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HomeMy WebLinkAboutStateFarm (2)StateFarm STATE FARM GENERAL INSURANCE COMPANY 11 A STOCK COMPANY WITH HOME OFFICES IN BLOOMINGTON, ILLINOIS DECLARATIONS AMENDED AUG 4 2023 g? Boy 291 oomington5 IL 61702-2915 Addl Insured -Section 11 Only 000211 3123 M-02-324B-FB80 F N THE TOWN OF LOS ALTOS HILLS, ITS ELECTIVE AND APPOINTED OFFICERS, EMPLOYEES, AND VOLUNTEERS 26379 W FREMONT RD LOS ALTOS HLS CA 94022-126,24 8 Businessowners'Polley Policy Number 97 -EA -D221.9 Policy Period Effective Date Expiration Date 12 Months MAY 17 2023 MAY 17 2024 The policy period bewiz np,nd ends at 12:01 am standard time atthe premises on. Named Insured LOS ALTOS, LOS ALTOS HILLS NEWCOMERSCLUB Autornatic Renewal -If the policy period is shown as 12montlis,this policywill be renewed automaticallysubjeatto 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 oras required by law. Entity: NOT FOR PROFIT 601(C)(7) Reason for Declarations: Your policy is amended AUG 4 2023 ADDITIONAL INSURED ADDED FORM CMP -4860.1 ADDED Endorsement Premium None Discounts Applied: Renewal Year Claim Record Prepared SEP 28 2023 CMP -4000 001240290 Al N O Copyright, State Form Mutual Automobile Insur'ance Company, 2008 InCIL(des copyrighted material of Insurance Services Office, Inc, with its permission, Continued on'Reverso Side of Page Pago' 1 of 6 filfl-fiflan.7 H-31-21111 folf.32.410 DECLARATIONS (CONTINUED) Businessowners Policy for THE TOWN OF LOS ALTOS HILLS, Policy Number 97 -EA -0221.9 SECTION I - INFLATION COVERAGE I X ES ..MM. Cov A - Inflation Coverage Index, N/A Cov B - Consumer Price Index; 299.2 SECTION I - DEDUCTIBLES Basic Deductible $500 Special Deductibles: Money and Securities $250 Equipinernt Breakdown $500 Other deductibles may apply - refer to policy. Prepared SEP 28 2023 C0 Copyright, State Farm Mutual Autoinubilo Insurgiico Goirnpony, 2008 CMP -4000 includes copyrighted material of Insurance Scavicras OfCine, Inc., with its permission, ON240 Continued on Next Page Page 2 of 6 Location Location of Limit of Insurance* Limit of Insurance* Seasonal Number Described Increase - Premises Coverage A - Coverage B - Business Personal Buildings Business ersonal Property Property 001 13721 LA PALOMA RD No Coverage $ 1,800 25% LCIS ALTOS HLS CA 94022-2639 * As of th6 effective AMM date of this policy, theiniit of Insurance as shown lncltades any increase ;IF the limit due to Inflation Coverage SECTION I - INFLATION COVERAGE I X ES ..MM. Cov A - Inflation Coverage Index, N/A Cov B - Consumer Price Index; 299.2 SECTION I - DEDUCTIBLES Basic Deductible $500 Special Deductibles: Money and Securities $250 Equipinernt Breakdown $500 Other deductibles may apply - refer to policy. Prepared SEP 28 2023 C0 Copyright, State Farm Mutual Autoinubilo Insurgiico Goirnpony, 2008 CMP -4000 includes copyrighted material of Insurance Scavicras OfCine, Inc., with its permission, ON240 Continued on Next Page Page 2 of 6 LU StateFarm ❑ • • •® DECLARATIONS '(CONTINUE D) Susinessowners Policy for THE TOWN OF LOS ALTOS HILLS, Policy Number 97 -EA -D221-9 .�E' " I ' „I - T NS O OF COVERAGE - LIMIT OFINSURANCE - EACH DE CRIBEb PR `MI E 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 poverage., , LIMIT OF COVERAGE INSURANCE Accounts Receivable On Premises $10,000 7ff Premises $5,000 Arson Reward $51,000. 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. .