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HomeMy WebLinkAboutState FarmSbteFarin Q& 0 STATE FARM GENERAL INSURANCE COMPANY A STOCK COMPANY WITH HOME OFFICES IN jz3LOOMING7('N, ILLINOIS RENEWAL DECLARATIONS 2to1n '51L 61702-2915 Roo" Addl Insured -Section 11 Only AT2 000309 3126 M-02-29F")-FBOC F N THE TOWN OF LOS ALTOS HILLS ITS ELECTIVE AND APPOINTED OFFICERS, EMPLOYEES & 11 Policy Number 97 -EM -Y197-7 Policy Porlod Effectivo Date Epliation Date '12 Months APR 2 2024 ACR 2 2025 Tho polipy priod be ins and ends at 12:01 am standard timp att ie remises ocation. VOLUNTEERS Named Insured 26379 W FREMONT RD ROGERS, LYN A LOS ALTOS HILLS CA 94022-2624 0 l Jil I I III 1 1111111 P, 11 9 II IIII III II li 1111 Offide Policy Automatic Ron'owal - If the policy period'is shown as 12 inontlis, this policy will be renewed automatically subjeotto the premiums, rul r es 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: Individual NOTICE: Information concerning changes in your policy language is included. Please call your agent ifyou hav0 , any questions. POLICY PREMIUM 325.00 Minimum Premium Discounts Applied: Renewal Year Years in Business Claim Record Prepared JAN 19 2024 CMP -4000 001772 294 A] N Oc Copyright, ht, State Form Mutual Automobile Insurojiue Company, 2008 Includes copyrighted ghted material of 111suranc'e Services I Offloo, I Inc., with I its permission, Continued on Reverse Side of Page Page 1 of 7 UHU-600 u.2 UB -31-2011 lolf32310 RENEWAL DECLARATIONS (CONTINUED) Office Policy for THE TOWN OF'LOS ALTOS HILLS Policy Number 97-EM-YI97.7 Location Location of Number Described Promises 001 12853 NORMANDY LN LOS ALTOS MLS CA 94022-4649 Limit of Insurance* Limit of Insurance* Seasonal Increase - Coverage A - CoveraBe B - Business Buildings Business Personal Personal Property. Property. No Coverage $ 1,300 �5% * As of.the effeotive date of this po ioy, the Limit of Insurance aElo—wn includes any increase —h—the limit due t�olryfration Goverage. §ECj1gN I TION WXEB#_0LE IN EXES) ---- Cov A - Inflation Coverage Index: N/A Cov B - Consumer Price Index: 307.8 Basic Deductible $1,000 Special Deductibles: Money and Securities $250 Employee Dishonesty $250 Equipment Breakdown $1,000 Other deductibles may apply - refer to policy. Prepared - JAN 19 2024 CMP -4000 001772 Copyright, State Fenn Mutual Autornobile Insurance Gornpany,2000 Includes copyrighted material of Insurance Services Office, Inc., with its permission. Continued on Next Page Page 2 of 7 Statef in ®®® 'RENEWAL DECLARATIONS (CONTINUED) Office Polio y for THE TOWN OF LOS ALTOS HILLS Policy Number 97-EM-Yf 97.7 0 SECTION I « E TENSIONS F C VEFtAGE « LIMIII 0 INSURANCS EACH DEaC I C PO�EIMiS The coverages and corresponding limits shown below apply separately to each described Declarations, unless indicated by "See Schedule." If a coverage does not have a but premises shown Inthese corresponding limit shown below, has "'Included" indicated, please refer to that policy provision for an explanation of that coverage, . COVERAGE LIMIT,OF , INSURANCE Accounts Receivable On Premises .Off Premises $p,OQq $15;000. Arson Reward $5,000 Back -Up Of Sewer Or Drain 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 insured on a replacement cost basis) Money And Securities (Off Premises) Money And Securities (On Premises) Money Orders And Counterfeit Money Newly Acquired Business Personal Property (applies only if this policy provides Coverage B - Business Personal Property) Newly Acquired Or Constructed Buildings (applies only if this policy provides Coverage A - Buildings) Prepared JAN 19 2024 0 Copyright, State Farm Mutual AUt4MON10 InSliranoo Company, 2008 CMP -4000 Includes copyrighted material of Insurance Services office, Inc,, with its permission. 001773 294 Continued on Reverse "wide of Page N $5,000 $10,000 $1,000 $100,000 $250,000 Page ' 3 of 7 RENEWAL. DECLARATIONS (CONTINUED) office ff i e Policy fror THE TOWNM F L ALTO HILLS Ordinance Or Law - Equipment Coverage Included $5,000 Outdoor Property Personal Effects (applies only .to thea premises provided Coverage.B.M usinpss $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 promises provided Coverage ;, Business $2,500 Personal_ Property) $2,500 Signs Unauthorized Business Card Use $5,000 Valuables Papers And Records $50,000 On Premises $15,000 Off Premises • The coverages and corresponding limits'shown below are the mostpay regardless w the numberR described promises shown in these Declarations. 'i LIMIT OF COVERAGE INSURANCE Dependent Property - Loss Of Income$5,000 Employee Dishonesty $10,000 Utility Interruption-, Loss Of Income $10'000 Doss Of Income And Extra Expense Actual Loss Sustained - 12 Months Prspared JAN 19 ®24 Q CopyrighMu t, State Farm tual Automl`nII obile Ins6�Ge Company, 2008 CMP -4080 Inclu[les copyrighted material of Insurance Services Of f ipe, Inc., with its permission, 00177 Continued on Text PapPage 4 of 7 me► ®®© Stateftni RENEWAL DECLARATIONS (CONTINUED) Office Policy for THE TOWN OF LOS ALTOS HILLS Policy Number 97 -EM -Y197-7 SECTION II a LIABILITY LIMIT OF COVERAGE INSURANCE Coverage L - Business 'Liability $1,000,000 Coverage M - Medical Expenses (Any One Person) $5,000 Damage To Premises Rented To You $300,000 LIMIT OF AGGREGATE LIMITS INSURANCE'' Products/Completed Operations Aggregate $2,000,000. General Aggregate $,OOO;OQO 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 endorsem' ents. 