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HomeMy WebLinkAbout548846 CAROLINE BRADFORD - INSURANCE CERTIFICATE (9)STATE FARM FIRE AND CASUALTY COMPANY A STOCK COMPANY WITH HOME OFFICES IN BLOOMINGTON, ILLINOIS RENEWAL DECLARATIONS StateFarm • • • 3 Ravini8 nvQQ Atlanta Ci 3o346-21 i7 Addl Insured -Section 11 Only AT2 M-20-1676-FAD1 F U 004165 3125 CITY OF FORT COLLINS PO BOX 580 FORT COLLINS CO 80522-0580 11111111111111111111111111111111111IN ... 11 Office Policy Policy Number 96-B6-G139-6 Policy Period 12 Months Effective Date Expiration Date AUG 19 2017 AUG 19 2018 The poll y period beggins time at a premises and ends at 12:01 am standard location. Named Insured BRADFORD, CAROLINE PO BOX 930 EAGLE CO 81631-0930 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 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 Years in Business Claim Record $ 325.00 Prepared MAY 08 2017 T Copyright, State Farm Mutual Automobile Insurance Company, 2008 CMP-4000 Includes copyrighted material of Insurance Services Office, Inc., with its permission. 026116 294 AI Continued on Reverse Side of Page Page 1 of 7 N 530 586 a.2 05 31 2011 lot RENEWAL DECLARATIONS (CONTINUED) Office Policy for CITY OF FORT COLLINS Policy Number 96-66-G139-6 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 49 HOCKETT ST No Coverage $ 1,300 25% EAGLE CO 81631 * 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 INDEWES) Cov A - Inflation Coverage Index: Cov B - Consumer Price Index: SECTION I - DEDUCTIBLES N/A 243.8 Basic Deductible $1,000 Special Deductibles: Money and Securities $250 Employee Dishonesty $250 Equipment Breakdown $1,000 Other deductibles may apply - refer to policy. Prepared MAY 08 2017 Cc Copyright, State Farm Mutual Automobile Insurance Company, 2008 CMP-4000 Includes copyrighted material of Insurance Services Office, Inc., with its permission. 026116 Continued on Next Page Page 2 of 7 StateFarm • • • RENEWAL DECLARATIONS (CONTINUED) Office Policy for CITY OF FORT COLLINS Policy Number 96-136-G139-6 9 SECTION I - EXTENSIONS OF COVERAGE - LIMIT OF INSURANCE - EACH DESCRIBED PREMISES 0 IT 0 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. 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 MAY 08 2017 © Copyright, State Farm Mutual Automobile Insurance Company, 2008 CMP-4000 Includes copyrighted material of Insurance Services Office, Inc., with its permission. 026117 294 Continued on Reverse Side of Page Page 3 of 7 N RENEWAL DECLARATIONS (CONTINUED) Office Policy for CITY OF FORT COLLINS Policy Number 96-66-G139-6 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 Unauthorized Business Card Use Valuable Papers And Records On Premises Off Premises Water Damage, Other Liquids, Powder Or Molten Material Damage Included $5,000 $5,000 $15,000 $10,000 30 Days $2,500 $2,500 $5,000 $50,000 $15,000 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 MAY 08 2017 '0 Copyright, State Farm Mutual Automobile Insurance Company, 2008 CMP-4000 Includes copyrighted material of Insurance Services Office, Inc., with its permission. 026117 Continued on Next Page Page 4 of 7 StateFarm • •• RENEWAL DECLARATIONS (CONTINUED) Office Policy for CITY OF FORT COLLINS Policy Number 96-B6-G139-6 SECTION II - LIABILITY 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 $2,0007000 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 FE-6999.2 CMP-4819.1 CMP-4206.1 CMP-4705 CMP-4710 CMP-4709 CMP-4706 CMP-4704 CMP-4703 CMP-4786 FE-3650 FD-6007 Prepared MAY 08 2017 CMP-4000 Businessowners Coverage Form `Terrorism Insurance Cov Notice Unauthorized Business Card Use Amendatory Endorsement Loss of Income & Extra Expnse Employee Dishonesty Money and Securities Back -Up of Sewer or Drain Dependent Prop Loss of Income Utility Interruption Loss Incm Addl Insd Owners Lessee Sched Actual Cash Value Endorsement Inland Marine Attach Dec © Copyright, State Farm Mutual Automobile Insurance Company, 2008 Includes copyrighted material of Insurance Services Office, Inc., with its permission. 026118 294 N Continued on Reverse Side of Page Page 5 of 7 RENEWAL DECLARATIONS (CONTINUED) Office Policy for CITY OF FORT COLLINS Policy Number 96-136-G139-6 * 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 MAY 08 2017 Copyright, State Farm Mutual Automobile Insurance Company, 2008 CMP-4000 Includes copyrighted material of Insurance Services Office, Inc., with its permission. 026118 Continued on Next Page Page 6 of 7 StateFarm • •• RENEWAL DECLARATIONS (CONTINUED) Office Policy for CITY OF FORT COLLINS Policy Number 96-1136-G139-6 NOTICE TO POLICYHOLDER: g 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 16 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 MAY 08 2017 CMP-4000 CD Copyright, State Farm Mutual Automobile Insurance Company, 2008 Includes copyrighted material of Insurance Services Office, Inc., with its permission. 026119 294 N Page 7 of 7 StateFarm • • • STATE FARM FIRE AND CASUALTY COMPANY A STOCK COMPANY WITH HOME OFFICES IN BLOOMINGTON, ILLINOIS INLAND MARINE ATTACHING DECLARATIONS N ,o 0 8 0 3 Ravinraa rry Atlanta v 3346 2117 Named Insured BRADFORD, CAROLINE PO BOX 930 EAGLE CO 81631-0930 ATTACHING INLAND MARINE M-20-1676-FAD1 F U Policy Number 96-B6-G139-6 Policy Period Effective Date Expiration Date 12 Months AUG 19 2017 AUG 19 2018 The poll��y period begins and ends at 12:01 am standard time attire 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 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 MAY 08 2017 Copyright, State Farm Mutual Automobile Insurance Company, 2008 FD-6007 Includes copyrighted material of Insurance Services Office, Inc., with its permission. 026120 530 686 a.2 05 31-2011 1o113232cI ATTACHING INLAND MARINE SCHEDULE PAGE ATTACHING INLAND MARINE ENDORSEMENT LIMIT OF DEDUCTIBLE ANNUAL NUMBER COVERAGE INSURANCE AMOUNT PREMIUM FE-8743 Inland Marine Computer Prop 5 25,000 S 500 Included Loss of Income and Extra Expense S 25,000 Included Prepared MAY 08 2017 FD-6007 OTHER LIMITS AND EXCLUSIONS MAY APPLY - REFER TO YOUR POLICY .c Copyright, State Farm Mutual Automobile Insurance Company, 2008 Includes copyrighted material of Insurance Services Office, Inc., with its permission. 026120 530 606 a.2 05-31 2011 WQ233c!