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HomeMy WebLinkAboutCOI - Applied Survey Research, Inc. - Expires 2022-11-201 State Farm STATE FARM GENEFfAL INSURANCE COMPANY 0 A STOCK COMPANY WITH HOME OFFICES IN BLOOMINQTON, ILLINOIS DECLARATIONS AMENDED MAY 11 2022 &® ~;ffi ~ ~?cNifcJf&~9f{ 15os5.s925 Addi Insured-Section II Only 000206 3123 CITY OF GILROY ITS OFFICERS EMPLOYEES & REPRESENTATIVES 7551 ROSANNA ST GILROY CA 95020-6141 M-02-255i-FC05 F U 111 11111 1 'I II il11I I 111 111 11111 1111 11•11 111 11 I1 11111 1111111 11 1111 I Office Policy Policy Number 97-CJ-N707-0 Policy Period Effective Date Expiration Date 12 Months NOV 20 2021 NOV 20 2022 T.he polir;y period begins and ends at 12:01 am standard time atthe premises location. Named Insured APPLIED SURVEY RESEARCH INC Automatic Renewal .. If the policy period is shown as 12 months, this policy will be renewed automatically subjectto the premiums, rules and forms in effect for each succeE1ding policy period. If this policy is terminated, we will give you and the Mortgagee/Lienholder written notice in compliance with the policy provisions or as required by law. Entity: Corporation Reason for Declarations: Your policy is amended MAY ii 2022 ADDITIONAL INSURED ADDED PREMIUM ADJUSTMENT Endorsement Premium Increase Discounts Applied: Renewal Year Years in Business Enclosed Building Protective Devices Claim Record Prepared MAY 24 2022 CMP-4000 FORM CMP-4786. i ADDED $ 44.00 © Copyright, State Farm Mutual Automobile Insurance Company, 2008 Includes copyrighted material of Insurance Services Office, Inc., with its permission. 001387 290 Al Continued on Reverse Side of Page N Page i of 7 530-686 u.2 U5-31-2U11 lo1f32!1cl DECLARATIONS (CONTINUED) Office Policy for CITY OF GILROY Polley Number 97-CJ-N707-0 .s,;;;,EC,;;;.T_,;1,,.;;O_,;N_,I_-_P ... RO_PE;,;R..,.T_Y_s_c_H_E_D_U_L_E ________________ ,.,._, __________ _ Location Location of Number Described Premises 001 1871 THE ALAMEDA STE 180 SAN JOSE CA 95126-1752 002 55 PENNY LN STE 101 WATSONVILLE CA 95076-6017 003 5440 PARK DR STE 104 ROCKLIN CA 95765-5580 Limit of Insurance* Coverane A· Build ngs No Coverage No Coverage No Coverage L. E .imit of ! nsurance* Coverage B- h.1sl11es~1 Personal Prope,·ty $ 24,700 $ 1,200 Seasonal Increase- Business Personal Property 25% 25% 25% * As of the effective date of this policy, the Limit of Insurance as shown includes any mcreas:e, in the limit due to Inflation Coverage . • s,;;;,E,;;.CT.:.:l.;;;;O.:.:N..,;.1_-.:.;.IN,;,;,F .. L_A...,Tl;,aoO_N._C._O_v __ E_,B ... AwG;;.;;E;,,;1;;.;N_,D,=EX;;,;,i(.;;;E.;;;S ... } _____________ , ___________ _ Gov A -Inflation Coverage Index: Cov 8 -Consumer Price Index: N/A 273.0 SECTION I -DEDUCTIBLES ..;.;;;;;.;;;,.;.~----------------------------------, .. ------------- Basic Deductible Prepared MAY 24 2022 CMP-4000 001387 $500 © Copyright, State Farm Mutual Automobile Insurance Company, 201l8 Includes copyrighted material of Insurance Services Office, ln,c., with its riai-mission. Continued on Next Page Page 2 of 7 I State Farm A® DECLARATIONS (CONTINUED) ffi/~ ~ Office Policy for CITY OF GILROY Policy Number 97-CJ-N707-0 Special Deductibles: Money and Securities Equipment Breakdown $250 $500 Other deductibles may apply -refer to policy. Employee Dishonesty □ $250 SECTIQN I -EXTENSIONS OF COVERAGE • LIMIT OF INSURANCE • EACH DESCRIBED PREMISES The coverages and corresponding limits shown below apply separately to each described premises shown in these Declai·ations, 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 Accounts Receivable On Premises Off Premises Arson Reward Back-Up Of Sewer Or Drain Collapse Damage To Non-Owned Buildings From Theft, Burglary Or Robbery Debris Removal Equipment Breakdown Fire Department Service Charge Fire Extinguisher Systems Recharge Expense Forgery Or Alteration Glass Expenses Increased Cost Of Construction