$2,500 Fire Extinguisher Systems Recharge Expense $5,000 Forgery Or Alteration $10,000 Clots. Expanses Included Increased Cost Of Construction And Demolition Costs (applies only when buildings are 10% insured on a: repi6dement cast basis) Money And Securities (Off Premises) $2,000 Money And Securities (On Premises) $5,000 Money Orders And Counterfeit Money $11,000 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 SEP 28 2023 0 Copyright, Stato Fenn MiitLlal ALitomobiIa lnsLire rice Company, 2000 CMP -4000 Includ'es`copyrighted material of Insurance Services Office, Inc„ with its permission. 001241 290 Continued on Reverse Side of Page Page 3 of 6 N DECLARATIONS (CONTINUEr _' .,usinessowners Policy for THE TOWNOF O. ALTOS _00ollcy Number A Ordinance Or Law - Equipment Coverage Outdoor Property Personal Effects (applies only to those premises provided Coverage B - Business, Personal Property) Included $5,000 $2,500 Personal Property cuff 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 Valuable Papers And Records On Premises Off Premises $2,500 $10,000 $5,000 SECTION I - EXTENSIONS NS F COVE AO - LIMIT OF INSURANCE . PED P LICY The coverages and corresponding limits shown below are the most we will pay regardless of the number of described premises shown In these Declarations. r w � Loss Of Income And Extra Expense LIMIT OF INSURANCE Actual' Loss Sustained 1, Months SECTION II - LIABILITY_ LIMIT OF COVERAGE INSURANCE Coverage L - Business Liability $43000,000 Prepared SEP 28 2023 Gopyright, State Farm Mutual Automobile Insurance Gompany, 2000 CMP -4000 Includes copyrighted material of Insurance Services Office, Inc., with its permission, 001241 Continued on Next Page Page 4 of 6 StateFarin ❑ DECLARATIONS (CONTINUED) Businessowners Policy for THE TOWN OF LOS ALTOS HILLS Policy Number 9 7 -EA -D221-9 Coverage M - Medical Expenses (Any One Person) $5,000 Damage To Promises Rented To You $300,000 AGGREGATE LIMITS LIMIT OF INSURANCE Products/Completed Operations Aggregate $8,000,000 General Aggregate s8;,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 -4101 Businessowners Coverage Form CMP -4860.1 *A] Design Person Org FE -6999.3 Terrorism Insurance Cov Notice CMP -4260.1 Amendatory Endorsement -CA CMP -4705.2 Loss of Income & Extra Expense CMP -4709 Money and Securities CMP -4804 Addl Insd Club Members CMP -4261 Amendatory Endorsement FD -6007 Inland Marine Attach Dec New Form Attached Prepared SEP 28 2023 @G6 1 pyright, State Fum WiLlal Automobile hwirance Company, 2008 CMP -4000 Includes copyrighted material of 111BUrance Services Offioe, Inc, with its permission, 001242296 Continued on Reverse Side of Page N Page 5 of 6 DECLARATIONS (CONTINUED) Businessowners Policy for THE TOWN OF LOS ALTOS,HILLS, Policy Number 97 -EA -0221-9 This policy is issued by the Mate Farm General Insurance Company, Participating Policy You are entitled to participate in a distribution of the earnings of the company as deterryyined'by our Board of Directors in accordance with the Company's /articles of Incorporation, as annernded, In Witness Whereof, the Mate Farre General Insurance Company has caused this policy to be signed by its President and Secretary at Bloomington, Illinois. Secretary President IMPORTANT NOTICE. California law requires us to .provide you with Information for filing complaints with the State Insurance Department regarding the coverage and service provided under this policy. . Your agent's name and content Information are provided on the front of this document. Another option is to reach out by mall or phone directly to: State Farm' Executive Cust6in6r Service PO Box 2320 Bloomington IL 61702 Phone # 1-800-STATEFARM 0.804.782.8332) Department of Insurance complaints should be filed only after you and State Frrrm or your agent or other company representative have failed to reach a satisfactory agreement on a problem, California