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. EORMS AND ENDORSEMENTS M. CMP -4101 Businessowners Coverage Form FE -6999.3 *'Terrorism Insurance Cov Notice CMP -4819.1 Unauthorized Business Card Use CMP -4260.1 Amendatory Endorsement -CA CMP -4261 Amendatory Endorsement CMP -4705.2 Loss of Income & Extra Expensb CMP -4710 Employee Dishonesty CMP -4709 Money and Securities CMP -4698 Back -Up of Sewer or Drain CMP -4704.1 Dependent Prop Loss of Income CMP -4703.1 Utility Interruption Loss Incm CMP -4713.1 Excl Testing Consulting E&O CMP -4795.1 Addl Insd Designated Premises Prepared JAN 19 2024 Q Copyright, State Farm Mutual Automobile InSUra4ice Company, 2008 CMP -4000 hicludes copyrighted material of Insurance Services Qffim Inc., with its permission. 001774 294 Continued on Reverse Side of Page Page 5 of 7 N RENEWAL, DECLARATIONS (CONTINUED) Iffice Policy forM OF LOSALTOS Policy be97-EM-YI97-7 CMI' -4786.1 Addl Insd Owners Lessee Sched CMI' -4787 Waiver of Trans Rgt of Recov FD -6007 inland Marine Attach Dec * New Form Attached This policy is issued by the State Farm General Insurance Company. Participating Policy You are entitled to participate In a distribution of the earnings of the company as determined, by our Berard of Directors in accordance with the Company's Articles of Incorporation, as amended. In Witness Whereof, the State Farm General Insurance Company has caused this policy to be signed by its President and Secretary at Bloomington, Illinois, Seorexary' Presidrrt IMPORTANT NOTICE: California law requires tr9 to provide you with information for filing complaints with the Mate insurance Department regarding the coverage and service provided under this policy. Your agent's tame and contact information are provided on the front of this document. Another option Is to reach out by mail or phone directly to: State FarnniO Executive trstorrrer Service, Po Box,2320 Bloomington IL 0002 Phone # 1-800•S`rATEFARM (1.800-782.8332) Department of Insurance complaints should be filed only after you and State Farm or your agent or other company representative have failed to roach a satisfactory agreement on a problem. California Department of Insurance Consumer solyloos Division 300 South Spring Street Loa Angeles, CA 900,13 Phone #f -8o0 -927 -HELP (4307) or visit www insurance,ca. ov/01-cons!il Prepared JAN 1 e X024 0 Copyright, State Farm Mutual Automobile Insurance Company, 2000 CMF' -4000 Includes copyrighted material of Insurance Services Office, Inc., with its permission. 001774 Continued on Next Page Page 6 of 7 StateFarin -aL MW RENEWAL DECLARATIONS (CONTINUED) Office Polley for THE TOWN OF LOS ALTO$ HILLS Policy Number 97 -EM -Y797-7 NOTICE TO POLICYHOLDER: For a comprehensive lesorl,lion 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. Anc forms attached to this notice are also effective on the Renewal Date of this policy. y overage 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 JAN 19 2024 CMP -4000 001775 294 N @ Copyright, State Form Mutual Automobile Insurance Company, 2008 Includes copyrighted material of Insurance Services Office, Inc,, with its permission. Page 7 of 7 97-EM-Yi 97-7 001775 StateFarni STATE FARM GENERAL INSURANCE COMPANY A STOCK COMPANY WITH HOME OFFICES IN SLOOMIN TON, ILLINOIS INLAND MARINE ATTACHING DECLARATIONS 1P3?00B10J1n2g?0'n'1L 61702-2,915 [PaI�WNum�ler �97 - E �M - Y 19 7 - 7 Named Insured M-02-29F"3-FB0C F N ROGERS, LYN A Polcy Porlod Effective Dato Ex piration Data 12 Wths APR 2 2024 A R 2 2025 Tho poligy period be iris and ends at 12:01 am standard time att e premises ocation, ATTACHING INLAND MARINE Automatic Ronowal -If the policy poriod is shown as 12 months, this policy will be renewed automatically subjeotto 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 low, Annual Policy Pri Included The above Premium Amountis 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 -8745 Inland Marino Computer Prop See Reverse for Schedule Page with Limits Prepared JAN 19 2024 fJ Copyright State Farm Mutual Automobile 111SUrajoe Company, 2008 FD -6007 Includes copyrightod material of Insurance Servicos offim Inc., with its ts imraiission. 001776 630-UUU u.2 U6-31-2011 (01f3232c) 97 -EM -Y197-7 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 25.,000 Included OTHER LIMITS AND EXCLUSIONS MAY APPLY - REFER TO YOUR POLICY Prepared (0 Copyright, Stato Form Mutual ALROITION16 Imirance Company, 2008 FD -6007 JAN 19 2024 hichidos copyrighted inaterial Of InUrance Servicesr offio s, Inc., with its permission. 001776 530-OOU al 05-31-201110242330