And Demolition Costs (applies only when buildings are insured on a replacement cost basis) Money And Securities (Off Premises) Prepared MAY 24 2022 CMP-4000 001388 290 N © Copyright, State Fann Mutual Automobile Insurance Company, 2008 Includes copyrighted material of Insurance Services Office, Inc., with its permission. Continued on Reverse Side of Page LIMIT OF INSURANCE See Schedule See Schedule $5,000 See Schedule Included Coverage 8 Limit 25% of covered loss Included $5,000 $5,000 $10,000 Included 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 Outdoor Property Personal Effects (applies only to those premises provided Coverage B -Business Personal Property) Personal Property Off Premises Pollutant Clean Up And Removal Preservation Of Property Property Of Others (applies only to those premises provided Coverage B -Business Personal Property) Signs Unauthorized Business Card Use Valuable Papers And Records On Premises Off Premises SECTION I • EXTENSIONS QF COVERAGE -LIMIT OF INSURANCE • SCHEDULE See Schedule $1,000 $100,000 $250,000 Included See Schedule $5,000 $15,000 $10,000 30 Days See Schedule See Schedule $5,.000 See Schedule See Schedule The coverages and corresponding limits shown below apply only to the described premises as shown. LOCATION 0001 Prepared MAY 24 2022 CMP-4000 001388 COVERAGE Signs Back-Up Of Sewer Or Drain Money And Securities (On Premises) Money And Securities (Off Premises) Property Of Others (applies only to those premises provided Coverage B -Business Personal Property) © Copyright, State Farm Mutual Automobile lnsuranoe Company, 2008 lnoludes oopyrighted material of lnsuranoe Servioes Offioe, Inc., with its permission. Continued on Next Page LIMIT OF INSURANCE $2,500 $15,000 $10,000 $5,000 $2,500 Page 4 of 7 State Farm DECLARATIONS (CONTINUED) Office Policy for CITY OF GILROY Policy Number 97-CJ-N707-0 0002 0003 Accounts Receivable (On Premises) Accounts Receivable (Off Premises) Outdoor Property Valuable Papers and Records (On Premises) Valuable Papers and Records (Off Premises) Accounts Receivable (On Premises) Accounts Receivable (Off Premises) Back-Up Of Sewer Or Drain Money And Securities (Off Premises) Money And Securities (On Premises) Outdoor Property Property 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) Accounts Receivable (On Premises) Accounts Receivable (Off Premises) Back-Up Of Sewer Or Drain Money And Securities (Off Premises) Money And Securities (On Premises) Outdoor Property Property 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) SECTION I • EXTENSIOJ::IS OF COVERAGE • LIMIT OF INSURANCE • PER POLICY $50,000 $15,000 $5,000 $50,000 $i5,000 $50,000 $15,000 $15,000 $5,000 $'10,000 $5,000 $2,500 $2,500 $50,000 $15,000 $50,000 $15,000 $'15,000 $5,000 $10,000 $5,000 $2,500 $2,500 $50,000 $15,000 □ The coverages and corresponding limits shown below are the most we will pay regardless of the number of described premises shown in these Declarations. · COVEFIAGE Dependent Property -Loss Of Income Employee Dishonesty Utility Interruption -Loss Of Income Prepared MAY 24 2022 CMP-4000 © Copyright, State Farm Mutual Automobile Insurance Company, 2008 Includes copyrighted material of Insurance Services Office, Inc., with its permission. 001389 290 N Continued on Reverse Side of Page LIMIT OF INSURANCE $5,000 $10,000 $10,000 Page 5 of 7 DECLARATIONS (CONTINUED) Office Polley for CITY OF GILROY Policy Number 97-CJ-N707-0 Loss Of Income And Extra Expense Actua.l Loss Sustained -12 Months ~S-=E.::;C.;.Tl;..;O .. N:..1:-l• ... L~lwA ... B,:,:.IL-IT_V _______________________ ~----------- COVERAGE Coverage L -Business Liability Coverage M -Medical Expenses (Any One Person) Damage To Premises Rented To Yau AGGREGATE LIMITS Products/Completed Operations Aggregate General Aggregate LIMITOF INSURANCE $2,000,000 $5,000 $300,000 LIMITOF 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 