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Home My WebLink AboutTIMBERLINE CHURCH - INSURANCE CERTIFICATE (6)c� �e Brotherhood Mutual' MinistryFirst" Commercial Multi -Peril Insurance Coverage Summary These are your policy's Declarations. Amended Effective Date: 07/27/2018 See Policy Change History TIMBERLINE CHURCH 2908 S Timberline Rd Fort Collins, CO 80525-2402 NAMED INSURED TIMBERLINE CHURCH POLICY NUMBER 05M5A0358236 POLICY PERIOD 07/27/2018 to 07/27/2019 at 12:01 a.m. Key Facts About Your Policy Policy Number 05M5A0358236 Brotherhood Mutual Insurance Company Print Date: July 19, 2018 Policy Period: 07/27/2018 to 07/27/2019 at 12:01 a.m. 866-215-7069 Borrett & Sons LLC 5551-001 PO Box 2225 Fort Collins, CO 80522-2225 Contact your agent with your customer service questions, including updating your policy or reporting a claim. www.brotherhoodmutual.com/payonline For your convenience, you can make premium payments online. These Declarations replace your previous ones. Your policy's Declarations contain a summary of the coverage contained in the insurance policy. Your policy contains a full explanation of your coverage. AGREEMENT: In return for the payment of the premium and subject to all the terms of the policy, we agree to provide the insurance stated in the policy. TYPE OF ORGANIZATION: Church Institution FORM OF ORGANIZATION: Corporation Policy Overview COVERAGE DESCRIPTION DETAILS COVERAGE DESCRIPTION DETAILS Property Coverage Page 2 - 6 Terrorism Premium $3,172 (See Notice Form BN6025A-D 3.1 for details) Inland Marine Coverage Page 7 - 8 Liability Coverage Page 9 - 16 Excess Liability Coverage Page 17 -17 Policy Premium Overview This premium is subject to adjustment at each anniversary. This premium is subject to adjustment due to premium audit provision. ANNUAL PREMIUM: $71,834.00 PAYMENT SCHEDULE: See invoice. Common Policy Forms FORM FORM NAME CL1001.0 Common Policy Conditions CPl 1.0 Table of Contents GL1001.0 Commercial Liability Coverage BN11A 1.2 Customer Notice: Value -Added Benefits BN1B 1.0 Notice Of Payment -Related Charges G13210 06 Notice To Policyholders BN6EX 1.0 Notice - Terrorism -Related Loss FORM FORM NAME CL3001.0 Amendatory Endorsement BCP100 4.0 Commercial Property Coverage Conditions ...........- BCL3011.0 Form Number Reference ..._...... CLO182 0101 Amendatory Endorsement Colorado BCL1001.1 Additional Policy Conditions EX0606 1.0 Conditional Terrorism Exclusion BN6025A-D 3.1 Notice Terrorism -Related Loss Brotherhood Mutual Insurance Company I www.brotherhoodmutual.com I 800.333.3735 P.O. Box 2227, Fort Wayne, IN 46801-2227 M1 DEC 09/16 "Bear ye one another's burdens and so fulfill the law of Christ" — Galatians 6:2 Page 1 of 17 Brotherhood Mutual i—,,r, CF.., NAMED INSURED TIMBERLINE CHURCH POLICY NUMBER 05M5A0358236 POLICY PERIOD 07/27/2018 to 07/27/2019 at 12:01 a.m. Liability Coverage Summary MinistryFirst"' commercial multi -peril policy Declarations continued... The Coverages listed here are provided according to the terms of the designated coverage form and any other applicable forms or endorsements. Only one liability coverage and one medical coverage will apply to an occurrence and any related loss. Any limit which is specifically stated within a coverage form or endorsement represents the most we will pay for the coverage to which such a limit applies. For application of limits, see Liability and Medical Coverage form (BGL114.0). Details of Related Organization/Operations NAME Everyday Joe's Additional Coverages COVERAGE DESCRIPTIONS Food Preparation Liability Coverage Privacy Violation Liability Coverage Damage To Property Of Others Coverage Not in Your Control In Your Control Prosthetic Devices Additional Incidental Contractual Liability Coverage Defense Coverage ADDRESS MINISTRY TYPE FORMS 144 S Mason St Fort Collins, CO 80524-2812 Food/Clothing/Thrift BGL58R 4.0 Operation COVERAGE LIMIT $1,000,000, $1000,000- ...._.. _._... $1,000,000' _.._......... _... ..... $1,000'+ $2,500'+ ... - - $500'+ $000,000" COVERAGE AGGREGATE LIMIT $3,000,000' $3,000,000' $3,000,000' $3,000,000' $3,000,000- $3,000,000` $3,000,000' Applies in addition to the liability limit unless otherwise specifically stated in an applicable coverage form. Counseling Acts Professional Liability Coverage COVERAGE DESCRIPTIONS Counseling Acts Liability Coverage Outside Counseling Reimbursement Coverage Cyber Liability Coverage COVERAGE LIMIT COVERAGE AGGREGATE LIMIT $1,000,000, $3,000,000' $5,000+ $3,000,000' FORM BGL58R 4.0 BGL58R 4.0 BGL58R 4.0 BGL58R 4.0 BGL58R 4.0 BGL58R 4.0 BGL58R 4.0 FORM BGL63 4.1 BGL63 4.1 COVERAGE DESCRIPTIONS COVERAGE LIMIT COVERAGE AGGREGATE LIMIT FORM Computer Use Liability Coverage $1,000,000' $3,000,000- BGL87 4.1 __ Electronic Commerce Liability Coverage $1,000,000' - $3,000,000' BGL87 4.1 Data Breach Liability Coverage $1,000,000' $3,000,000' BGL87 4.1 Outsourced IT Liability Coverage $1,000,000' $3,000,000' BGL87 4.1 Special Reimursement Coverage (Data Breach Rectification $250,000 $250,000 BGL87 4.1 Costs) Special Reimbursement Coverage (Electronic Discovery Costs) $100,000 .......... ......_...... _. _.._........... $100,000 _.........._.. BGL87 4.1 Special Defense Coverage (Subpoenas, Regulatory Actions and $100,000 $100,000 BGL87 4.1 Injunctive) Only a single limit applies to the loss. All coverage limits are subject to the general occurrence limit and all aggregate limits are subject to the general aggregate limit. + per person limit Brotherhood Mutual Insurance Company I www.brotherhoodmutual.com I 800.333.3735 I P.O. Box 2227, Fort Wayne, IN 46801-2227 M1 DEC 09/16 "Bear ye one another's burdens and so fulfill the law of Christ." — Galatians 6:2 Page 10 of 17 Brotherhood Mutual' In,eu,an,, Company NAMED INSURED TIMBERLINE CHURCH POLICY NUMBER 05M5A0358236 POLICY PERIOD 07/27/2018 to 07/27/2019 at 12:01 a.m. Liability Coverage Summary MinistryFirstsm commercial multi -peril policy Declarations continued... The Coverages listed here are provided according to the terms of the designated coverage form and any other applicable forms or endorsements. Only one liability coverage and one medical coverage will apply to an occurrence and any related loss. Any limit which is specifically stated within a coverage form or endorsement represents the most we will pay for the coverage to which such a limit applies. For application of limits, see Liability and Medical Coverage form (BGL114.0). Defense Reimbursement Coverage COVERAGE DESCRIPTIONS Legal Liability Defense Reimbursement Coverage Directors and Officers Liability Coverage COVERAGE DESCRIPTIONS Directors and Officers (Leadership) Liability Coverage Benefits Administration Liability Coverage COVERAGE DESCRIPTIONS Employee Benefit Liability Coverage (Medical Expense Limit) COVERAGE LIMIT See Form BGL89 COVERAGE LIMIT $1,000,000- COVERAGE LIMIT $1,000,000 $100,000' Employment Practices ("Employment Pract") Liability Coverage COVERAGE DESCRIPTIONS Employment -Related Liability Coverage COVERAGE AGGREGATE LIMIT See Form BGL89 COVERAGE AGGREGATE LIMIT $3,000,000- COVERAGE AGGREGATE LIMIT $3,000,000 $500,000, COVERAGE LIMIT COVERAGE AGGREGATE LIMIT $1,000,000, $3,000,000' Fire Legal/Nonowned Property Damage Liability Coverage COVERAGE DESCRIPTIONS Nonowned Property Damage Liability Coverage Additional Incidental Contractual Liability Coverage Media Liability Coverage COVERAGE LIMIT COVERAGE AGGREGATE LIMIT $1,000,000- $3,000,000` $1,000,000- $3,000,000' FORM BGL89 4.1 FORM BGL81B 4.1 FORM BGL83 4.0 BGL83 4.0 FORM BGL85 4.1 FORM BGL951 3.0 BGL951 3.0 COVERAGE DESCRIPTIONS COVERAGE LIMIT COVERAGE AGGREGATE LIMIT FORM Personal Injury Liability Coverage (Media/Communications $1,000,000- $3,000,000' BGL411.0 Activity) Personal Injury Liability Coverage (Personal Violations) $1000,000 .. $3000,000" _........