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HomeMy WebLinkAboutCOI - Petdata Inc - Expires 2024-01-08State Farm Insurance PO Box 2915 Bloomington, IL 61702-2915 08 3864 AT1 0021641005 01 CITY OF GILROY ITS OFFICERS & EMPLOYEES 7351 ROSANNA ST GILROY CA 95020-6141 OCT 31 2022 GILROY CITY CLERKS OFFICE �� ndPdlrlrlrlptf,IrllddllllilPhPdhrrprlrlrrlrlylrgrr No Notice of Reinstatement Office Reinstatement date: January 8, 2023, 12:01 a.m. Standard Time Date processed: October 18, 2022 Amount paid: No Amount Due Please keep for your records Policy number: 93-TV-3354-6 SFPP number: 1238498908 Your State Farm Agent Mike Baker 2100 Valley View Lane Suite 425 Dallas, TX 75234-8953 Bus: 214-780-0900 Email: mike.baker.b4h4@statefarm.com State Farm Lloyds We are pleased to acknowledge receipt of the premium due on this policy. This policy will be continued in force subject to its printed terms and conditions upon the payment check clearing through your bank. Insured: PETDATAINC Location: 8585 N STEMMONS FWY STE 110ON DALLAS TX 75247-3822 Policy Number: 93-TV-3354-6 Prepared. October 18, 2022 a-V Page 1 or 1 1009354 2000152832 200 09-06-2017 00216,1 97-CJ-N707-0 ATTACHING INLAND MARINE SCHEDULE PAGE ATTACHING INLAND MARINE ENDORSEMENT NUMBER COVERAGE FE-8745 Inland Marine Computer Prop Loss of Income and Extra Expense Prepared OCT 12 2022 FD-6007 OCT 3 1 2022 GILROY CITY CLERK'S OFFICE LIMIT OF DEDUCTIBLE ANNUAL INSURANCE AMOUNT PREMIUM S 25,000 $ 500 Included S 25,000 Included OTHER LIMITS AND EXCLUSIONS MAY APPLY - REFER TO YOUR POLICY © Copyright, State Farm Mutual Automobile Insurance Company, 2009 Includes copyrighted material of Insurance Services Office, Inc., with its permission. 001075 530 636 u,2 05.31 2011 Io 113233c StateFarm O OW STATE FARM GENERAL INSURANCE COMPANY A STOCK COMPANY WITH HOME OFFICES IN BLOOMINGTON, ILLINOIS INLAND MARINE ATTACHING DECLARATIONS 9?Box 2915 om►ng on IL 61702-2915 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 Exppiration Date 12 Months NOV 20 2022 NOV 20 2023 The poll y period begins and ends at 12:01 am standard time att�ie premises Tocabon. Automatic Renewal - If the policy period is shown as 12 months, this policy will be renewed automatically subjectto 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 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 Inland Marine Conditions FE-6271 Amendatory Endorsement FE-8745 Inland Marine Computer Prop See Reverse for Schedule Page with Limits Prepared OCT 12 2022 Oc Copyright, State Farm Mutual Automobile Insurance Company, 2008 FD-6007 Includes copyrighted material of Insurance Services Office, Inc., with its permission. 001075 530-536 a.2 05 31 2011 (0113232cl StateFarm ®o DECLARATIONS (CONTINUED) F Office Policy for CITY OF GILROY Policy Number 97-CJ-N707-0 CMP-4860.1 Al Design Person Org CMP-4787 Waiver of Trans Rgt of Recov CMP-4791.1 Addl Insd State Political Perm CMP-4793.1 Al State Political Perm Prem CMP-4260.1 Amendatory Endorsement -CA CMP-4261 Amendatory Endorsement o 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 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. *VW.-G rn- 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 Fans 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.ce.ctovl01-consumers Prepared OCT 12 2022 CMP-4000 O Copyright, State Farm Mutual Automobile Insurance Company, 2008 Includes copyrighted material of Insurance Services Office, Inc., with its permission. 001074 290 N Page 7 of 7 DECLARATIONS (CONTINUED) Office Policy for CITY OF GILROY Policy Number 97-CJ-N707-0 Loss Of Income And Extra Expense EGT,IQN 11-LIABILITY Actual Loss Sustained - 12 Months LIMIT OF COVERAGE INSURANCE Coverage L - Business Liability $2,000,000 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 $4,000,000 General Aggregate $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, and 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-4786.1 *Addl Insd Owners Lessee Sched CMP-4819.1 Unauthorized Business Card Use FE-6999.3 Terrorism Insurance Cov Notice CMP-4705.2 Loss of Income & Extra Expense 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-4788.1 Addl Insd Mgrs Lessor of Prem Prepared OCT 12 2022 © Copyright, State Farm Mutual Automobile Insurance Company, z008 CMP-4000 Includes copyrighted material of Insurance Services Office, Inc., with its permission. 