attach1ed 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 issuod subsequent to the issuance of this policy . .,.FO_R_M_S;;;..,:,.:A_,;;N_D_E_N=D=O.;.;;R ... S5 __ M_E __ N_r_s ____________________ ,_, __________ _ CMP-4"101 CMP-4786.1 CMP-4787 CMP-4819. i FE-6999.3 CMP-4705.2 CMP-4710 CMP-4709 CMP-4698 CMP-4704.1 CMP-4703.1 Prepared MAY 24 2022 CMP-4000 001389 Businessowners Coverage Form *Addi lnsd Owners Lessee Sched *Waiver of Trans Rgt of Recov Unauthorized Business Card Use Terrorism Insurance Gov Notice Loss of Income & Extra Expense Employee Dishonesty Money and Securities Back-Up of Sewer or Drain Dependent Prop Loss of Income Utility Interruption Loss lncm © Copyright, State Farm Mutual Automobile Insurance Company, ?..ODB Includes copyrighted material of Insurance Services Office, Inc., with its 1:imrmission. Continued on Next Page Page 6 of 7 I State Farm A® DECLARATIONS (CONTINUED) ~~ m Office Policy for CITY OF GILROY Policy Number 97-CJ-N707-0 CMP-4788.1 CMP-4860.1 CMP-4791.1 CMP-4793.1 CMP-4260.1 CMP-4261 FD-6007 Addi lnsd Mgrs Lessor of Prem Al Design Person Org Addi lnsd State Political Perm Al State Political Perm Prem Amendatory Endorsement-CA Amendatory Endorsement Inland Marine Attach Dec 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 ara 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. D In Witness Whereof, the State Farm General Insurance Company has caused this policy to be signed by its President and Secretary at Bloomington, Illinois. ~ht-~ 4~~ Secretary President IMPORTANT NOTICE: Callfomla law requires us to provide you with information for filing complaints with the State Insurance Department regarding the covernge 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 Farm® Executive Customer Service PO Box2320 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 company representative have failed to reach a satisfac10Iy agreement 011 a problem. California Depal'tment of Insurance Consumer Seivioos Division 300 South Spring Street Los Angeles, CA 90013 Phone# 1·800·927-HELP (4357) or visit www.insuranoo.ca.govro·1-cons4mers Prepared MAY 24 2022 CMP-4000 001390 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 001390 State Farm A® STATE FARM GENEFfAL INSURANCE COMPANY n A STOCK COMPANY WITH HOME OFFICES IN BLOOMINGTON, ILLINOIS INLAND MARINE ATTACHING DECLARATIONS- Po Box 853925 Richardson, TX 75085,3925 Named Insured M-02-2551-FC05 F U APPLIED SURVEY RESEARCH INC ATTACHING INLAND MARINE Policy Number 97-CJ-N707-0 Policy Period Effective Date Ex_piration Date ·12 Months NOV 20 2021 NOV 20 2022 The polii-:y period begins <1nd ends at 12:01 am standard time atthe premises location. Automatic Renewal -If the policy period is shown as 12 months, this policy will be renewed automatically subjectto the premiums, rules and forms in effect for each succeeding policy period. If this policy is terminated, we will give you and the Mortgagee/Lienholder written notice in compliance with the policy provisions or as required by law. Annual Policy Premium Included The above Premium Amount is Included in the Policy Premium shown on the Declarations. Your policy consists of these Declarations, the INLAND MARINE CONDITIONS shown below, and any other forms and endorsements that apply, including those shown below as well as those issued subsequentto the issuance of this policy. Forms, Options, and Endorsements FE-8739 FE-6271 FE-8745 Inland Marine Conditions Amendatory Endorsement Inland Marine Computer Prop See Reverse for Schedule Page with Limits Prepared MAY 24 2022 FD-6007 001391 © Copyright, State Farm Mutual Automobile Insurance Company, 2008 Includes copyrighted material of Insurance Services Office, Inc., with its permission. 