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Home My WebLink AboutCOI - State Farm General Insurance Company - Expires 2022-11-20S a eFarm 0 STATE FARM GENERAL INSURANCE COMPANY A STOCK COMPANY WITH HOME OFFICES IN BLOONIINGTON, ILLINOIS DECLARATIONS AMENDED MAR 2 2022 , Op PfcgE60,96 75085-3925 Addl Insured -Section II Only 000224 3123 CITY OF GILROY ITS OFFICERS EMPLOYEES & REPRESENTATIVES 7351 ROSANNA ST GILROY CA 95020-6141 IiiiIIIirtiIIiIIiIiiIiiIiIiIIIIIiIIiiiIiIIiIIIIt ) • OffiCbTolioy. • M-02-2551-FC05 F U 1::LQ72,511E1 v't, ED APR 06 2022 CLERICSOFfiCE Policy Number 97-C4-N707-0 Policy Period Effective Date Expiration Date 12 Months NOV 20 2021 NOV 20 2022 The polipy period begins and ends at 12:01 am standard time attne premiseslocation. Named Insured APPLIED SURVEY RESEARCH INC Atitoinatid Renewal -•If the'policy periedis shown as 12 months , this policy will be renewed automaticaksyyject_totitOternitims, rules and OffeCtioidactisubceeding peried. If this PelidViSterininated,'We will give Yotl'afd th-e-Mortgageeittenholder-Written notice n compliance with the policy provisions or as required by law, Entity: Corporation Reason for Declarations: Your policy is amended MAR 2 2022 ADDITIONAL INSURED ADDED PREMIUM AD)USTMENT, FORM CMP-4791.1 ADDED• ", +•;.;!! ;.!,!+ ' . ••! ••• + • H! •,+ -- Endorsement Premium • increase $ 12.00 Discounts Applied: Renewal Year Years in Business Protective Devices Claim Record Prepared MAR 24 2022 CMP-4000 00144 290 Al ® eo'py State Frrn`Mutu'al AutoMobile Insurance Company, 2008 Includes copyrighted Material of Insurance Services Office, Inc.,irvith its permission, 'COntintJed on ReVerse Side of Page Page 1 of 7 N sso-umiLms--si•nn iemm DECLARATIONS (CONTINUED) Office Policy for CITY OF GILROY Policy Number 97-CJ-N707.0 SECTION I - PROPERTY SCHEDULE Location Number Location of Described Premises ' Limit of Insurance* Coverage A - BuildMngs Limit of Insurance* Coverage B - Business Personal , :Property { ;:, Seasonal Increase - „{_: Business ° Personal '. :71* Property 001 - 1871 THE ALAMEDA STE-180 SAN JOSE CA 95126-1752 No Coverage $ . 24,700 V 25% ` 002 55 PENNY LN STE 101 WATSONVILLE CA 95076-6017 No Coverage $ 57,500 25% 003 5440 PARK DR STE 104 ROCKLIN CA 95765-5580 No Coverage $ 1,200 25% * As of the effec ive date of this policy, the Limit of Insurance as shown includes any increase in the limit due to Inflation Coverage. SECTION I - INFLATION COVERAGE INDEX(ESJ Cov A - Inflation Coverage Index: Cov B - Consumer Price Index: SECTION I - DEDUCTIBLES Basic Deductible Prepared MAR 24 2022 CMP-4000 001424 N/A 273.0 $500 0) Copyright, State Perim Mutual Automobile Insurance Company, 2008 Includes copyrighted material of Insurance Services Office, lno., with its permission, Continued on Next Page Assmaateamme e— State farm • 01C) DECLARATIONS (CONTINUED) Office Policy for CITY OF GILROY Policy Number 97-CJ-N707-0 Special Deductibles: Iv Money arid Securities Equipment Breakdown $250 Employee Dishonesty ' ' $250 - $500 Other deductibles may apply - refer to policy. SECTION I - EXTENSIONS OF COVERAGE - LIMIT OF INSURANCE - EACH' DES6RIBED PREMISES The coverages and corresponding Iirnits 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. COVERAGE Account S Receivable LIMIT OF INSURANCE On Premises See Schedule Off Premises See SchedOle ArSon Reward $5,000 . Back -.Up Of Sewer Or Drain See Schedule Collapse „ Jncluded Damage To Non -Owned Buildings From Theft, Burglary Or Robbery Coverage B Limit, Debris 'Removal 25% of eevered loss Equipment Breakdown Included Fire Department Service Charge $5,000 Fire Extinguisher Systems RechargeExpense . $5 000 Forgery Or Alteration $10,000. Glass Expenses Included