Department of Insurance. Consumer Services Division $00 Mouth spring Street Los Angeles, CA 90013 Phone # 1 -840 -927 -HELP (4387) or visit WWW.In tiran+ce. a. ov! :.1�fffn Prepared SEP 28 2023 CMP -4000 0012442 29.0 N P Copyright, State Farm Mutual Automrahile Insuraltoo Company, 2008 4iiciudes copyrighted material of Insurance Servicer Offlue, Inc., with its permission. StateFarm s -TATE FARM GENERAL INSURANCE COMPANY INLAND MARINE ATTACHING DECLARATION�] A STOCKOOMPANY WIT14 HOME OFFICES IN BLOOMINGTON, ILLINOIS b??6o"m0'1'n2JYo'n5 IL 61702-2915 Policy Nuinbor 97 -EA -D221-9 Named Insured Policy Period Effective Date Evniration Date M-02-324B-FB80 F N 12 Months MAY 17 2023 MAY 17 2024 The poliNy period beiins and ends at 12:01 am standard LOS ALTOS, LOS ALTOS HILLS time att e premises ocation. NEWCOMERS CLUB A"rTACVIING INLAND MARINE Automatic 6;17oil - 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. Annual Policy Proinimm 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 subsequeritto the issuance of this policy. Forms, Options, and Endorsements FE -8739 Inland Marine Conditions FE -6271 Amendatory Endorsement FE -8746 Inland Marine Computer Prop See Reverse for Schedule Page with Limits Prepared SEP 28 2023 06Copyright, State Farin Mutual Automobile InsuranceCompany, 2000 FD -6007 Includes I copyr q ighted material of h1surance Services Office, Inc., with its permission, 001243 in 530-606a.2 05.31-2011 1a113N& 97 -EA -D221-9 ATTACHING INLAND MARINE SCHEDULE PAGE ATTACHING INLAND MARINE ENDORSEMENT LIMIT OF DEDUCTIBLE ANNUAL NUMBER COVERAGE INSURANCE AMOUNT PREMIUM FE -8745 inland Marine Computer Prop S 25,000 500 Included Loss of Income and Extra Expense 0 25,000 Included OTHER LIMITS AND EXCLUSIONS MAY APPLY - REFER TO YOUR POLICY Prepared SEP 28 2023 Copyright, State Form Mutual ALItO1 ON10 Insurance Company, 2008 FD -6007 Includes copyrighted material of Instirance Services Office, Inc., with its permission. 001243 530-608 u.2 05-31-2011 (01132330 ' StateFarm 97 -EA -D221-9 091244 0 P-4860.1 ®• Q Page 1 of 2 THIS ENDORSEMENT CHANGES THE POLICY. AREEULI. Y PLEASE READ IT CAREFULLY - 'CMP -4860.1, 'CMP -4860.11 ADDITIONAL INSURED -- DESIGNATED PERSON OR ORGANIZATION w This endorsement modifies insurance provided under the fallowing: BUSINESSOWNERS COVERAGE FORM SCHEDULE ' Policy Number: 97 -EA -D221.9'; Named Insured: LOS ALTOS, LOS ALTOS;HILLS ' Name And Address Of Additional Insured Person Or Organizaitlorl: THE TOWN OF LOS ALTOS HILLS, ITS ELECTIVE ,AND APPOINTED OFFICERS EMPLOYEES, AND VOLUNTEERS 26379 W FREMONT RD LOS ALTOS HLS CA ,94022.2698 SECTION p -- WHCi I'. AN INSURED of b. If coverage, .provided to ths• additional in - f SECTION II --- LIABILITY is amended to in- '` sured is required by a contract or agree - dude, as an additional insured, any person or merit; the insurance provided to the organization shown'in the Schedule, but only additional insured will not, be broader than E with respect to liability, for "bodily injury", that which you are. -required by the con - "property damage" or " personal and advertis-tract or agreement to provide for such ad- ing injury" caused, In, whole or in, part, by:. ditional insured; and a. Premises And Ongoing Operations c. If the contract or agreement between you Your acts or omissions or the acts or and the additional insured is governed, by omissions of those acting on your behalf: California' Civil Code Section 2782 or 2782.05, the insurance provided to the (1) In connection with your premises; or additional insured is the lesser of that (2) In the performance of your ongoing which: operations; or (1) Is allowed for the