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HomeMy WebLinkAboutNATIONAL RESEARCH CENTER INC - INSURANCE CERTIFICATEStateFarm • STATE FARM FIRE AND CASUALTY COMPANY A STOCK COMPANY WITH HOME OFFICES IN BLOOMINGTON, ILLINOIS RENEWAL DECLARATIONS a 0 g r in L6 0 0 3 Ravinnta Ai1 Dr31346-2117 Atla Addl Insured -Section II Only AT2 M-20-2388-FA65 F U 002173 3125 CITY OF FORT COLLINS, CITY HALL WEST 300 LAPORTE AVE FORT COLLINS CO 80521-2719 IIIIIIIII"IIIIIII'Il'Illl'Illlllllll'I"II"IIIIII'I'I'I"I'l'Ill Office Policy Policy Number 96-BU-3823-8 Policy Period Effective Date Expiration Date 12 Months NOV 16 2017 i ON 16 2018 The poly period be?ins and ends at 12:01 am standard time at a premises ocalion. Named Insured NATIONAL RESEARCH CENTER INC 2955 VALMONT RD STE 300 BOULDER CO 80301-1360 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: Renewal Year Years in Business Sprinkler Claim Record $ 734.00 Prepared AUG 04 2017 C Copyright, State Farm Mutual Automobile Insurance Company, 2008 CMP-4000 Includes copyrighted material of Insurance Services Office, Inc., with its permission. 013777 294 Al Continued on Reverse Side of Page Page 1 of 7 N 5m-RAR a i nti ii inii im StateFarm • • • STATE FARM FIRE AND CASUALTY COMPANY A STOCK COMPANY WITH HOME OFFICES IN BLOOMINGTON, ILLINOIS DECLARATIONS AMENDED JUL 24 2017 3 tlanta CAA Ravinia r9v A346-2117 M-20-2388-FA65 F U 002041 3123 Addl Insured -Section II Only CITY OF FORT COLLINS, CITY HALL WEST 300 LAPORTE AVE FORT COLLINS CO 80521-2719 Office Policy Policy Number 96-BU-3823-8 Policy Period Effective Date Expiration Date 12 Months NOV 16 2017 NOV 16 2018 The poll y period begins and ends at 12:01 am standard time at a premises location. Named Insured NATIONAL RESEARCH CENTER INC 2955 VALMONT RD STE 300 BOULDER CO 80301-1360 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: Corporation Reason for Declarations: Your policy is amended JUL 24 2017 ADDITIONAL INSURED ADDED PREMIUM ADJUSTMENT FORM CMP-4786 ADDED Endorsement Premium Discounts Applied: Renewal Year Years in Business Sprinkler Claim Record Other items shown are effective with the policy's 2017 renewal None Prepared AUG 14 2017 © Copyright, State Farm Mutual Automobile Insurance Company, 2008 CMP-4000 Includes copyrighted material of Insurance Services Office, Inc., with its permission. 017441 290 Al Continued on Reverse Side of Page Page 1 of 6 N can aus o ns i inn a i DECLARATIONS (CONTINUED) Office Policy for CITY OF FORT COLLINS, Policy Number 96-BU-3823-8 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 2955 VALMONT RD STE 300 No Coverage $ 81.600 25% BOULDER CO 80301-1360 * 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 INDEVES1 Cov A - Inflation Coverage Index: Cov B - Consumer Price Index: SECTION I - DEDUCTIBLES N/A 245.0 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 AUG 14 2017 O Copyright, State Farm Mutual Automobile Insurance Company, 2008 CMP-4000 Includes copyrighted material of Insurance Services Office, Inc., with its permission. 017441 Continued on Next Page Page 2 of 6 StateFarm • •'� DECLARATIONS (CONTINUED) Office Policy for CITY OF FORT COLLINS, Policy Number 96-BU-3823-8 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 AUG 14 2017 © Copyright, State Farm Mutual Automobile Insurance Company, 2008 CMP-4000 Includes copyrighted material of Insurance Services Office, Inc., with its permission. 017442 290 Continued on Reverse Side of Page Page 3 of 6 N DECLARATIONS (CONTINUED) Office Policy for CITY OF FORT COLLINS, Policy Number 96-BU-3823-8 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 $100,000 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 AUG 14 2017 © Copyright, State Farm Mutual Automobile Insurance Company, 2008 CMP-4000 Includes copyrighted material of Insurance Services Office, Inc., with its permission. 