_..........................._._........_...__ BGL411.0 .......... Personal Injury Liability Coverage (Unauthorized Access/ ....... $1,000,000' $3,000,000' BGL411.0 Posting) Special Defense Coverage (Alleged Intentional Acts) $1,000,000- $3,000,000" BGL411.0 Only a single limit applies to the loss. All coverage limits are subject to the general occurrence limit and all aggregate limits ore subject to the general aggregate limit. + per person limit Brotherhood Mutual Insurance Company I www.brotherhoodmutual.com I 800.333.3735 I P.O. Box 2227, Fort Wayne, IN 46801-2227 ... .._._... _ Ml DEC 09/16 "Bear ye one another's burdens and so fulfill the law of Christ." — Galatians 6:2 Page 11 of 17 Brotherhood Mutual' Insurance ('".P—, NAMED INSURED TIMBERLINE CHURCH POLICY NUMBER 05M5A0358236 POLICY PERIOD 07/27/2018 to 07/27/2019 at 12:01 a.m. Liability Coverage Summary MinistryFirst'm commercial multi -peril policy Declarations continued... The Coverages listed here are provided according to the terms of the designated coverage form and any other applicable forms or endorsements. Only one liability coverage and one medical coverage will apply to an occurrence and any related loss. Any limit which is specifically stated within a coverage form or endorsement represents the most we will pay for the coverage to which such a limit applies. For application of limits, see Liability and Medical Coverage form (BGL114.0). Medical Coverage COVERAGE DESCRIPTIONS COVERAGE LIMIT COVERAGE AGGREGATE LIMIT FORM Student/Day Care Medical $5,000'+ $3,000,000' BGL93A 4.0 Religious Athletic Medical Coverage $10,000-+ $3,000 000" BGL914.0 Nonowned Vehicle Coverage COVERAGE DESCRIPTIONS COVERAGE LIMIT COVERAGE AGGREGATE LIMIT FORM Nonowned Vehicle Liability Coverage $1,000,000, $3,000,000' BGL714.0 Defense Coverage: Authorized Operator $1,000,000- $3,000,000' BGL71 4.0 Loss of Use Coa vera _........ g _____.. _._ . $500 per vehicle .._._._ _..._..__ _ $1,p00` BGL71 4.0 Trip occupant Coverage $3,000,000' BGL714.0 Damage to Property of Others Coverage $500' $3,000,000' BGL71 4.0 Nonowned Vehicle Deductible Reimbursement Coverage $1,000' $3,000,000' BGL71 4.0 Rental Vehicle Physical Damage Coverage $80,000 per vehicle, $250 $160,000' BGL777 3.0 deductible Nonowned Vehicle Medical Payments Extension $10,000'+ $150,000' BGL778 4.0 Nurse Liability Coverage COVERAGE DESCRIPTIONS COVERAGE LIMIT COVERAGE AGGREGATE LIMIT FORM Nurses' Professional Liability Coverage $1,000,000- $3,000,000' BGL234 4.1 Other Liability Coverage COVERAGE DESCRIPTIONS COVERAGE LIMIT COVERAGE AGGREGATE LIMIT FORM Terrorism Liability Coverage $1,000,000 $3,000,000 BGL0250 3.1 Relief Activity Additional Coverages COVERAGE DESCRIPTIONS COVERAGE LIMIT COVERAGE AGGREGATE LIMIT FORM Emotional Injury and Financial Damage Liability $1,000,000' $3,000,000' BGL9941.0 Additional Medical Expense Coverage $50,000+,$250,000 per $3,000,000 BGL9941.0 occurrrence Broadened Wage Loss Reimbursement Coverage per 000 , $10,000+, 50 $ p $3,000,000 BGL9941.0 occurrence Damage to Relief Worker's Tools and Equipment Coverage $2,500+, $10,000 per $3,000,000 BGL9941.0 occurrence Primary Liabili Covera a for Relief Workers Y b g $_1,000,000' $3,0p0,000,* BGL9941.0 Only a single limit applies to the loss. All coverage limits are subject to the general occurrence limit and all aggregate limits are subject to the general aggregate limit. +per person limit Brotherhood Mutual Insurance Company I www.brotherhoodmutual.com I 800.333.3735 I P.O. Box 2227, Fort Wayne, IN 46801-2227 M1 DEC 09/16 "Bear ye one another's burdens and so fulfill the law of Christ" — Galatians 6:2 Page 12 of 17 Brotherhood Mutual' Insurance Cum Pany NAMED INSURED TIMBERLINE CHURCH POLICY NUMBER 05M5A0358236 POLICY PERIOD 07/27/2018 to 07/27/2019 at 12:01 a.m. Liability Coverage Summary MinistryFirstsm commercial multi -peril policy Declarations continued... The Coverages listed here are provided according to the terms of the designated coverage form and any other applicable forms or endorsements. Only one liability coverage and one medical coverage will apply to an occurrence and any related loss. Any limit which is specifically stated within a coverage form or endorsement represents the most we will pay for the coverage to which such a limit applies. For application of limits, see Liability and Medical Coverage form (BGL1I 4.0). Religious Freedom Protection Coverage COVERAGE DESCRIPTIONS COVERAGE LIMIT Religious Communication Liability Coverage $1,000,000- Religious Activity Liability Coverage $1,000,000` Discriminatory Acts Liability Coverage $1,000,000' Tax Exempt Challenge: Expense Reimbursement Coverage $25,000' Litigation Activity: Legal Defense Reimbursement Coverage See f1. o1. rm Litigation Activity: Declaratory Action Reimbursement Coverage See form Security Operations Coverage COVERAGE AGGREGATE LIMIT FORM $3,000,000' BGL66 1.1 $3,000,000 BGL661.1 $3,000,000' BGL661.1 $25,000' BGL661.1 See form BGL661.1 See form BGL661.1 COVERAGE DESCRIPTIONS COVERAGE LIMIT COVERAGE AGGREGATE LIMIT FORM Additional Medical Expense Coverage $50,000'+ $50,000" BGL993 4.0 Broadened Wage Loss Reimbursement Coverage (Emotional $10,000- $50,000' BGL993 4.0 Injury) Individual Counseling Coverage $10,000'+ $10,000' BGL993 4.0 Damage to Security -Related Equipment $2,500'+ $1,000,000' BGL993 4.0 Primary Coverage for Specified Individuals $1400,000' $1,000,000` BGL993 4.0 Enforcement of Security Policy or Weapons Policy $1,000,000' $1,000,000' BGL993 4.0 Negligent Infliction of Emotional Distress Arising from Security $1,000,000' $1,000,000. BGL993 4.0 Operations Sexual Acts Liability Coverage COVERAGE DESCRIPTIONS COVERAGE LIMIT COVERAGE AGGREGATE LIMIT FORM Sexual Acts Liability Coverage With Screening $1,000,000` $1,000,000' BGL614.1 ......... _ _.... Sexual Harassment Liability Coverage (other than your $1,000,000' $1,006,000' BGL61 4.1 employees) ........ Improper Reporting of Sexual Acts Liability Coverage $1000 000 $1000 000 _..........._ .. _........