Increased Cbst Of Construction And Demolition Costs (applies only when'bbildingSare insured on a replacement cost basis) Money And Securities (Off Premises) Prepared MAR 24 2022 CMP-4000 001425 290 N . • . CD Copyright State Farm Mutual Automobile Insurance Company, 2008 Includes copyrighted material of Insurance Services Office, Inc., with its permission, Continued on Reverse Side of Page • 10% - See Schedule Page 3 of 7 DECLARATIONS (CONTINUED) Office Policy for CITY OF GILROY Policy Number 97-CJ-N707-0 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) Ordinance Or Law - Equipment Coverage Included. Outdoor. Property See Schedule 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 See Schedule Personal Property) Signs Unauthorized Business Card Use Valuable Papers And Records On Premises Off Premises See Schedule. $1,000 $100,000 $250,000 See Schedule $5, 000 See Schedule See Schedule SECTION I - EXTENSIONS OF COVERAGE - LIMIT OF INSURANCE - SCHEDULE The coverages and corresponding limits shown below apply only to the described premises as shown. LIMIT OF INSURANCE LOCATION COVERAGE 0001 Signs $2,500 Back -Up Of Sewer Or Drain $15,000 Money And Securities (On Premises) $10,000 Money And Securities (Off Premises) $5,000 Property Of Others (applies only to those premises provided Coverage B - Business $2,500 Personal Property) Prepared MAR 24 2022 0 Copyright, State Farm Mutual Automobile Insurance Company, 2000 CMP-4000 Includes copyrighted material of Insurance Services Office, Inc., with its permission. 001425 Continued on Next Page Page 4 of 7 StateFarm DECLARATIONS (CONTINUED) Office Policy for CITY OF GILROY Policy Number 97-CJ-N707-0 , - Accounts Receivable (On Premises) $50,00000 Accounts Receivable (Off Premises) ,150 Outdoor Property $5,000 Valuable Papers and Records (On Premises) $50,000 Valuable Papers and Records (Off Premises) $1 5,090 0002 Accounts Receivable (On Premises) $50,000 Accounts Receivable (Off Premises) $15,000 Back -Up Of Sewer Or Drain $15,000 Money And Securities (Off Premises) $5,000 C , Money And Securities (On Premises) $10,000 ' Outdoor Property ,$5,000Property Of Others (applies only to those premises provided Coverage B -Business Personal Property) Signs Valuable Papers and Records (On Premises) Valuable Papers and Records (Off Premises) 15-15°',0°0°0° 0003 Accounts Receivable (On Premises) $50,000 , - Accounts Receivable (Off Premises) $15,000 Back -Up Of Sewer Or Drain $15,000 Money And Securities (Off Premises) $' ' $1 05 : 0° °O 0° Money And Securities (On Premises) Outdoor Property Property Of Others (applies only to those premises provided Coverage E3 - I3usiness $2,500 Personal Property) ' '. ' ' Signs $2,500 Valuable Papers and Records (On Premises) $50,000 Valuable Papers and Records (Off Premises) $15,000 SECI"loWl EXTENSIONS OF COVERAGE .'LIMIT OFINSURANCELPER POUCY 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 Prepared MAR 24 2022 CMP-4000 001426 290 N 0 Copyright, State Farm Mutual Automobile IMs'urance Company, 2008 . Includes copyrighted material of Insuranbe Services Office, Inc.; with its permission. Contindeel on'ReverSe Side of Page Page 5 of 7 LIMIT OF INSURANCE $5,000 o,boo $10,000 DECLARATIONS (CONTINUED) Office Policy for CITY OF GILROY Policy Number 97-CJ-N707-0 Loss Of Income And Extra Expense Actual Loss Sustained - 12 Months SECTION II - LIABILITY COVERAGE Coverage L - Business Liability Coverage M - Medical Expenses (Any One Person) Damage To Premises Rented To You AGGREGATE LIMITS Products/Completed Operations Aggregate General Aggregate LIMITOF INSURANCE $2,000,000 $5,000 $300, 000 LIMIT OF INSURANCE $4,000,000 $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,.ancl 