530-688 u.2 85-31-2011 fo1t3232cl 97-CJ-N707 •0 ATTACHING INLAND MARINE SCHEDULE PAm: ATTACHING INLAND MARINE --------------------------------1/11\110 ___ , _______ _ ENDORSEMENT NUMBER FE-8745 COVERAGE Inland Marine Computer Prop Loss of Income and Extra Expense LIMIT OF INSURANCE .25, 0 0 0 25,000 Df:OUCTI BLE AMOUNT 500 ANNUAL PREMIUM Included Included ----------OTHER LIMITS AND EXCLUSIONS MAY APPLY· REFER TO YOUH POLICY--------- Prepared MAY 24 2022 FD-6007 001391 © Copyright, State Farm Mutual Automobile Insurance Com11any, 20ll8 Includes copyrighted material of Insurance Services Office, ln,c., with its piormission. 530-6060.2 05-31-2011 (o1f3233c) State Farm STATE FARM GENERAL INSURANCE COMPANY 0 A STOCK COMPANY WITH HOME OFFICES IN BLOOMINGTON, ILLINOIS DECLARATIONS AMENDED APR 28 2022 A® Po Box 853925 R1cnardson, TX 75085-3925 Addi Insured-Section II Only 000337 3123 CITY OF GILROY ITS OFFICERS EMPLOYEES & REPRESENTATIVES 7351 ROSANNA ST GILROY CA 95020-6141 M-02-2551-FC05 F U 111 l1 111lll1 11 l1l •'l1 'l1 11111 l111l11 111 1l111 111 11111l1 1 1l 111 1ll 1I Office Policy Policy Number 97-CJ-N707-0 Policy Period Effective Date Expiration Date 12 Months NOV 20 2021 NOV 20 2022 T.he policy period begins 11nd ends at 12:01 am standard time atthe prem1seslocat1on. Named Insured APPLIED SURVEY RESEARCH INC Autom_atic Renewal -If the policy peri~d is sh~wn as ~2 mo.nth~, this _policy will b~ re~ewed automatically subject.to the premiums, rules and forms 1n effect for each succeeding pol1ey period. If this policy 1s terminated, we will give you and the Mortgagee/L1enholder written notice in compliance with the policy provisions or as required by law. Entity: Corporation Reason for Declarations: Your policy is amended APR 28 2022 ADDITIONAL INSURED ADDED PREMIUM ADJUSTMENT Endorsement Premium Increase Discounts Applied: Renewal Year Years in Business Enclosed Building Protective Devices Claim Record Prepared MAY 23 2022 CMP-4000 FORM CMP-4786.1 ADDED $ 44.00 © Copyright, State Farm Mutual Automobile Insurance Company, 2008 Includes copyrighted material of Insurance Services Office, Inc., with its permission. 002199 290 Al Continued on Reverse Side of Page N Page i of 7 fiSll-68611.2 0fi-31-21111 lo1f3231cl I State farm A® DECLARATIONS (CONTINUED) Office Policy for CITY OF GILROY Policy Number 97-CJ-N707-0 Special Deductibles: Money and Securities Equipment Breakdown $250 $500 Other deductibles may apply -refer to policy. Employee Dishonesty □ $250 SECTION I -EXTENSIONS OF COVERAGE -LIMIT OF INSURANCE -EACH DESCRIBED PREMISES The coverages and corresponding limits shown below apply separately to each described premises shown in these Declarations, unless indicated by "See Schedule." If a coverage does not have a corresponding limit shown below, but has "Included" indicated, please refer to that policy provision for an explanation of that coverage. COVEFJAGE Accounts Receivable On Premises Off Premises Arson Reward Back-Up Of Sewer Or Drain Collapse Damage To Non-Owned Buildings From Theft, Burglary Or Robbery Debris Removal Equipment Breakdown Fire Department Service Charge Fire Extinguisher Systems Recharge Expense Forgery Or Alteration Glass Expenses Increased Cost Of Construction And Demolition Costs (applies only when buildings are insured on a replacement cost basis) Money And Securities (Off Premises) Prepared MAY 23 2022 CMP-4000 002200 290 N © 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 LIMIT OF INSURANCE See Schedule See Schedule $5,000 See Schedule Included Coverage B Limit 25% of covered loss Included $5,000 $5,000 $"10,000 Included "10% See Schedule Page 3 of 7 State Farm &® DECLARATIONS (CONTINUED) Office Policy for CITY OF GILROY · Policy Number 97-CJ-N707-0 0002 0003 Accounts Receivable (On Premises) Accounts Receivable (Off Premises) Outdoor Property Valuable Papers and Records (On Premises) Valuable Papers and Records (Off Premises) Accounts Receivable (On Premises) Accounts Receivable (Off Premises) Back-Up Of Sewer Or Drain Money