_ BGL614.1 Improper Supervision of Convicted Sexual Offenders Liability $1,000,000" $1,000,000" BGL614.1 Coverage _ Outside Counseling11 11 nt ReimbursemeCoverage $5 000'+ $160,000` BGL614.1 Sexual Acts Medical Payment Extension $10,000" $100,000 BGL614.1 Image Restoration Extension $10000' $1,000,000` BGL614.1 Redemptive Employment/Appointment $.301.0,000' $300,000- BGL6131.1 ` Only a single limit applies to the loss. All coverage limits are subject to the general occurrence limit and all aggregate limits are subject to the general aggregate limit. + per person limit Brotherhood Mutual Insurance Company I www.brotherhoodmutual.com I 800.333.3735 I P.O. Box 2227, Fort Wayne, IN 46801-2227 M1 DEC 09/16 "Bear ye one another's burdens and so fulfill the law of Christ." — Galatians 6:2 Page 13 of 17 ' Brotherhood Mutual® Insurance Company NAMED INSURED TIMBERLINE CHURCH POLICY NUMBER 05M5A0358236 POLICY PERIOD 07/27/2018 to 07/27/2019 at 12:01 a.m. Liability Coverage Summary MinistryFirstsm commercial multi -peril policy Declarations continued The Coverages listed here are provided according to the terms of the designated coverage form and any other applicable forms or endorsements. Only one liability coverage and one medical coverage will apply to an occurrence and any related loss. Any limit which is specifically stated within a coverage form or endorsement represents the most we will pay for the coverage to which such a limit applies. For application of limits, see Liability and Medical Coverage form (BGL114.0). Traumatic Incident Response Coverage COVERAGE DESCRIPTIONS COVERAGE LIMIT COVERAGE AGGREGATE LIMIT FORM Additional Medical Expense Coverage $50,000'+ $1,000,000' ..._...._._ . _.._._... BGL991D 4.1 - ._.._I.._ .... _...... Broadened Wage Loss Reimbursement Coverage (Including _..__.. See form $1,000,000- BGL991D 4.1 Emotional Injury)_._.._....._._._ Individual Counseling Coverage $t000D + $1,000,000' BGL991D 4.1 Additional Organizational Expense _ $50Q000' $1,000,000' BGL991D 4.1 Wage Reimbursement Coverage COVERAGE DESCRIPTIONS COVERAGE LIMIT COVERAGE AGGREGATE LIMIT FORM Wage Loss Reimbursement Coverage $3.500+ $35,000 per occurrence BGL99 4.0 Worldwide Liability Extension Coverage COVERAGE DESCRIPTIONS COVERAGE LIMIT COVERAGE AGGREGATE LIMIT FORM Limited Worldwide Kidnap and Extortion Expense See form See form BGL111T 1.2 Reimbursement Coverage Expanded Medical Coverage for Short -Term Foreign Trip See form See form BGL111T 1.2 Participants Schedule of Liability Exposures In issuing this policy, we have relied on material information provided to us by the Named Insured. The following schedule discloses all of the insured's insurable exposures (as conveyed by the Named Insured) known to exist at the policy inception date. Declared premises must be owned occupied, or rented by you or your scheduled related organizations. EXPOSURE DESCRIPTIONS ADDRESS / BUILDING DESCRIPTION CODE RATING BASIS Offices - NOC Location 4 Building 1 Office 04504 5,000 Square Feet Food & Clothing Pantry Location 1 Building 1 Church 05813 2,000 Square Feet Book/Magazines/Stationery Stores - Small Location 1 Building 1 Church 05813 2,000 Square Feet Retail Thrift Shop Location 1 Building 1 Church OS813 1,000 Square Feet Thrift Shop _.— ......__..__._.__._._.___ Location 2 Building 1 Other ..._.._. _.....__- .__...... ............ .. ........... .. ........ 05813 -.__.__._.__ _._. 1,000 Square Feet ....... ._.___._ ._......._.. Coffee Shop Location 2 Building 1 Other 06501 ....... 4,800 Square Feet After School Ministry 2908 S Timberline Rd Fort Collins CO 80525-2402 07900 30 Students Medical Including Students __ .__. ......... I—_ ___ -_._ ......__._.._...-_._.--._.___._._..._... _.__._. _._ ... _.............. _..... ....... ..__...._._._.___.._._._..-.__._._._..._.._._._._..___... Church Location 1 Building 1 Church _ _._...__ 08101 .. .............. _ 115,068 Square Feet Location 2 Building 1 Other 4,800 Square Feet ' Only a single limit applies to the loss. All coverage limits are subject to the general occurrence limit and all aggregate limits are subject to the general aggregate limit. + per person limit Brotherhood Mutual Insurance Company I www.brotherhoodmutual.com I 800.333.3735 I P.O. Box 2227, Fort Wayne, IN 46801-2227 Ml DEC 09/16 "Bear ye one another's burdens and so fulfill the law of Christ"— Galatians 6:2 Page 14 of 17 Brotherhood Mutual' Insurance Company NAMED INSURED TIMBERLINE CHURCH POLICY NUMBER 05M5A0358236 POLICY PERIOD 07/27/2018 to 07/27/2019 at 12:01 a.m. Liability Coverage Summary MinistryFirst" commercial multi -peril policy Declarations continued... The Coverages listed here are provided according to the terms of the designated coverage form and any other applicable forms or endorsements. Only one liability coverage and one medical coverage will apply to an occurrence and any related loss. Any limit which is specifically stated within a coverage form or endorsement represents the most we will pay for the coverage to which such a limit applies. For application of limits, see Liability and Medical Coverage form (BGL114.0). EXPOSURE DESCRIPTIONS ADDRESS / BUILDING DESCRIPTION ......... _._._...... CODE . ...._.__ .... RATING BASIS ---. _.. ....._ ............._.. ... __ .... _._........ ..----•-._._._.. Mission Church __..... Location 1 Building 1 Church 08101 2,500 Square Feet Church Location 6 Building 1 Church ........_.._..... _ 08101 ......._... 13,342 Square Feet .... __. _ .._... _._..._....._...-......_..... _ .._._..... Mobile Classroom Rated As A Church Location 6 Building 2 Mobile Classroom 08101 1,440 Square Feet .........,.......... ........... 1___.........__.. ......_.._ _.......... _ _ Golf Cart ._................_.................. _ 2908 S Timberline Rd Fort Collins CO 80525-2402 15002 3 Each ... ................. ..........._.. ___.._ _....... _....... ....... .. Grounds - Excess of Five Acres 2908 5 Timberline Rd Fort Collins CO 80525-2402 _ .........__._ __.......... __. _............. 15100 33 Acres _._...._..----- .._.._. _. _......_.._._ Vacant Land - 5 Acres or More 29918 Weld County Road 17 windsor CO 80550 17401 200 Linear Feet Bleachers or Grandstands 2908 S Timberline Rd Fort Collins CO 80525-2402 ................._ 30035 1 Each ...................................................... Outreach Ministry 2908 S Timberline Rd Fort Collins CO 80525-2402 30130 1 # items/activities Bicycle Trip 2908 5 Timberline Rd Fort Collins CO 80525-2402 30130 1 # items/activities Playgrounds _ _...,._. _ ... _ ......... _ _........__...._._......_ 2908 5 Timberline Rd Fort Collins CO 80525-2402 .............. ... ...._...... _ _...................................._ ......_._..-._........ 30320 _ . _ ...._- 1 Each Softball Field Rated As Playground .. _..._. 2908 S Timberline Rd Fort Collins CO 80525-2402 _.,._. 30320 _....... _ 1 Each ..........._ _ Books, Magazines and Stationery Stores _._. _. ........ Location 6 Building 1 Church _ . _.._.._ 34113 _._... _ . 50,000 Receipts Food or Drink - Retail Stores - NOC Location 1 Building 1 Church 83800 58,000 Sales Location 2 Building 1 Other .... ........