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-4791.1 *Addl Insd State Political Perm CMP-4787 *Waiver of Trans Rgt of Recov CMP-4819.1 Unauthorized Business Card Use FE-6999.3 Terrorism Insurance Cov Notice CMP-4705.2 Loss of Income & Extra Expense CM P-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 Prepared MAR 24 2022 CMP-4000 001426 Copyright, State Farm Mutual Automobile Insurance Company, 2008 Includes copyrighted material of Insurance Services Office, Inc., with its permission. Continued on Next Page Page 6 of 7 StateFarm El 00 DECLARATIONS (CONTINUED) Office Policy for CITY OF GILROY Policy Number 97-CJ-N707-0 CMP-4786.1 Addl Insd Owners Lessee Sched '. CMP-4788.1 Addl Insd Mgrs Lessor of Prem CMP-4860.1 Al Design Person Org CMP-4793.1 Al State Political Perm Prem CMP-4260.1 Amendatory Endorsement -CA CMP-4261 Amendatory Endorsement 0 FD-6007 Inland Marine Attach Dec F/58 NOTICE: INFORMATION CONCERNING CHANGES IN YOUR POLICY LANGUAGE IS INCLUDED. PLEASE CALL YOUR AGENT IF YOU HAVE ANY QUESTIONS. * 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 Board 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. )11 Secretary IMPORTANT NOTICE: 401/44., President 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 contact information are provided on the front of this document. Another option is to reach out by mail or phone directly to: State Fann® Executive Customer Service PO Box 2320 Bloomington IL 61702 Phone # 1-800-STATEFARM (1-800-782-8332) Department of Insurance complaints should be filed only after you and State Farm or your agent or other cotnpany representative have failed to reach a satisfacim agreement on a problem. California Department of Insurance Consumer Services Division 300 South Spring Street Los Angeles, CA 90013 Phone it 1 -800-927-11ELP (4357) or visit www.insurance.camov/01-consumers Prepared MAR 24 2022 CMP-4000 001427 290 N @ Copyright, State Farm Mutual Automobile Insurance Company, 2008 Includes copyrighted material of Insurance Services Office, Inc., with its permission, Page 7 of 7 97-CJ-N707-0 001427 STATE FARM GENERAL INSURANCE COMPANY I ASTOCK COMPANY WITH HOME OFFICES IN BLOOMINGTON, ILLINOIS1NLAND MARINE ATTACHING DECLARATIONS 75085�3925 Named Insured APPLIED SURVEY RESEARCH INC ATTACHING INLANDIVIARINE Policy Number 97^W'N707^0 Po' Pmdod Effoctive Date nQato 12Mbnthu NOV2O2021 Ex !ration The policy periodbe 'n and ends ot12'O1amstandard time atthe premises locaton. ,/. / Automatic mvva|-|fthe policy poriodioshown oe1X mouths,thio policywillbomnewodautomatically subject,to 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 uroorequired b«law, Annual Policy Prornitum Included The above Premium Amount is included in the Policy Premium shown on the Declarations, Your m|i consists nfthese 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. Fmnno Options, and EnWomomwntw FE-8739 FE-8271 FE'8745 Inland Marine Computer Prop Inland Marine Conditions Amendatory Endorsement See Reverse for Schedule Page with Limits Prepared MAR 242O22 FO-GDO7 001428 `111$6ralke Company, 2008 includes colyighW material of Instirancia Servim Office, Inc., with its permission, 97-ICJ-N707.0 ATTACHING INLAND MARINE SCHEDULE PAGE ATTACHING INLAND MARINE ENDORSEMENT NUMBER COVERAGE LIMIT OF DEDUCTIBLE ANNUAL INSURANCE AMOUNT PREMIUM FE-8745 Inland Marine Computer Prop $ 25,000 Loss of Income and Extra Expense $ 25,000 Prepared MAR 24 2022 FD-6007 001428 OTHER LIMITS AND EXCLUSIONS MAY APPLY - REFER TO YOUR POLICY CO Copyright, State Farm Mutual Automobile Insurance Company, 2008 Includes copyrighted material of Insurance Services office, Inc„ with its permission. 500 Included Included i 3U-UUU 0.2 U!i-31-2011 (o1f323301