017442 Continued on Next Page Page 4 of 6 StateFarm • •• DECLARATIONS (CONTINUED) Office Policy for CITY OF FORT COLLINS, Policy Number 96-BU-3823-8 SECTION 11 - LIABILITY LIMIT OF COVERAGE INSURANCE Coverage L - Business Liability $2,000,000 Coverage M - Medical Expenses (Any One Person) $10,000 Damage To Premises Rented To You $300,000 LIMIT OF AGGREGATE LIMITS INSURANCE Products/Completed Operations Aggregate $4,000,000 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 CMP-4786 CMP-4206.1 FE-6999.2 CMP-4746 CMP-4787 CMP-4713 CMP-4819.1 CMP-4706 CMP-4704 CMP-4710 CMP-4709 CMP-4703 Prepared AUG 14 2017 CMP-4000 Businessowners Coverage Form `Addl Insd Owners Lessee Sched Amendatory Endorsement Terrorism Insurance Cov Notice Hired Auto Liability Waiver of Trans Rgt of Recov Excl Testing Consulting E&O Unauthorized Business Card Use Back -Up of Sewer or Drain Dependent Prop Loss of Income Employee Dishonesty Money and Securities Utility Interruption Loss Incm © Copyright, State Farm Mutual Automobile Insurance Company, 2008 Includes copyrighted material of Insurance Services Office, Inc., with its permission. 017443 290 N Continued on Reverse Side of Page Page 5 of 6 DECLARATIONS (CONTINUED) Office Policy for CITY OF FORT COLLINS, Policy Number 96-BU-3823-8 CMP-4705 Loss of Income & Extra Expnse CMP-4788 Addl Insd Mgrs Lessor of Prem CMP-4785 Addl Ins Owners Lessee Blkt CMP-4860 Al Design Person Org FE-3650 Actual Cash Value Endorsement CMP-4859 Al Engineer Architect Survey 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 AUG 14 2017 CMP-4000 © Copyright, State Farm Mutual Automobile Insurance Company, 2D08 Includes copyrighted material of Insurance Services Office, Inc., with its permission. 017443 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 Ra vini2�Jr3S346-21 i 7 tlanta CGS M-20-2388-FA65 F U Named Insured NATIONAL RESEARCH CENTER INC 2955 VALMONT RD STE 300 BOULDER CO 80301-1360 ATTACHING INLAND MARINE Policy Number 96-BU-3823-8 Policy Period Effective Date Expiration Date 12 Months NOV 16 2017 NOV 16 2018 The policy period begins and ends at 12:01 am standard time at the premisesTocabon. 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-8743 Inland Marine Computer Prop FE-8739 Inland Marine Conditions See Reverse for Schedule Page with Limits Prepared AUG 14 2017 © Copyright, State Farm Mutual Automobile Insurance Company, 2008 FD-6007 Includes copyrighted material of Insurance Services Office, Inc., with its permission. 017444 538 686 a.2 85-31-2811 (oIQ232cI ATTACHING INLAND MARINE SCHEDULE PAGE ATTACHING INLAND MARINE ENDORSEMENT NUMBER FE-8743 Prepared AUG 14 2017 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 017444 530-686 a.2 05 31 2011 10033d State Farm • ••; STATE FARM FIRE AND CASUALTY COMPANY A STOCK COMPANY WITH HOME OFFICES IN BLOOMINGTON, ILLINOIS DECLARATIONS AMENDED JUL 11 2017 Atlanta 1GA r3Y346-2117 M-20-2388-FA65 F U 002293 3123 Addl Insured -Section II Only CITY OF FORT COLLINS, CITY HALL WEST 300 LAPORTE AVE FORT COLLINS CO 80521-2719 Policy Number 96-BU-3823-8 Policy Period Effective Date Expiration Date 12 Months NOV 16 2017 NOV 16 2018 The policy period begins and ends at 12:01 am standard time atthe premisesTocation. Named Insured NATIONAL RESEARCH CENTER INC 2955 VALMONT RD STE 300 BOULDER CO 80301-1360 Office Policy Automatic Renewal -If the policy period is shown as 12 months , this policy will be renewed automatically subject to 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 JUL 11 2017 ADDITIONAL INSURED ADDED PREMIUM ADJUSTMENT FORM CMP-4786 ADDED Other items shown are effective with the policy's 2017 renewal Endorsement Premium None Discounts Applied: Renewal Year Years in Business Sprinkler Claim Record Prepared AUG 07 2017 © Copyright, State Farm Mutual Automobile Insurance Company, 2008 CMP-4000 Includes copyrighted material of Insurance Services Office, Inc., with its permission. 