_.._._................. _.._..... ........._.._._.... ........._._ _._..._ -- 50,000 Sales __._.._._....___.. _._.__..__. Pastoral Counseling 17 Pastor(s) Special Events High Hazard Activities For details regarding how these coverage limits will apply, see the How Much We Pay section of the High Hazard Activities Coverage Limits Form (BGL-21). ACTIVITY DESCRIPTION MEDICAL LIMIT OCCURRENCE LIMIT COVERAGE AGGREGATE LIMIT FORM Skate Park Operations $0 per person _ ........._ ........_... - $100,000 _.---..............$300,000 _..._... ............._--- _..... . Fireworks Sales ........ . $0 per person $100,000 .............................. $300,000 _ __..............._....._._.._............. . BGL21 4.1 Fireworks Display $0 per person $100,000 _----__-----.. $300,000 ._. __.._.-.___ BGL21 4.1 Construction Oversight $0 per person $100,000 $300,000 BGL21 4.1 Other Liability and Medical Forms FORM FORM NAME BCL966CO 1.0 Additional Policy Definition BG1_11 4.0 Liability And Medical Coverage Form BGL59RA 4.0 Related Org Principal and Additional Cov ....._.......... GLO163 0108 Exclusion War and Military Action_._.._.. ..._..._ _.._._ _._.._... _.._. _.......... _... 1. 1_......_......._......._._......... GL8901.0 ...................... ....I.... _._......................._....._....... Lead Liability Exclusion _ . ... EX939ESP 4.0 Additional Exclusions FORM FORM NAME BGL100A1 2.2 Commercial Liability Endorsement BGL1521.0 Additional Insured Endorsement EX9091.0 Asbestos Exposure Exclusion _ .. ..................... .. _...._ _ GL095012 99 ....._ _._.. Known Injury or Damage Amendments _...__ . _ . _...._. .. .. ........._..... ._...... BGL939AISP 1.0 _.. _..._.... Provision Modification -Excess Liability -_ ......,. ...... _ ....I... _.......... ....... _................... EX02812.4 NBC Terrorism Exclusion Only a single limit applies to the loss. All coverage limits are subject to the general occurrence limit and all aggregate limits are subject to the general aggregate limit. per person limit Brotherhood Mutual Insurance Company I www.brotherhoodmutual.com I 800.333,3735 I P.O. Box 2227, Fort Wayne, IN 46801-2227 Ml DEC 09/16 'Bear ye one another's burdens and so fulfill the law of Christ" — Galatians 6:2 Page 15 of 17 NAMED INSURED TIMBERLINE CHURCH POLICY NUMBER 05M5A0358236 Brotherhood Mutual' POLICY PERIOD 07/27/2018 to 07/27/2019 at 12:01 a.m. A l o c u m... C n m P a n y Liability Coverage Summary MinistryFirstsm commercial multi -peril policy Declarations continued... The Coverages listed here are provided according to the terms of the designated coverage form and any other applicable forms or endorsements. Only one liability coverage and one medical coverage will apply to an occurrence and any related loss. Any limit which is specifically stated within a coverage form or endorsement represents the most we will pay for the coverage to which such a limit applies. For application of limits, see Liability and Medical Coverage form (BGL11 4.0). FORM FORM NAME FORM FORM NAME GL1270 06 06 Conditional Terrorism Exclusion Additional Insureds NAME LOAN/REFERENCE NUMBER INTEREST ADDRESS City of Fort Collins, Additional Loc 02 Outdoor area 215 N Mason St Fort Collins, CO 80524 -4402 Insured Satellite Shelters, Additional 0602 6680 E 86Th Ct Commerce City, CO 80022 Insured -5003 . Only a single limit applies to the loss. All coverage limits are subject to the general occurrence limit and all aggregate limits are subject to the general aggregate limit. + per person limit Brotherhood Mutual Insurance Company ( www.brotherhoodmutual.com I 800.333.3735 I P.O. Box 2227, Fort Wayne, IN 46801-2227 M1 DEC 09/16 "Bear ye one another's burdens and so fulfill the law of Christ." — Galatians 6:2 Page 16 of 17 NAMED INSURED TIMBERLINE CHURCH BrothBrotherhood ^{m rL,Q 1`.' (� �] POLICY NUMBER 05MSA0358236 erhood Mutual- POLICY PERIOD 07/27/2018to07/27/2019at12:01a.m. Insurance Company Commercial Excess Liability Supplemental Coverage Summary MinistryFirstsm commercial multi -peril policy Declarations continued In return for the payment of the premium, and subject to all the terms of the policy, we agree with you to provide the insurance as stated in the Excess/Umbrella Liability Coverage endorsement BGL939 4.0. Key Excess Liability Coverage Facts NAME OF INSURED TIMBERLINE CHURCH ADDRESS 2908 5 Timberline Rd, Fort Collins, CO 80525-2402 EXCESS LIABILITY POLICY PERIOD 7/27/2018 to 7/27/2019 at 12:01 a.m, at the location listed above EXCESS LIABILITY ANNUAL PREMIUM $3,472 Excess Liability Coverage - Limit of Insurance Coverage Limit (per Occurrence) $4,000,000 Coverage Aggregate Limit $4,000,000 Deductible/Retention N/A Optional Excess Coverage Information COVERAGE STATUS LIMIT Directors and Officers Included $4,000,000 Sexual Acts Excluded N/A Employment Practices Excluded N/A Optional Coverage Limits are the some as the Excess Liability "per Occurrence" and Aggregate limits shown above, unless otherwise specified. Schedule of Underlying Insurance TYPE INSURER POLICY PERIOD POLICY NUMBER LIMITS OF LIABILITY General Liability Brotherhood Mutual Insurance Company 07/27/2018 - 07/27/2019 05M5AO358236 $1,000,000 Occ/$3,000,000 Agg -. ..._.... ..... .. _ ... _._ ....__ ......_....... _.._...... ................. ... ..... ..... Automobile Liability Brotherhood Mutual Insurance Company See applicable declarations page 05A0358237 $1000 000 CSL _.....,._...... ... ...... ................ ....._.._ ....... ........ ............ .... ... ....... Employer's Liability Brotherhood Mutual Insurance Company See applicable declarations page. 05W0358238 $100,000/$500,000/$100,000 Brotherhood Mutual Insurance Company I www.brotherhoodmutuaI.com I 800.333.3735 I P.O. Box 2227, Fort Wayne, IN 46801-2227 M1 DEC 09/16 "Bear ye one another's burdens and so fulfill the law of Christ." — Galatians 6:2 Page 17 of 17 05M5A0358236 This Coverage Endorsement is subject to the terms of the Commercial Liability Coverage Form (GL-100), the Liability and Medical Coverage Form (BGL-11) and the Nonowned Vehicle Coverage Form (BGL-71) [or the', Broadened Nonowned Vehicle Coverage Form (BGL-71 B)]. Only one liability coverage (Principal. Supplemental, or Additional) will apply to an occurrence and any related loss. Attachment of this endorsement to the policy will not covert the policy into an automobile policy. - PLEASE READ THIS CAREFULLY - PROVISION MODIFICATION - RENTAL VEHICLE PHYSICAL DAMAGE COVERAGE - MODIFIED LIMIT OF COVERAGE - PER VEHICLE LIMIT: $ 80,000 PER POLICY PERIOD LIMIT: $160,000 AGREEMENT We provide the Provision Modification described in this endorsement, but only if this form (BGL-777) and the Nonowned Vehicle Coverage Form (BGL-71) [or the Broadened Nonowned Vehicle Coverage Form (BGL- 71 B)] is properly designated in the Declarations, and only with respect to the Rental Vehicle Physical Damage Additional Coverage. DEFINITIONS Each of the words or phrases defined in the Definition section of the Commercial Liability Coverage Form (GL-100), the Liability and Medical Coverage Form (BGL-11) and the Nonowned Vehicle Coverage Form (BGL-71) [or the Broadened Nonowned Vehicle Coverage Form (BGL-71 B)] apply to this endorsement, unless otherwise modified herein. The following definitions apply only to the Provision Modifications of this endorsement. Per vehicle limit means only the amount entered above as the PER VEHICLE LIMIT. 