001073 Continued on Next Page Page 6 of 7 Statefarm 9 DECLARATIONS (CONTINUED) 1 J Office Policy for CITY OF GILROY Policy Number 97-CJ-N707-0 •• Accounts Receivable (On Premises) Accounts Receivable (Off Premises) $50,000 $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 OCT 12 2022 © Copyright, State Farm Mutual Automobile Insurance Company, 2008 CMP-4000 Includes copyrighted material of Insurance Services Office, Inc., with its permission. LIMIT OF INSURANCE $5,000 $10,000 $10,000 001073 290 Continued on Reverse Side of Page Page 5 of 7 N 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 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 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 LOCATION COVERAGE INSURANCE 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 OCT 12 2022 To Copyright, State Farm Mutual Automobile Insurance Company, 2008 CMP-4000 Includes copyrighted material of Insurance Services Office, Inc., with its permission. 001072 Continued on Next Page Page 4 of 7 StateFarm neD DECLARATIONS (CONTINUED) Wo Office Policy for CITY OF GILROY Policy Number 97-CJ-N707-0 Special Deductibles: Money and Securities $250 Employee Dishonesty $250 Equipment Breakdown $500 s Other deductibles may apply - refer to policy. 0 0 th N (no ECTION I - EXTENSIONS OF COVERAGE - LIMIT OF INSURANCE - EACH DESCRIBED PREMISE 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. LIMIT OF COVERAGE INSURANCE 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 OCT 12 2022 M Copyright, State Farm Mutual Automobile Insurance Company, 2008 CMP-4000 Includes copyrighted material of Insurance Services Office, Inc., with its permission. 001072 290 Continued on Reverse Side of Page N 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 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 - Buildings Limit of Insurance* Coverage B - Business Personal Property Seasonal Increase - Business Personal Property 001 1871 THE ALAMEDA STE 180 No Coverage $ 26,800 25% SAN JOSE CA 95126-1752 002 55 PENNY LN STE 101 No Coverage $ 62,400 25% WATSONVILLE CA 95076-6017 003 5440 PARK DR STE 104 No Coverage $ 1,400 25% ROCKLIN CA 95765-5580 * As of the effective date of this policy, the Limit of Insurance as shown includes any increase in the limit due to Inflation Coverage. §ECTION 1- INFLATION COVERAGE INDEX(ES) Cov A - Inflation Coverage Index: Cov B - Consumer Price Index: SECTION I - DEDUCTIBLES Basic Deductible $500 N/A 296.3 Prepared OCT 12 2022 © Copyright, State Farm Mutual Automobile Insurance Company, 2008 CMP-4000 Includes copyrighted material of Insurance Services Office, Inc., with its permission. 001071 Continued on Next Page Page 2 of 7 StateFarm STATE FARM GENERAL INSURANCE COMPANY A STOCK COMPANY WITH HOME OFFICES IN BLOOMINGTON, ILLINOIS DECLARATIONS AMENDED SEP 22 2022 P Box 29r 15 BFoomrngon IL 61702-2915 Addl Insured -Section II Only 000134 3123 CITY OF GILROY ITS OFFICERS EMPLOYEES _••� & REPRESENTATIVES ' 7351 ROSANNA ST GILROY CA 95020-6141 g �o M-02-2551-FC05 F U II"IIII'Illlllll�lllllllIII III IIIIIIII'Itill llll'Il'IIIIIIIII'Il Office Policy Policy Number 97-CJ-N707-0 Policy Period Effective Date Exppiration Date 12 Months NOV 20 2022 NIM 20 2023 The poli y period begins and ends at 12:01 am standard time at le premises Tocation. 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 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: Corporation Reason for Declarations: Your policy is amended SEP 22 2022 ADDITIONAL INSURED ADDED PREMIUM ADJUSTMENT FORM CMP-4786.1 ADDED Endorsement Premium Increase Discounts Applied: Renewal Year Years in Business Enclosed Building Protective Devices Claim Record Other items shown are effective with the policy's 2022 renewal $ 88.00 Prepared OCT 12 2022 (D Copyright, State Farm Mutual Automobile Insurance Company, 2000 CMP-4000 Includes copyrighted material of Insurance Services Office, Inc., with its permission. 