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HomeMy WebLinkAboutCOI - Applied Survey Research, Inc. - Expires 2021-11-20State Farm STATE FARM GENERAL INSURANCE COMPANY □ A® A STOCK COMPANY WITH HOME OFFICES IN BLOOMINGTON, /LUNOIS DECLARATIONS AMENDED MAY 25 2021 Po Box 853925. Richardson, TX 75085-3925 Addi Insured-Section II Only 000287 3123 CITY OF GILROY M-02-2551-FC0S F U Policy Number 97-CJ-N707-0 Policy Period Effective Date bpiration Date 12 Months NOV 20 2020 NOV 20 2021 The policy period begins and ends at 12:01 am standard time at the premises Tocatlon. ~;~!ii ~ ITS OFFICERS EMPLOYEES & REPRESENTATIVES 7351 ROSANNA ST Named Insured 2 0 ~ ~~ (l)o GILROY CA 95020-6141 11Ill11111111I111h 11ii11111111111111IiI'iiI1111111111 I• 111111111 Office Policy APPLIED SURVEY RESEARCH INC PO BOX 1927 WATSONVILLE CA 95077-1927 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/Uenholderwritten notice in compliance with the policy provisions or as required by law. Entity: Corporation Reason for Declarations: Your policy is amended MAY 25 2021 ADDITIONAL INSURED ADDED PREMIUM ADJUSTMENT Endorsement Premium Increase Discounts Applied: Renewal Year Years in Business Enclosed Building Protective Devices Claim Record Prepared JUN 08 2021 CMP-4000 FORM CMP-4786.1 ADDED Other items shown are effective with the policy's 2020 renewal $ 44.00 © Copyright, State Farm Mutual Automobile Insurance Company, 2008 Includes copyrighted material of Insurance Services Office, Inc., with its permission. 002396 290 Al Continued on Reverse Side of Page N Page 1 of 7 .5.3.0cnR6_a)L0.5c3J~?.OJJ_l.olt3?..3J.r.J_J DECLARATIONS (CONTINUED) Office Policy for CITY OF GILROY Policy Number 97-CJ-N707-0 SECTION I -PROPERTY SCHEDULE Location Location of Limit of Insurance* Number Described Premises Coverage A-Buildings 001 1871 THE ALAMEDA STE 180 No Coverage SAN JOSE CA 95126-1752 002 55 PENNY LN STE 101 WATSONVILLE CA 95076-6017 No Coverage 003 5440 PARK DR STE 104 ROCKLIN CA 95765-5580 No Coverage Limit of Insurance* Seasonal Increase-Covera~e B-Business Business ersonal Personal Property Property $ 23,400 25% $ 54,500 25% $ 1 ,iOO 25% * As of the effective 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!ES) Gov A -Inflation Coverage Index: Gov B -Consumer Price Index: SECTION I -DEDUCTIBLES Basic Deductible Prepared JUN 08 2021 CMP-4000 002396 $500 N/A 259.1 © Copyright, State Farm Mutual Automobile Insurance Company, 2008 Includes copyrighted material of Insurance Services Office, Inc., with its permission. Continued on Next Page Page 2 of 7 I State Farm □ A® DECLARATIONS (CONTINUED) Office Policy for CITY OF GILROY Policy Number 97-CJ-N707-0 Special Deductibles: I ~ Money and Securities Equipment Breakdown $250 $500 Employee Dishonesty $250 ~ Other deductibles may apply -refer to policy. 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. 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 JUN 08 2021 CMP-4000 002397 290 N JUN 08 202i CMP-4000 002398 29n © Copyright, State Farm Mutual Automobile Insurance Company, 20D8 Includes copyrighted material of Insurance Services Office, Inc., with its permission. Continued on Reverse Side of Page © Copyright,. State Farm Mutual Automobile Insurance Company, 2D08 Includes copyrighted material of Insurance Services Office, Inc., with its permission. Continued on Reverse Side of Paae 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 Paae 5 of 7 DECLARATIONS (CONTINUED) 97-CJ-N707-0 ATTACHING INLAND MARINE SCHEDULE PAGE ATTACHING INLAND MARINE ENDORSEMENT NUMBER FE-8745 COVERAGE Inland Marine Computer Prop Loss of income and Extra Expense $ $ LIMIT OF INSURANCE 25,000 25,000 DEDUCTIBLE AMOUNT $ 500 ANNUAL PREMIUM Included Included ----------OTHER LIMITS AND EXCLUSIONS MAY APPLY -REFER TO YOUR POLICY---------Prepared JUN 08 2021 FD-6007 002400 © Copyright, State Farm Mutual Automobile Insurance Company, 2008 Includes copyrighted material of insurance Services Office, Inc., with its permission. 530-686 a.2 05-31-2011 {o1f3233cl