2. Per policy period limit means only the amount entered above as the PER POLICY PERIOD LIMIT. PROVISION MODIFICATIONS 1. Modification of Additional Coverage - Within the Nonowned Vehicle Coverage Form (BGL- 71) or, alternatively, the Broadened Nonowned Vehicle Coverage Form (BGL-71 B), the following provision replaces and supersedes the grant of coverage entitled Vehicle Rental Vehicle Physical Damage Coverage: RENTAL VEHICLE PHYSICAL DAMAGE COVERAGE - We will pay for physical damage to, or the total loss of, a rented vehicle regardless of your liability, but only if: a. the damage to, or total loss of, the rented vehicle is properly documented; and b. the damage or loss occurs in the basic territory during the policy period. This Physical Damage Coverage is a primary coverage, subject to a $250 deductible. We will pay the lesser of the amount to repair or to replace the vehicle. We will not under any circumstances pay more than the actual cash value of the vehicle, and will pay no more than the per vehicle limit toward the repair or replacement of any one vehicle covered herein, subject to the per policy period limit stated in the How Much We Pay section of this endorsement. 2. Modification of How Much We Pay Section - The following provision replaces and supersedes the Physical Damage Limit provision stated in the How Much We Pay section of the Nonowned Vehicle Coverage Form (BGL-71) or, alternatively, in the Broadened Nonowned Vehicle Coverage Form (BGL- 71 B): Physical Damage Limit We will pay no more than the per vehicle limit for all damage or loss sustained by any covered rented vehicle to which the Rental Vehicle Physical Damage Coverage applies. We will pay no more than the per policy period limit under BGL-777 (3.0) Copyright.2007 Brotherhood Mutual Insurance Co. Page 1 of 2 All Right Reserved 05M5A0358236 the Rental Vehicle Physical Damage Coverage for all covered Rental Vehicle Physical Damage losses occurring during the policy period. EXCLUSIONS Each of the exclusions set forth in the Exclusions Section of the GL-100, BGL-11 and the BGL-71 [or the BGL-71 B] will apply to the Provision Modification of this endorsement. CONDITIONS Each of the Conditions set forth in the Conditions Section of the GL-100, BGL-11 and the BGL-71 [or the BGL-71 B] will apply to the Provision Modification of this endorsement. LIMITATION Nothing in this endorsement will act to increase any other limits of coverage of this policy. No coverage is provided by this endorsement unless the Nonowned Vehicle Coverage Form (BGL-71) or the Broadened Nonowned Vehicle Coverage Form (BGL-71 B) is included as part of this policy. OTHER PROVISIONS All other provisions of this policy remain unchanged. Nothing in this endorsement will act to modify any terms of the policy other than the terms specified herein. BGL-777 (3.0) Copyright.2007 Brotherhood Mutual Insurance Co. Page 2 of 2 All Right Reserved NAMED INSURED TIMBERLINE CHURCH ��f% R�"�}hp�^h POLICY NUMBER 05M5A0358236 �� B V {�1141 I lood Mutual POLICY PERIOD 07/27/2018 to 07/27/2019 at 12:01 a.m. Insurance Company Property Coverage Summary MinistryFirstsm commercial multi -peril policy Declarations continued... We provide the Commercial Property coverage at the declared premise(s) for the coverage and limits indicated. The Coverages listed here are provided according to the terms of the designated coverage form and any other applicable forms or endorsements. Property Coverage Details PROPERTY DEDUCTIBLE $2,500 GLASS DEDUCTIBLE $2,500 Schedule of Locations LOCATION # DESCRIPTION ADDRESS 0101 Church .. _ . ._..._. ................ _.._ _ _. _._ _.._. _ __ ___.- . 2908 S Timberline Rd Fort Collins, CO 80525-2402 ....... 0102 __..._......__-..____.___._.._.._._._ . Playground Equipment 2908 S Timberline Rd Fort Collins, CO 80525-2402 0201 Coffee House -__.-..__.._._.--_._._.---._. 144 S Mason St Fort Collins, CO 80524-2812 .... _....,.._.........._._..._..... _._._._.._...__._...... __.._.._.._......_._._._.... _........... .._._..__.. -----..---.----.___..._..__.____.__._ _ -_ 0401 __ __-..___._._-------_.__----- Office 1136 E Stuart St Fort Collins, CO 80525-1195 0601 Church 360 Crossroads Blvd Windsor, CO 80550-7264 0602 Mobile Classroom 360 Crossroads Blvd Windsor, CO 80550-7264 Schedule of Buildings and Personal Property CHURCH 2908 S Timberline Rd Fort Collins, CO 80525-2402 LOCATION 0101 Mortgagee Firstbank Isaoa Loan#8755590 8755620 10403 W Colfax Ave Lakewood, CO 80215-3811 COVERAGE DESCRIPTION COVERAGE LIMIT COINSURANCE EQ DED VALUATION TYPE AUTO INCR PERIL TYPE FORM (INCL. TYPE OF PROPERTY) Building $27,534,00_0 Agreed Amount N/A Replacement Cost 0% Special with Theft BCP85 4.0 _ Ordinance or Law -Increased $27,534,000 N/A- N/A N/A N/A N/A BCP138 4.0 Building Loss(ORD&LAW1) Ordinance or Law- $300,000 _._._._._._._._._._.._....._.___N/A._ N/A ._.._._.._N/A ._.._.._._...._.._-4.0- N/A N/A BCP138 Incr. Debris Removal (ORD&LAW2) _-._...----- ......-_-----------.._._$--.-._._..--._._.._..---------- Ordinance or Law-Incr. Cost $300,000 ------- N/A ----------_ N/A _..._..------ N/A -- ------ N/A --------------...._ N/A 8CP138 4.0 of Constr.(ORD&LAW3) Personal Property - $2,096,000 .._..._._._.-. Agreed Amount ____._._..-_.____-..__..-._.-..-.-____-____.._.-.-.-.-.--•-_.._.._.-_.-.._.._-_--_.___--_._._.._._._....._. N%A Replacement Cost 4% Special with Theft BCP85 4.0 Personal Property of Others $3,000 Agreed Amount N/A Replacement Cost 0% Special with Theft BCP85 4.0 PLAYGROUND EQUIPMENT 2908 S Timberline Rd Fort Collins, CO 80525-2402 LOCATION 0102 COVERAGE DESCRIPTION COVERAGE LIMIT COINSURANCE EQ DIED VALUATION TYPE AUTO INCR PERILTYPE FORM (INCL. TYPE OF PROPERTY) Property -in -the -Open $133,000 Agreed Amount N/A Replacement Cost 0% Special with Theft BCP85 4.0 Brotherhood Mutual Insurance Company I www.brotherhoodmutual,com I 800.333.3735 I P.O. Box 2227, Fort Wayne, IN 46801-2227 M1 DEC 09/16 'Bear ye one another's burdens and so fulfill the law of Christ." - Galatians 6:2 Page 2 of 17 NAMED INSURED TIMBERLINE CHURCH n{ �"(� POLICY NUMBER 05M5A0358236 B Vtherhood Mutual' POLICY PERIOD 07/27/2018 to 07/27/2019 at 12:01 a.m. A I,,,u... company Property Coverage Summary MinistryFirstsm commercial multi -peril policy Declarations continued... We provide the Commercial Property coverage at the declared premise(s) for the coverage and limits indicated. The Coverages listed here are provided according to the terms of the designated coverage form and any other applicable forms or endorsements. COFFEE HOUSE 144 5 Mason St Fort Collins, CO 80524-2812 