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Home My WebLink AboutCOI - Applied Survey Research, Inc. - Expires 2023-11-20State Farm STATE FARM GENERAL INSURANCE COMPANY Q 0 0) 0 A STOCK COMPANY WITH HOME OFFICES IN BLOOMINGTON, ILLINOIS Po Box2915 Bloomington IL 61702-2915 Addl Insured -Section II Only M-02-2551-FC05 F U 000174 3123 CITY OF GILROY ITS OFFICERS EMPLOYEES & REPRESENTATIVES 7351 ROSANNA ST GILROY CA 95020-6141 1111.1111I''III'll'I"IIIIIIIIIIIII'1"I"'1'lIIIIlIl1111NI1I111 Office Policy DECLARATIONS AMENDED DEC 2 2022 Policy Number 97-CJ-N707-0 Policy Period Effective Date Expiration Date 12 Months NOV 20 2022 NOV 20 2023 The policy period begins and ends at 12:01 am standard time at the premises location. Named Insured APPLIED SURVEY RESEARCH INC RE JAN 2 5 2023 GILROY CITY CLERK'S OFFICE 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. Entity: Corporation Reason for Declarations: Your policy is amended DEC 2 2022 ADDITIONAL INSURED ADDED PREMIUM ADJUSTMENT FORM CMP-4791.1 ADDED Endorsement Premium Increase $ 60.00 Prepared DEC 30 2022 CMP-4000 001100 290 Al N CO 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 Page 1 of 7 State Farm 0 00 DECLARATIONS (CONTINUED) Office Policy for CITY OF GILROY Policy Number 97-CJ-N707-0 Special Deductibles: WIMoney and Securities Equipment Breakdown 0 0 0 (flo $250 Employee Dishonesty $250 $500 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 LIMIT OF INSURANCE See Schedule See Schedule Arson Reward $5,000 Back -Up Of Sewer Or Drain See Schedule 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 10% insured on a replacement cost basis) Money And Securities (Off Premises) See Schedule Prepared DEC 30 2022 CMP-4000 001101 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 Page 3 of 7 State Farm O F, 0 0 DECLARATIONS (CONTINUED) Office Policy for CITY OF GILROY Policy Number 97-CJ-N707-0 Accounts Receivable (On Premises) $50,000 Accounts Receivable (Off Premises) $15,000 Outdoor Property $5,000 Valuable Papers and Records (On Premises) $50,000 Valuable Papers and Records (Off Premises) $15,000 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 Money And Securities (On Premises) $10,000 Outdoor Property $5,000 Property Of Others (applies only to those premises provided Coverage B - Business $2,500 Personal Property) Signs $2,500 Valuable Papers and Records (On Premises) $50,000 Valuable Papers and Records (Off Premises) $15,000 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) $5,000 Money And Securities (On Premises) $10,000 Outdoor Property $5,000 Property Of Others (applies only to those premises provided Coverage B - Business $2,500 Personal Property) Signs $2,500 Valuable Papers and Records (On Premises) $50,000 Valuable Papers and Records (Off Premises) $15,000 SECTION I - EXTENSIONS OF COVERAGE - LIMIT OF INSURANCE - PER POLICY 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 DEC 30 2022 CMP-4000 001102 290 N C, 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 Continued on Reverse Side of Page Page 5 of 7 State Farm 0 00 DECLARATIONS (CONTINUED) Office Policy for CITY OF GILROY Policy Number 97-CJ-N707-0 CMP-4788.1 Addl lnsd Mgrs Lessor of Prem CMP-4860.1 Al Design Person Org CMP-4787 Waiver of Trans Rgt of Recov CMP-4793.1 Al State Political Perm Prem CMP-4260.1 Amendatory Endorsement -CA CMP-4261 Amendatory Endorsement FD-6007 Inland Marine Attach Dec * New Form Attached (no 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. �� tad. COZ-"4 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 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 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 company representative have failed to reach a satisfactory agreement on a problem. California Department of Insurance Consumer Services Division 300 South Spring Street Los Angeles, CA 90013 Phone # 1-800-927-HELP (4357) or visit www.insurance.ca.uov/01-consumers Prepared DEC 30 2022 CMP-4000 001103 290 N CO Copyright, State Farm Mutual Automobile Insurance Company, 2008 Includes copyrighted material of Insurance Services Office, Inc., with its permission. Page 7 of 7 StateFarm STATE FARM GENERAL INSURANCE COMPANY CYO 0 0 0 th W0 A STOCK COMPANY WITH HOME OFFICES IN BLOOMINGTON, ILLINOIS 'MAWmington 2915 BlooIL 61702-2915 Named Insured M-02-2551-FC05 F U APPLIED SURVEY RESEARCH INC ATTACHING INLAND MARINE INLAND MARINE ATTACHING DECLARATION Policy Number 97-CJ-N707-0 Policy Period Effective Date Expiration Date 12 Months NOV 20 2022 NOV 20 2023 The policy period begins and ends at 12:01 am standard time atthe premises-focation. 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/Lienholderwritten 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 farms 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 DEC 30 2022 FD-6007 001104 OD Copyright, State Farm Mutual Automobile Insurance Company, 2008 Includes copyrighted material of Insurance Services Office, Inc., with its permission. 530-61.16 0.2 05 31-2011 10113232