And Securities (Off Premises) Money And Securities (On Premises) Outdoor Property Property 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) Accounts Receivable (On Premises) Accounts Receivable (Off Premises) Back-Up Of Sewer Or Drain Money And Securities (Off Premises) Money And Securities (On Premises) Outdoor Property Property 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) SECTION I -EXTENSIONS OF COVERAGE • LIMIT OF INSURANCE· PER POLICY $50,000 $15,000 $5,000 $50,000 $15,000 $50,000 $15,000 $15,000 $5,000 $10,000 $5,000 $2,500 $2,500 $50,000 $15,000 $50,000 $15,000 $15,000 $5,000 $10,000 $5,000 $2,500 $2,500 $50,000 $15,000 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 MAY 23 2022 CMP-4000 © Copyright, State Farm Mutual Automobile Insurance Company, 2008 Includes copyrighted material of Insurance Services Office, Inc., with its permission. LIMIT OF INSURANCE $5,000 $10,000 $10,000 □ 002201 290 N Continued on Reverse Side of Page Page 5 of 7 State Farm A® DECLARATIONS (CONTINUED) Office Policy for CITY OF GILROY Policy Number 97-CJ-N707-0 CMP-4860.1 CMP-4787 CMP-4791.1 CMP-4793.1 CMP-4260.1 CMP-4261 FD-6007 Al Design Person Org Waiver of Trans Rgt of Recov Addi lnsd State Political Perm Al Sta,te Political Perm Prem Amendatory Endorsement-CA Amendatory Endorsement Inland Marine Attach Dec * New Form Attached This policy is issued by the State Farm General Insurance Company. Participating Policy You are entitled to participate in a distribution of the earnings of the company as determined by our Board of Directors in accordance with the Company's Articles of Incorporation, as amended. □ In Witness Whereof, the State Fann General Insurance Company has caused this policy to be signed by its President and Secretary at Bloomington, Illinois. ~m.~ ~~ Secretary President IMPORTANT NOTICE: California law require$ us to provide you with information for filing complaints with the State Insurance Department regarding the coverage and service provided under this policy. Your ageni'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 Farnf!i1 Executive Customer Service POBox2320 Bloomington ll 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 company representative have foiled to reach a satisfactory agreement on a problem. Califomia Department of Insurance Consumer Services DIVislon 300 South Spring Street Los Angeles, CA 90013 Phone# 1-800-927-HELP (4357) or visit www.insurance.ca.gov/01-consumers Prepared MAY 23 2022 CMP-4000 002202 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 State Farm A® STATE FARM GENERAL INSURANCE COMPANY n A STOCK COMPANY WITH HOME OFFICES IN BLOOMINGTON, ILLINOIS INLAND MARINE ATTACHING DECLARATIONS- ~?c~ifcJf5~9f-Y< 75085-3925 Named Insured M-02-2551-FC0S F U APPLIED SURVEY RESEARCH INC ATTACHING INLAND MARINE Policy Number 97-CJ-N707-0 Policy Period Effective Date Expiration Date 12 Months NOV 20 2021 NOV 20 2022 T.he polipy period begins c1nd ends at 12:01 am standard time atthe premises location. Automatic Renewal -If the policy period is shown as 12 months, this policy will be renewed automatically 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 Premium Included The above Premium Amount is included in the Policy Premium shown on the Declarations. Your policy consists of these Declarations, the INLAND MARINE CONDITIONS shown below, and any other forms and endorsements that apply, including those shown below as well as those issued subsequentto the issuance ofthis policy. Forms, Options, and Endorsements FE-8739 FE-6271 FE-8745 Inland Marine Conditions Amendatory Endorsement Inland Marine Computer Prop See Reverse for Schedule Page with Limits Prepared MAY 23 2022 FD-6007 002203 © Copyright, State Farm Mutual Automobile Insurance Company, 2008 Includes copyrighted material of Insurance Services Office, Inc., with its permission. 530-686 u.2 05·31-2011 (olfJ232c)