LOCATION 0201 COVERAGE DESCRIPTION COVERAGE LIMIT COINSURANCE EQ DED VALUATION TYPE AUTO INCR PERIL TYPE FORM (INCL. TYPE OF PROPERTY) Personal Property $183,000 Agreed Amount N/A Replacement Cost 4% Special with Theft BCP85 4.0 OFFICE 1136 E Stuart St Fort Collins, CO 80525-1195 LOCATION 0401 COVERAGE DESCRIPTION COVERAGE LIMIT COINSURANCE EQ DED VALUATION TYPE AUTO INCR PERIL TYPE FORM (INCL. TYPE OF PROPERTY) Personal Property $50,000 Agreed Amount N/A Replacement Cost 4% Special with Theft BCP85 4.0 CHURCH 360 Crossroads Blvd Windsor, CO 80550-7264 LOCATION 0601 Mortgagee Firstbank Isaoa Loan#8755590 8755620 10403 W Colfax Ave Lakewood, CO 80215-3811 COVERAGE DESCRIPTION COVERAGE LIMIT COINSURANCE EQ DED VALUATION TYPE AUTO INCR PERIL TYPE FORM (INCL. TYPE OF PROPERTY) Building $2,838,000 Agreed Amount N/A Replacement Cost 0% Special with Theft BCP85 4.0 Personal Property $96,000 Agreed Amount N/A Replacement Cost 4% Special with Theft BCP85 4.0 MOBILE CLASSROOM 360 Crossroads Blvd Windsor, CO 80550-7264 LOCATION 0602 COVERAGE DESCRIPTION COVERAGE LIMIT COINSURANCE EQ DED VALUATION TYPE AUTO INCR PERIL TYPE FORM (INCL. TYPE OF PROPERTY) Building $97,000 Agreed Amount N/A Replacement Cost 4% Special with Theft BCP85 4.0 ... .. .. Personal Property $14,000 Agreed Amount N/A Replacement Cost 4% Special with Theft BCP85 4.0 Brotherhood Mutual Insurance Company I www.brotherhoodmutual.com I 800.333.3735 I P.O. Box 2227, Fort Wayne, IN 46801-2227 M1 DEC 09/16 "Bear ye one another's burdens and so fulfill the law of Christ:' — Galatians 6:2 Page 3 of 17 Brotherhood Mutual I nv,roncc Cnm pan � NAMED INSURED TIMBERLINE CHURCH POLICY NUMBER OSM5AO358236 POLICY PERIOD 07/27/2018 to 07/27/2019 at 12:01 a.m. Property Coverage Summary MinistryFirstsm commercial multi -peril policy Declarations continued... We provide the Commercial Property coverage at the declared premise(s) for the coverage and limits indicated. The Coverages listed here are provided according to the terms of the designated coverage form and any other applicable forms or endorsements. Schedule of Additional Coverages: All Locations The policy's property deductible applies to each of these coverages. Details are found on the Commercial Property Coverages BCP12 4.1 form. COVERAGE DESCRIPTION COVERAGE LIMIT DEDUCTIBLE FORM Property Off Premises $25,000+ $2,500 BCP12 4.1 Inter -Continent $2,500/Item, $25,000 total+ $2,500 9CP12 4.1 Owned Personal Property - Parsonage $2,500 $2,500 ..._......._ BCP12 4.1 _ ......_._.... _.._._......- ---- Building/Personal Property - Newly Acquired/Constructed -- ... _... . ............ ........._.. _ $2,000,000++ _...._.. ....... ............. . _ $2,500 _..........._ BCP12 4.1 . _._ Outside Objects/Structures $15,000/category, $20,000 Total $2,500 BCP12 4.1 For any one tree, shrub, or plant $1,000 $2,500 BCP12 4.1 Each loss caused by wind $2,500 _.._____._.___ _ $2,500 - BCP12 4.1 Detached Structures and their Contents (Unscheduled) $10,000 for structures, $10,000 for Contents $2,500 BCP12 4.1 Owned Personal Property - Dwellings 5% of dwelling value $2,500 ............. BCP12 4.1 Contents - Buildings and Structures Described on the $10,000+++ $2,500 BCP12 4.1 Declarations T... .. railers _ _-._._ __.. _........ - ..... $10,000 -----._._..-_...._ $2,500 BCP12 4.1 Vehicle Equipment and Accessories $10,000 $2,500 BCP12 4.1 Money and Securities $5,000 (Loss from specified perils only. Doubled on specified $2,500 BCP12 4.1 holidays) Spoilage $5,000 $2,500 BCP12 4.1 Damage to Buildings and Personal Property from Animals $2,500 (Except types of damage excluded in policy form) $2,500 BCP12 4.1 Building Glass Included; no per pane or per plate limits $2,500 BCP12 4.1 + if the loss resulted from a covered peril and the property is off premises for no longer than 780 days. ++ Coverage applies for 780 days from the time construction begins or the new property is acquired. +++ Only applies if the limit of insurance shown for the structure is no more than $10,000 and there is no limit of Organizational Personal Property shown on the declarations for the structure. The policy's property deductible does not apply to the following coverages. Details are found on the Commercial Property Coverages BCP12 4.1 form. COVERAGE DESCRIPTION COVERAGE LIMIT FORM Debris Removal Expense - Partial or Total Loss Partial Loss: Remaining Limit for Covered Property - Total BCP12 4.1 Loss: $10,000 Emergency Removal Coverage applies up to 30 days after property is first moved BCP12 4.1 _.... _....._ Fire -be" partment Service Charges _..........._............_ _.. $25,000 _ _ . BCP12 4.1 Fire Extinguisher Recharge $25,000 if recharged within 30 days BCP12 4.1 Pollutant Clean -Up and Removal $10,000 (annual aggregate)' BCP12 4.1 Installed Lock Recalibration $5,000 if recalibrated within 10 days BCP12 4.1 Arson Reward $15,000*1 BCP12 4.1 Papers and Records $_25,000 BCP12 4.1 Personal Property Owned by Others (non -clergy) $2,500 per person/$10,000 maximum (excess)''" BCP12 4.1 Personal Property Owned by Clergy $30,000 (excess)-' BCP12 4.1 Theft or Vandalism Reward $5,000"` BCP12 4.1 If the loss resulted from a covered peril and was reported within 780 days. Or the amount paid to the insured as a result of the direct loss, if less than the limit stated above. "- Additional limits are available Brotherhood Mutual Insurance Company I www.brotherhoodmutual.com I 800.333.3735 I P.O. Box 2227, Fort Wayne, IN 46801-2227 Ml DEC 09/16 "Bear ye one another's burdens and so fulfill the law of Christ" - Galatians 6:2 Page 4 of 17 �] NAMED INSURED TIMBERLINE CHURCH Brotherhood Mutual„ POLICY NUMBER OSMS 2018to36 POLICY PERIOD 07/27/2018 to 07/27/2019 at 12:01 a.m. I n.urancc (nm pony Property Coverage Summary MinistryFirsts' commercial multi -peril policy Declarations continued... We provide the Commercial Property coverage at the declared premise(s) for the coverage and limits indicated. The Coverages listed here are provided according to the terms of the designated coverage form and any other applicable forms or endorsements. Optional Coverages: All Locations Combined Ordinance or Law Enforcement Coverage COVERAGE DESCRIPTION COVERAGE LIMIT Increased Building Loss (Ord & Law A) $500,000 Increased Debris Removal (Ord & Law B) $250,000 Increased Cost of Construction (Ord & Law C) $250,000 Organizational Optional Theft Coverage COVERAGE DESCRIPTION COVERAGE LIMIT Theft of Money & Securities (Thft M & S) $10,000 Theft of Building Materials (Thft Bldg Mtls) $5,000 Ministry Personnel Dishonesty Coverage COVERAGE DESCRIPTION COVERAGE LIMIT Personnel Dishonesty Coverage $100,000 Income, Extra Expense, and Donations Coverage Part COVERAGE DESCRIPTION COVERAGE LIMIT Earnings and Expenses $25,000 Extra Expense $100,000 Water Damage Coverage Part COVERAGE DESCRIPTION Water Damage Sewer and Drain Backup Extension COVERAGE DESCRIPTION Sewer/Drain Backup Extension Systems / Equipment Breakdown Coverage COVERAGE DESCRIPTION Systems/Equipment Breakdown Coverage COVERAGE LIMIT $10,000 COVERAGE LIMIT See Building/Personal Property Limit COVERAGE LIMIT Building/Personal Property Urnit DEDUCTIBLE FORM $2,500 BCP138B 1.1 $2,500 BCP138B 1.1 $2,500 BCP13861.1 DEDUCTIBLE $250 $250 DEDUCTIBLE N/A DEDUCTIBLE N/A N/A DEDUCTIBLE $2,500 DEDUCTIBLE $2,500 DEDUCTIBLE $2,500 FORM BCP36 4.1 BCP36 4.1 FORM BCP37A 4.0 FORM BCP711.1 BCP71 1.1 FORM BCP27 4.1 FORM BCP135 4.1 FORM BSEB100 4.1 Brotherhood Mutual Insurance Company I www.brotherhoodmutual.com I 800.333.3735 I P.O. Box 2227, Fort Wayne, IN 46801-2227 M1 DEC 09/16 'Bear ye one another's burdens and so fulfill the law of Christ" — Galatians 6:2 Page 5 of 17 NAMED INSURED TIMBERLINE CHURCH Bn{ m a POLICY NUMBER 05M5A0358236 therhood Mutual POLICY PERIOD 07/27/2018 to 07/27/2019 at 12:01 a.m. A I n.u..... ("., P.