,000,000 Coverage M - Medical Expenses (Any One Person) $5,000 Barber And Cosmetologist Professional Liability $1,000,000 Damage To Premises Rented To You $300,000 LIMIT OF AGGREGATE LIMITS INSURANCE Products/Completed Operations Aggregate Excluded General Aggregate $2,000,000 Professional Aggregate $1,000,000 Prepared FEB 16 2017 C Copyright, State Farm Mutual Automobile Insurance Company, 2008 CMP-4000 Includes copyrighted material of Insurance Services Office, Inc., with its permission. 039688 294 Continued on Reverse Side of Page Page 5 of 7 N RENEWAL DECLARATIONS (CONTINUED) Hair Salon, Day Spa and Barber Policy for CITY OF FORT COLLINS Policy Number 96-138-1<105-4 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-3650 `Actual Cash Value Endorsement FE-6999.2 'Terrorism Insurance Cov Notice CMP-4826 Employee Equipment Coverage CMP-4825 Brands and Labels CMP-4206.1 Amendatory Endorsement CMP-4705 Loss of Income & Extra Expnse CMP-4710 Employee Dishonesty CMP-4709 Money and Securities CMP-4706 Back -Up of Sewer or Drain CMP-4704 Dependent Prop Loss of Income CMP-4703 Utility Interruption Loss Incm CMP-4793 Al State Political Perm Prem CMP-4402 Barber Cosmetologist Prof Liab CMP-4845 Excl Product Comp Operatn Liab 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 Prepared FEB 16 2017 Cc Copyright, State Farm Mutual Automobile Insurance Company, 2008 CMP-4000 Includes copyrighted material of Insurance Services Office, Inc., with its permission. 039688 Continued on Next Page Page 6 of 7 StateFarm • • RENEWAL DECLARATIONS (CONTINUED) Hair Salon, Day Spa and Barber Policy for CITY OF FORT COLLINS Policy Number 96-138-K105-4 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 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 FEB 16 2017 CMP-4000 © Copyright, State Farm Mutual Automobile Insurance Company, 2008 Includes copyrighted material of Insurance Services Office, Inc., with its permission. 039689 294 N Page 7 of 7 STATE FARM FIRE AND CASUALTY COMPANY A STOCK COMPANY WITH HOME OFFICES IN BLOOMINGTON, ILLINOIS INLAND MARINE ATTACHING DECLARATIONS StateFarm • • • ELM 3 Ravinia8 nv Atlanta G 3346 2i 17 M-20-2644-FAF1 F Z Named Insured LLOYDS BARBER SHOP LLC 226 S COLLEGE AVE FORT COLLINS CO 80524-2811 ATTACHING INLAND MARINE Policy Number 96-138-K105-4 Policy Period Effective Date Expiration Date 12 Months JAN 12 2017 JAN 122018 The poll y period begins and ends at 12:01 am standard time ame premises location. Automatic Renewal - If the policy period is shown as 12 months, this policy will be renewed automatically subjectto the premiums, rules and forms in effect for each succeeding policy period. If this policy is terminated, we will give you and the Mortgagee/Lienholder written notice in compliance with the policy provisions or as required by law. Annual Policy Premium Included The above Premium Amount is included in the Policy Premium shown on the Declarations. Your policy consists of these Declarations, the INLAND MARINE CONDITIONS shown below, and any other forms and endorsements that apply, including those shown below as well as those issued subsequentto the issuance of this policy. Forms, Options, and Endorsements FE-8739 Inland Marine Conditions FE-8743 Inland Marine Computer Prop See Reverse for Schedule Page with Limits Prepared FEB 16 2017 C Copyright, State Farm Mutual Automobile Insurance Company, 2008 FD-6007 Includes copyrighted material of Insurance Services Office, Inc., with its permission. 039690 96-138-11<105-4 ATTACHING INLAND MARINE SCHEDULE PAGE ATTACHING INLAND MARINE ENDORSEMENT LIMIT OF DEDUCTIBLE ANNUAL NUMBER COVERAGE INSURANCE AMOUNT PREMIUM FE-8743 Inland Marine Computer Prop Loss of Income and Extra Expense Prepared FEB 16 2017 FD-6007 039690 $ 25,000 $ 25,000 5 500 Included Included 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. 530 686 a.2 05 31-2011 loi f3233c