001071 290 Al Continued on Reverse Side of Page Page 1 of 7 NI.— --- - -. _. __.. ,_. ®Apostate. You're in good hands. CERTIFICATE OF INSURANCE Cl CW A02 10 11 This certificate is issued for informational purposes only. It certifies that the policies listed in this document have been issued to the Named Insured. It does not grant any rights to any party nor can it be used, in any way, to modify coverage provided by such policies. Alteration of this certificate does not change the terms, exclusions or conditions of such policies. Coverage is subject to the provisions of the policies, including any exclusions or conditions, regardless of the provisions of any other contract, such as between the certificate holler and the Named Insured. The limits shown below are the limits provided at the policy inception. Subsequent paid claims may reduce these limits. Certificate Holder. Named Insured: CITY OF GILROY, ITS AARON BENTLEY OFFICERS,OFFICIALS,AND EMPLOYEES PO BOX 52 7351 ROSANNA ST SAN MARTIN CA 95046-0052 GILROY, CA USA 950206141 Automobile Uability Insurer Name: Allstate Insurance Company Poll Number 648258512 1 --Any Auto 2 - Owned Autos Only 3 - Owned Priv. Pass. Autos Only 4 -- Owned Autos Other Than Priv. Pass. Autos Only 5 - Owned Autos Subject to No Fault 6 - Owned Autos Subject to a Compulsory UM Law X 7 -- Specifically Described Autos X 8 - Hired Autos Only X 9 - Nonowned Autos Only Policy Effective Date : 12 - 3 0- 2 0 2 2 Policy Expiration Date: 12 - 3 0- 2 0 2 3 Limits of $1, 000, 000 Combined Single Limit (each accident) Insurance: BI Per Person Bl Per Accident PD Per Accident Description of 0 rations/Locations/Vehicles/Endorsements /Special Provisions Interested Party Type: Additional Insured - Municipality THIS CERTIFICATE DOES NOT GRANT ANY COVERAGE OR RIGHTS TO THE CERTIFICATE HOLDER. IF THIS CERTIFICATE INDICATES THAT THE CERTIFICATE HOLDER IS AN ADDITIONAL INSURED, THE POLICY(IES) MUST EITHER BE ENDORSED OR CONTAIN SPECIFIC LANGUAGE PROVIDING THE CERTIFICATE HOLDER WITH ADDITIONAL INSURED STATUS. THE CERTIFICATE HOLDER IS AN ADDITIONAL INSURED ONLY TO THE EXTENT INDICATED IN SUCH POLICY LANGUAGE OR ENDORSEMENT. Producer. MAUREEN HARRIS INSURANCE Authorized Representative: Date: 10-17-22 Includes copyrighted material of Insurance Services Office, Inc., with its permission CI CW A021011 Allstate Insurance Company Additional Insured Copy Page 1 of 1 ®Allstate. You'm in good hands. POLICY NUMBER: 648258512 COMMERCIAL AUTO CA20481013 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. DESIGNATED INSURED FOR COVERED AUTOS LIABILITY COVERAGE This endorsement modifies insurance provided under the following: AUTO DEALERS COVERAGE FORM BUSINESS AUTO COVERAGE FORM MOTOR CARRIER COVERAGE FORM With respect to coverage provided by this endorsement, the provisions of the Coverage Form apply unless modified by this endorsement. This endorsement identifies person(s) or organization(s) who are "insureds" for Covered Autos Liability Coverage under the Who Is An Insured provision of the Coverage Form. This endorsement does not alter coverage provided in the Coverage Form. This endorsement changes the policy effective on the inception date of the policy unless another date is indicated below. Named Insured: AARON BENTLEY Endorsement Effective Date: 12 - 3 0- 2 0 2 2 SCHEDULE Name Of Person(s) Or Organi'zation(s): CITY OF GILROY, ITS OFFICERS,OFFICIALS,AND EMPLOYEES 7351 ROSANNA ST GILROY, CA USA 950206141 I Information required to complete this Schedule, if not shown above, will be shown in the Declarations. Each person or organization shown in the Schedule is an "insured" for Covered Autos Liability Coverage, but only to the extent that person or organization qualifies as an "insured" under the Who Is An Insured provision contained in Paragraph A.1. of Section 11 — Covered Autos Liability Coverage in the Business Auto and Motor Carrier Coverage Forms and Paragraph D.2. of Section I — Covered Autos Coverages of the Auto Dealers Coverage Form. BJ1a- CA20481013 © Insurance Services Office, Inc., 2011 Additional Insured Copy Page 1 of 1