—, Property Coverage Summary MinistryFirst'm commercial multi -peril policy Declarations continued... We provide the Commercial Property coverage at the declared premise(s) for the coverage and limits indicated. The Coverages listed here are provided according to the terms of the designated coverage form and any other applicable forms or endorsements. Other Optional Coverages COVERAGE DESCRIPTION COVERAGE LIMIT DEDUCTIBLE FORM Certified and Non -Certified Terrorism Loss $33,044,000 $2,500 BCL0600 3.0 Interior Building Damage Coverage -Including Gutters/ $33,044,000 $2,500 BCP49 4.0 Downspouts Coverage Rented Personal Property of Others $10,000 $000 BCP12 4.1 Additional Property Forms FORM FORM NAME FORM FORM NAME BCP0643 0108 Exclusion - War and Military Action BCP500 4.0 Loss -Free Ded Reduction Endorsement BCP88 4.0 Earth Movement & Volcanic Eruption Excl BN12V 1.0 Notice Regarding Building Valuation BN151.0 Notice To Mortgagee BN25671.0 Notice Water Damage/Flood Coverage CP0171 10 08 Exclusion Water Damage CP1321.0 Loss Payable Options CPlll 1.0 Automatic Increase CL1630 06 06 Conditional Terrorism Exclusion EX0651 2.3 NBC Terrorism Exclusion Additional Interests NAME TYPE LOAN NUMBER INTEREST Konica Minolta Premier Loss Payee Copier Finance ADDRESS PO Box 5000 Johnston, IA 50131 -5000 Brotherhood Mutual Insurance Company I www.brotherhoodmutuaI.com I 800.333.3735 I P.O. Box 2227, Fort Wayne, IN 46801-2227 M1 DEC 09/16 "Bear ye one another's burdens and so fulfill the law of Christ" — Galatians 6:2 Page 6 of 17 Brotherhood Mutual' Insurance (..P—n NAMED INSURED TIMBERLINE CHURCH POLICY NUMBER 05M5A0358236 POLICY PERIOD 07/27/2018 to 07/27/2019 at 12:01 a.m. Inland Marine Coverage Summary MinistryFirst" commercial multi -peril policy Declarations continued... Schedule of Inland Marine Coverages: All Locations COVERAGE DESCRIPTION COVERAGE LIMIT DEDUCTIBLE FORM Computer Hardware _._... ---.. ..... _........ _._......... _........ _................... _ ........... _....._.._... _ $34,633 $500 BIM7201 4,0 Actual Cash Value TOSHIBA PA 5254U A 59693704A $1,300 _..._... IBM 2611-412 412 AA-DHKLT _........ _ _ _.._ ......................................._.... __..._......__._.....-.__._.._...._......-............ $1,680 .............._ ........ ............ .._.......__.... _ .._...._... ..._. IBM M11 412 AADFVN6 _ _ $1,410 SONY PCG F680 4-650-186-11 SKID $2,278 TOSHIBA SATELLITE 1800-5203 X1071541PU $1,154 ........, .. _._.... __._...._ .... SONY PCG EX370 28332430-3531019 _.- _.. .. ........ ........ $1,978 SONY 992L 992L 28332430-3530806 $1,978 _.__......... .-_ ....._.... .._...- COMPAQ PRESARIO 4784 TWO1211698 - _. ... ...._.._.., $450 SONY PCG GR300K 6CTTAI-35533-M5- ~� $1,885 _.. __..........._ ._..._ ...._..__ IBM THINKPAD A30 78-DL59_5 ............ ..................................... ........ ,... ...-... .._.. $2,362 SONY SUPERSLIM R508 PCGRSOSGCK _ .__ ...__.. __....__ ........ _.. -• • $1,900 ..... ...... ....... .__._._............... __. SONY GRS 700 A2224MG6 - .......... ........................... $1,670 _ . SONY VA10 PCG-GR5700K 600215413000006 - $1,670 'SONY PCG GRZ660 3112766 _._.._._..._..._.._._ .._._....... _....... ..._ - ._1._._....._..._ -.... _..........................._...... .......... _..._......_._.... $1,600 _._...._..__.._..__.. _.._.__...... _.....-_._ __ _---_.._.. _.. _.......... . _. DELL MFG LATITUDE D500 DRV8831 _ .... _._._._.__.._.... _ ._........_._ _.-.- -----. -- _.._.. _......_.___._._.__ $1,436 .........................._._._..._. __...... _ .. _ _ ._. _.....__._._._._._. __._.._._..._. _. _.. _. _._ _. _._____...._..._ SONY PCG ZIR 2.814363032E+014 ___. _.._ - $2,200 DELL MFG LATITUDE C600 CN09C748481551A $505 ' COMPAQ CPQR 3030US CND407OGlK _.._.. ... .... $1,500 _,............._..._..........__._....__...._.........__......... ................... _........... DELL MMINSPIRON5150 SONY VGN-A170P 142621943000001 �^ $2,150 _..... .................. - ..... _. ... _....__..__. DELL MFG INSPIRION 5150 CN-0W0940-12961- $1,274 DELL MFG 5150 $1,126 Musical Instruments __......._.. ... ... .. _. $25,414 $500 IM1250 Ol 05 BASS GUITAR AMP, BRAND: DAVID EDEN, MODEL -METRO, SERIAL #1342 $1,500 ROLAND KEYBOARD, MODEL-RD700, 66 KEY ELECTRIC PIANO, SERIAL $1,200 BASS GUITAR, MODEL SQUIRE, SERIAL #E1007007 $500................................._.............-_.........._.._....... ...... ..._............. ........_...._..._.. ELEC SIX STRING GUITAR, MODEL-STRAT $1,000 IBANEZ SR900 C04061915 BASS GUITAR $600 .................. . CONGAS -MATADOR CUSTOM W/STANDS _..__...._.... .... $375 EXTREME POWERED SPEAKER MN-MPA5500 SN-B1110077 $400--- _____......_._.._._._... ........... __------- .... _.............. EXTREME COMPANION SPEAKER MN-MP5601 SN-H24949 ...... .............. _._._.....__...... $300 2 ULTIMATE SPEAKER STANDS MN-TS80B @ $75 EACH _ $150 _._.0 FOOL SPEAKER CONNECTING CABLE _ _._.._. .... ......... .............__._.... 10 $50 ........ NIACKIE MiS_ff 4102-VLZ PRO SN-B0102560 .. $200 FENDER PASSPORT WIN-P250 WHOLE SYSTEM SN-N10362000_ PN-069-1t)02 $1,100 ...._._ _.._...... __. _...._. 2 ULTIMATE SPEAKER STANDS MN-T5806 @ $75 EACH ___- - ....... ...... ... _..-............. $150 ____. -- 1 FENDER MICROPHONE WIXLR CABLE --_._.... ---------------- _.._..__......... $65 _ ..... _. . . ._..._._._.......... _ . ._....__.._.__.._ 1 FENDER PASSPORT MN-PD-250 WHOLE SYSTEM SN-GD82806FM $1,100 ....... ..... ... ...... _._.... ..._.____ _.._._. _ ... 2 FENDER SPEAKER STANDS is $50 EACH __..... _..-..._._..___.._._......._..._........ ___...... $100 FENDER MICROPHONE W/XLR CABLE IN CASE $65 4 BELMORE PORTABLE MUSIC STANDS NO SN OR MN !d, $65 EACH $260 Brotherhood Mutual Insurance Company I www.brotherhoodmutual.com I 800.333.3735 I P.O. Box 2227, Fort Wayne, IN 46801-2227 Ml DEC 09/16 "Bear ye one another's burdens and so fulfill the law of Christ." — Galatians 6:2 Page 7 of 17 Brotherhood Mutual I, c u r,,— C o m P a n NAMED INSURED TIMBERLINE CHURCH POLICY NUMBER 05M5A0358236 POLICY PERIOD 07/27/2018 to 07/27/2019 at 12:01 a.m. Inland Marine Coverage Summary MinistryFirst'm commercial multi -peril policy Declarations continued... COVERAGE DESCRIPTION COVERAGE LIMIT DEDUCTIBLE FORM WHIRLWIND 24 CHANNEL SNAKE (BLUE) NO MN OR SN $300 RAPCO 12 CHANNEL SNAKE NO MN OR SN ......... ....... ....... ..................