satisfaction of a de- b. Products -Completed Operations fense or indemnity obligation by Cali - "Your work" performed for that additional "products- fornia Civil Code Section 2782 or 2782.05 for your sole liability; or insured and included in the completed operations hazard". (2) You are required by contract or However, Paragraph 1. above is subject to the f agreement to provide for such addi- tional insured. � following: a. The insurance afforded to the additional We have no duty to defend or indemnify the f i insured only applies to the extent permit- additional insured under this endorsement un - ted by law; til a claim or "suit' is tendered to us, ©, Copyright, State Farm Mutual Automobile Insurance Company, 2013 j Includes copyrighted material of Insurance Services Office, Inc., with its permission. CONTINUED 97 -EA -D221-9 001244 2. Any insurance provided to the additional in- sured shall only apply with respect to a claim made or a "suit" brought for damages for which you are provided coverage. This endorsement shall not increase the ap- pIicable Limits Of Insurance shown in the Declarations. 3. With respect to the insurance afforded to the additional insured, the followingg is added to :SECTION 11--�- LIMITS OF IN IRAN E: If coverage provided to the additional insured is required by contract or agreement, the most we will pay on behalf of the additional insured will be the lesser of the amount of insurance: . Required by the contract or agreement; or . Available under the appplicable Limits Of Insurance shown in the Declarations. This endorsement shall not increase the ap- plicable Limits Of Insurance. shown in the Declarations. 4. With respect to the insurance afforded to the additional insured, the following is added to Paragraph 3. Duties In -rhe Event Of Occur- rence, Offense, Claire Or Suit of SECTION 11 GENERAL CONDITIONS: The additional insured must: a. See to it that we are notified as soon as practicableof an "occurrence" or an of- fense f fense "which may result"in a claim. To the extent possible, notice should include: (1) How, when and where the "occur- rence" or offense took place; (2) The 'names and addresses of any in- jured persons and witnesses; and CMP -4860.1 Page 2 of 2 () The, nature and location of any injury or damage arising out of the "occur- rence" or offense; b. Tender the _defense, and indemnity of any clair or "suit" to us and to all other incur - ere who may have insurance potentially available to the additional insured; and c. Agree to make available any other insur- ance the additional insured has for de- fence or damages for which we would provide coverage under SECTION 11 -- LIABILITY. S. With respect to the insurance afforded the ad- ditional insured, the following replaces SEC- TION II --- LIABILITY of Paragraph 7. Other Insurance of SECTION I AND SECTION II --- COMMON POLICY CONDITIONS: A 'This .insurance is primary to .and will not seek contribution f'rorn any other insur- ance available to the additional insured, provided, that the additional. insured is a ri'ar ed insured under such other insur- ance. b. Regardless .of any agreement between you and the additional insured, this insur- ance its excess over any other insurance whether primary, excess, contingent or on any other basis for which the additional in- Wred has been added as an additional in- sUred on other policies. There will be no refund of. premium in the event this endorsement is cancelled. All other policy provisions apply. CMP -4860.1 0, Copyright, State Farm Mutual Automobile Irisuranoe Company, 20118 Includes copyrighted material of Insurance Servicasrfice, Inc., with Its permission.