019396 290 Al Continued on Reverse Side of Page Page 1 of 6 N HO 686 e.2 65-31-2611 fo1 DECLARATIONS (CONTINUED) Office Policy for CITY OF FORT COLLINS, Policy Number 96-BU-3823-8 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 2955 VALMONT RD STE 300 No Coverage $ 81,600 25% BOULDER CO 80301-1360 * As of the effective date of this policy, the Limit of Insurance as shown includes any increase in the limit due to Inflation Uoverage. SECTION I - INFLATION COVERAGE INDEX(ES1 Cov A - Inflation Coverage Index: Cov B - Consumer Price Index: SECTION I - DEDUCTIBLES N/A 245.0 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 AUG 07 2017 © Copyright, State Farm Mutual Automobile Insurance Company, 2008 CMP-4000 Includes copyrighted material of Insurance Services Office, Inc., with its permission. 019396 Continued on Next Page Page 2 of 6 RENEWAL DECLARATIONS (CONTINUED) Office Policy for CITY OF FORT COLLINS, Policy Number 96-BU-3823-8 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 2955 VALMONT RD STE 300 No Coverage $ 81,600 25% BOULDER CO 80301-1360 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 245.0 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 AUG 04 2017 Copyright, State Farm Mutual Automobile Insurance Company, 2008 CMP-4000 Includes copyrighted material of Insurance Services Office, Inc., with its permission. 013777 Continued on Next Page Page 2 of 7 StateFarm • • • , DECLARATIONS (CONTINUED) Office Policy for CITY OF FORT COLLINS, Policy Number 96-BU-3823-8 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 AUG 07 2017 © Copyright, State Farm Mutual Automobile Insurance Company, 2008 CMP-4000 Includes copyrighted material of Insurance Services Office, Inc., with its permission. 019397 290 Continued on Reverse Side of Page Page 3 of 6 N DECLARATIONS (CONTINUED) Office Policy for CITY OF FORT COLLINS, Policy Number 96-BU-3823-8 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 $100,000 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 AUG 07 2017 © Copyright, State Farm Mutual Automobile Insurance Company, 2008 CMP-4000 Includes copyrighted material of Insurance Services Office, Inc., with its permission. 019397 Continued on Next Page Page 4 of 6 StateFarm • •• DECLARATIONS (CONTINUED) Office Policy for CITY OF FORT COLLINS, Policy Number 96-BU-3823-8 SECTION II - LIABILITY LIMIT OF COVERAGE INSURANCE Coverage L - Business Liability $2,000,000 Coverage M - Medical Expenses (Any One Person) $10,000 Damage To Premises Rented To You $300,000 LIMIT OF AGGREGATE LIMITS INSURANCE Products/Completed Operations Aggregate $4,000,000 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 FE-6999.2 Terrorism Insurance Cov Notice CMP-4746 Hired Auto Liability CMP-4787 Waiver of Trans Rgt of Recov CMP-4713 Excl Testing Consulting E&O 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 AUG 07 2017 © Copyright, State Farm Mutual Automobile Insurance Company, 2008 CMP-4000 Includes copyrighted material of Insurance Services Office, Inc., with its permission. 019398 290 Continued on Reverse Side of Page Page 5 of 6 N DECLARATIONS (CONTINUED) Office Policy for CITY OF FORT COLLINS, Policy Number 96-BU-3823-8 CMP-4705 Loss of Income & Extra Expnse CMP-4788 Add[ Insd Mgrs Lessor of Prem CMP-4785 Addl Ins Owners Lessee Blkt CMP-4860 Al Design Person Org FE-3650 Actual Cash Value Endorsement CMP-4859 Al Engineer Architect Survey 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 AUG 07 2017 CMP-4000 © Copyright, State Farm Mutual Automobile Insurance Company, 2008 Includes copyrighted material of Insurance Services Office, Inc., with its permission. 019398 290 N Page 6 of 6 StateFal* STATE FARM FIRE AND CASUALTY COMPANY A STOCK COMPANY WITH HOME OFFICES IN BLOOMINGTON, ILLINOIS INLAND MARINE ATTACHING DECLARATIONS Atlanta & 31346-2117 M-20-2388-FA65 F U Named Insured NATIONAL RESEARCH CENTER INC 2955 VALMONT RD STE 300 BOULDER CO 80301-1360 ATTACHING INLAND MARINE Policy Number 96-BU-3823-8 Policy Period Effective Date Expiration Date 12 Months NOV 16 2017 NOV 16 2018 The policy period begins and ends at 12:01 am standard time atthe 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-8743 Inland Marine Computer Prop FE-8739 Inland Marine Conditions See Reverse for Schedule Page with Limits Prepared AUG 07 2017 © Copyright, State Farm Mutual Automobile Insurance Company, 20D8 FD-6007 Includes copyrighted material of Insurance Services Office, Inc., with its permission. 