__........ ..,..... .... _,...,...__.......- ..._............................ ........ ..... ._.............. _....... $150 PEAVEY BASS AMP MN-300CHS SN-CK250376 $350 PEAVEY BASS SPEAKER ENCLOSER MN-210TX SN-00124250/JHA23 $200 2 GREY PLASTIC TUBS MISC CABLES/MICS 2-SHURE CORDED MICS $130 212-XLR CABLES 20 EACH $40 1 LARGE GREEN PLASTIC TUB -POWER CORDS 2-YELLOW 50' CORDS $230 2 YAMAHA SPEAKERS (MONITOR TYPE) MN-SM121V SN-07717877 & $800 FENDER GUITAR AMPLIFIER MN -CHAMP 25 PR201300 SN-Lb-319980 $300 2 SOUNDTECH SPEAKERS CX4C MN-SMZ SN-951204121 & 941002749 $900 - _-.- .--...._._..._.._.._.----.. 2 ULTIMATE SPEAKER STANDS SN-282582 & 282M00 $150 .... SOUNDTECH AMP MN-PL502 ENCLOSED IN A BLACK TRAVat ASE ..._...._.......... _............... _........... -- ... ...._ _... _.. $300 PEAVEY AMP MN-PV4C ENCLOSED IN A BLACK TRAVEL CASE $400 __._....__._._._.__.._._._.__....._........... ..... .._:.......____.__._..___...__.._._.._._......................... _...... __...__..._._._._._.______._.._._._..._......_._._......__....._..___.__---...._..---_--.._....._._._..-...................._...... PEAVEY AMP MN PV8.5C ENCLOSED IN A BLACK TRAVEL CASE $600 JVC VHS PLAYER/RECORDER MN-HRS35000 5N024J0786 ENCLOSED IN A $200 TASCAM CD/CA55 PLAYER MN CD A500 SN 0120716 ENCLOSED IN A __......._----._._ _..._......... ........_.____.._.- --.__ . _.. .-..._ ...___._._ $200 _.._ 2 ALESIS REVERB UNITS ENCLOSED IN A SKB TRAVEL CASE.:a. $250 $500 ALESIS COMPRESSOR ENCLOSED IN A SKB TRAVEL CASE $200 ALESIS EQ UNIT MN-MEQ230 SN-QS1606611 ENCLOSED IN A SKB $150 SOUNDTECH EQ UNIT MN-Q150 ENCLOSED IN A SKB TRAVEL CASE $150 MACKIE MIXER CONSOLE MN-T36459 ... ............ .,..... ...._._......._.._...__ $600 2 EV LARGE STAGE SPEAKERS (WITH COVERS) MN-1512ER $1,000 KURZEWIL KEYBOARD W/TRAVEL CASE MN-K2000 SN-4996030SO354 $1,000 ROLAND KEYBOARD (NO CASE) MN-A90EX SN-_2J963_60 $750 ROLAND PIANO AMP MN-KC500 SN-CP16045 __...__._._............... _. _............ _-..__.__ $500 ROLAND V-DRUMS CLUB SERIES (ELECTRONIC) MN-TD6 SN-AQ46183 $1,100 YAW HA CLAVINOVA KEYBOARD MN CLP123 SN 046858 __._._--.--•-.---__._._---.-----._.. _.__._._.._....__ --- _._._._._.-_._._..---------- $400 BA55 AMP W/ONBOARD MIXER MN-SW65 SN-S011205842- _ .. _.._...$4�.._-.._- �._........-__..__ AKAI DVD PLAYER (STORED IN CABINET) MN-DVP5760 SN-02040 74364 _._...__.._ _.._._. _._._......---.........-._.._.__.._. _.---.--._._.__..__._.. ..._.... _ _.._... $200 ._._ SONYCD PLAYER (STORED IN CABINET) MN-cDP390 SN-867914 __ $250 --- ___ _ ' _ YELLOW TOOLBOX W%MISC PATCH CABLES, ORANGE 50' POWER CORD, _.._._.._._.._._.._._._.......__._._..._._._._._.__.....____.___.._.._._._._--_._._._._.___.... 2-ULTIMATE SPEAKER STANDS MN-TS80B @ $75 EACH _ _ _ $150 _ MACKIE MISER CONSOLE MN CR1604 SN-A34942 _- ...._ _ ..._._.... _ . ........ _.. _ _ . ....... .... ._ _... _.__.... $700 ROLAND 88 KEY BLACK KEYBOARD MODEL RD 700SX S#ZT01521 $050 ROLAND 88 KEY BLACK KEYBOARD MODEL RD 700SX SXZT01371 $1,450 Photographic Equipment $10,900 $500 IM1350 0105 1 CANON XL1 3CCD DIGITAL VIDEO CAMCORDER NTSC (MODEL $2,500 #2610201783) 1 CANON XL1 3CCD DIGITAL VIDEO CAMCORDER NTSC (MODEL $2,500 #2720700128) _._.._.._...._.__.._._.___._.___ 1PUS CAMEDIA E-10 (MODEL #E-10) __._..._._..._.___..___ 0LYM . $400 _. _._ ...____. ._ _._..._.....___ _____.____.__---- ..............._ _ 150NY LCD DATA PROJECTOR (MODEL �VLP-PX20) � _. _._._ ._...___...... __........_..._..... _.... ...... .... _----- .-.__.._._._...__ $2,000 -_ 1 LI BEC TRIPOD T57 (NO MODEL 3) $500 1 CHRISTIE LX25 PROJECTOR (MODEL #38VIV208-01 SERIAL #20815626) $3,000 REPLACEMENT Brotherhood Mutual Insurance Company I www.brotherhoodmutual.com I 800.333.3735 I P.O. Box 2227, Fort Wayne, IN 46801-2227 M1 DEC 09/16 'Bear ye one another's burdens and so fulfill the law of Christ:' — Galatians 6:2 Page 8 of 17 Brotherhood Mutual In> "r " Company NAMED INSURED TIMBERLINE CHURCH POLICY NUMBER 05M5A0358236 POLICY PERIOD 07/27/2018 to 07/27/2019 at 12:01 a.m. Liability Coverage Summary MinistryFirstsm commercial multi -peril policy Declarations continued.,. The Coverages listed here are provided according to the terms of the designated coverage form and any other applicable forms or endorsements. Only one liability coverage and one medical coverage will apply to an occurrence and any related loss. Any limit which is specifically stated within a coverage form or endorsement represents the most we will pay for the coverage to which such a limit applies. For application of limits, see Liability and Medical Coverage form (BGL11 4.0). Key Liability Coverage Facts: Schedule of Limits GENERAL OCCURRENCE LIMIT $1,000,000 GENERAL AGGREGATE LIMIT $3,000,000 Principal Liability Coverages COVERAGE DESCRIPTIONS COVERAGE LIMIT Bodily Injury/Property Damage Liability (L) $1,000,000, Medical Payments (M) _....... __._._.._.........._._.._... ._._ - $10,000`+ Products/Completed Work (N) $1,000,000, Fire Legal Liability (0) $1,000,000, Supplemental Coverages COVERAGE DESCRIPTIONS COVERAGE LIMIT Incidental Contractual Liability $1,000,000' Incidental Medical Malpractice $1,000,000' Mobile Equipment $1,000,000` Additional Coverages COVERAGE AGGREGATE LIMIT FORM $3,000,000' GL1001.0 $3,000,000' GL1001.0 $3,000,000' GL1001.0 $3,000,000- BGL951 3.0 COVERAGE AGGREGATE LIMIT FORM $3,000,000' GL1001.0 $3,000,000' GL1001.0 $3,000,000' GL1001.0 COVERAGE DESCRIPTIONS COVERAGE LIMIT COVERAGE AGGREGATE LIMIT Membership Emotional Injury Liability Coverage $1,000,000, $3,000,000' Nursery/Child Care Corporal Punishment Liability $1,000,000, .. $3,000,000' Supervision -Related Emotional Injury Liability Coverage $1,000,000' $3,000,000' Food Preparation Liability Coverage $1,000,000, $3,000,000' Privacy Violation Liability Coverage $1000 000 ... .. _..... ___._..._._._.._.._.._...._._._ $3,000,000- _. Damage To Property Of Others Coverage $1,000,000' $3,000,000' Not in Your Control $1,000"+ $3,000,000" In Your Control $2,500'+ $3,000,000' Prosthetic Devices $500'+ $3,000,000' Incidental Camper Medical Coverage $10000' _ ...__ $3,000,000* _..._.._..____ ...... Additional Incidental Contractual Liability Coverage ----_.--. $1,000,000' $3,000,000' Related Organizations/Operations The following entities are insured for designated related Coverages. 'Only a single limit applies to the loss. All coverage limits are subject to the general occurrence limit and all aggregate limits are subject to the general aggregate limit. + per person limit FORM BGL51 4.0 BGL51 4.0 BGL51 4.0 BGL51 4.0 ................ BGL51 4.0 BGL51 4.0 BGL51 4.0 BGL51 4.0 BGL51 4.0 BGL51 4.0 -- ........... _.... .._ BGL514.0 Brotherhood Mutual Insurance Company I www.brotherhoodmutual.com I 800.333.3735 I P.O. Box 2227, Fort Wayne, IN 46801-2227 Ml DEC 09/16 'Bear ye one another's burdens and so fulfill the law of Christ"— Galatians 6:2 Page 9 of 17