019399 530-6B5 a.2 05-31-2011 WN2320 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 $ 500 Included Loss of Income and Extra Expense 5 25,000 Included Prepared AUG 07 2017 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. 019399 630-686 a.2 O6 31-2011 W1132330 StateFarm • • L RENEWAL DECLARATIONS (CONTINUED) Office Policy for CITY OF FORT COLLINS, Policy Number 96-BU-3823-8 0 0 8 0 0 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 AUG 04 2017 O Copyright, State Farm Mutual Automobile Insurance Company, 2008 CMP-4000 Includes copyrighted material of Insurance Services Office, Inc., with its permission. 013778 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-BU-3823-8 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 $100,000 $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 AUG 04 2017 C Copyright, State Farm Mutual Automobile Insurance Company, 2008 CMP-4000 Includes copyrighted material of Insurance Services Office, Inc., with its permission. 013778 Continued on Next Page Page 4 of 7 StateFarm • ••, RENEWAL DECLARATIONS (CONTINUED) 0 0 S 0 0 Office Policy for CITY OF FORT COLLINS, Policy Number 96-BU-3823-8 SECTION II - LIABILITY LIMIT OF COVERAGE INSURANCE Coverage L - Business Liability $2,000,000 Coverage M - Medical Expenses (Any One Person) $10,000 Damage To Premises Rented To You $300,000 LIMIT OF AGGREGATE LIMITS INSURANCE Products/Completed Operations Aggregate $4,000,000 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 11 - 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-4746 Hired Auto Liability CMP-4787 Waiver of Trans Rgt of Recov CMP-4713 Excl Testing Consulting E&O 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 AUG 04 2017 Copyright, State Farm Mutual Automobile Insurance Company, 2008 CMP-4000 Includes copyrighted material of Insurance Services Office, Inc., with its permission. 013779 294 Continued on Reverse Side of Page Page 5 of 7 N RENEWAL DECLARATIONS (CONTINUED) Office Policy for CITY OF FORT COLLINS, Policy Number 96-BU-3823-8 CMP-4788 Addl Insd Mgrs Lessor of Prem CMP-4785 Addl Ins Owners Lessee Blkt CMP-4786 Addl Insd Owners Lessee Sched CMP-4860 Al Design Person Org FE-3650 Actual Cash Value Endorsement CMP-4859 Al Engineer Architect Survey 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 AUG 04 2017 Copyright, State Farm Mutual Automobile Insurance Company, 2008 CMP-4000 Includes copyrighted material of Insurance Services Office, Inc., with its permission. 013779 Continued on Next Page Page 6 of 7 StateFarm • ••" RENEWAL DECLARATIONS (CONTINUED) Office Policy for CITY OF FORT COLLINS, Policy Number 96-BU-3823-8 U.". 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 AUG 04 2017 CMP-4000 C Copyright, State Farm Mutual Automobile Insurance Company, 2008 Includes copyrighted material of Insurance Services Office, Inc., with its permission. 013780 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 Atlanta iV3V346-2117 M-20-2388-FA65 F U Named Insured NATIONAL RESEARCH CENTER INC 2955 VALMONT RD STE 300 BOULDER CO 80301-1360 ATTACHING INLAND MARINE Policy Number 96-BU-3823-8 Policy Period Effective Date Exppiration Date 12 Months NOV 16 2017 TV 16 2018 The poly period be�ins and ends at 12:01 am standard time at a premises ocatlon. 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-8743 Inland Marine Computer Prop FE-8739 Inland Marine Conditions See Reverse for Schedule Page with Limits Prepared AUG 04 2017 © Copyright, State Farm Mutual Automobile Insurance Company, 2008 FD-6007 Includes copyrighted material of Insurance Services Office, Inc., with its permission. 013781 530 606 a.2 05 31 2011 1oIf32320 96-BU-3823-8 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 AUG 04 2017 FD-6007 013781 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 IoV3233cl