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HomeMy WebLinkAboutCOI - Special K Productions - Expires 2023-09-01StateFarm STATE FARM GENERAL INSURANCE COMPANY ❑ A STOCK COMPANY WITH HOME OFFICES IN BLOOMINGTON, ILLINOIS DECLARATIONS AMENDED MAR 272023 s § B ngton IL 61702-2915 28815 Policy Number 97-B8-B286-6 Add[ Insured -Section II Only Policy Period Effective Date Expiration Date M-02-6868-FBFF F N 12 Months SEP 1 2022 SEP 1 2023 000333 3123 The poll�CCy period beggins and ends at 12:01 am standard CITY OF GILROY time attnepremises locatlon. ITS OFFICERS, OFFICIALS & EMPLOYEES 7351 ROSANNA ST Named Insured GILROY CA 95020-6141 ALI, KENYATTA DBA SPECIAL p �D "Ill�lrinl���l�r�III�ILItIILIldndr��Il�J�r�r�IJI�IIJII s MAY 16 2023 �$ GILROY CITY CLERICS OFFICE Businessowners Policy 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/Lien holder written notice in compliance with the policy provisions or as required by law. Entity: Individual Reason for Declarations: Your policy is amended MAR 27 2023 ADDITIONAL INSURED ADDED PREMIUM ADJUSTMENT FORM CMP-4860.1 ADDED Endorsement Premium None Discounts Applied: Renewal Year Years in Business Claim Record Prepared APR 24 2023 © Copyright State Farm Mutual Automobile Insurance Company, 2008 CMP-4000 Includes copyrighted material of Insurance Services Office, Inc., with its permission. 002222 290 Al Continued on Reverse Side of Page N Page 1 of 6 DECLARATIONS (CONTINUED) Businessowners Policy for CITY OF GILROY Policy Number 97-138-13286-6 ,SECTION 1- PROPERTY SCHEDULE Location Location of Limit of Insurance* Limit of Insurance* Seasonal Number Described Increase - Premises Coverage A - Coverage B - Business Buildings Business Personal Personal Property Property 001 3687 ROCKY CREEK CT No Coverage $ 2,000 25% SAN JOSE CA 95148-1421 * 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 COMgRA� GE INDEMES1 Cov A - Inflation Coverage Index: Cov B - Consumer Price Index: SECTION I - DEDUCTIBLES N/A 289.1 Basic Deductible $1,000 Special Deductibles: Money and Securities $250 Equipment Breakdown $1,000 Other deductibles may apply - refer to policy. Prepared APR 24 2023 4 Copyright, State Farm Mutual Automobile Insurance Company, 2008 CMP-4000 Includes copyrighted material of Insurance Services Office, Inc., with its permission. 002222 Continued on Next Page Page 2 of 6 StateFarm ®, DECLARATIONS (CONTINUED) Businessowners Policy for CITY OF GILROY Policy Number 97-138-13286-6 n 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, �o but has "Included" indicated, please refer to that policy provision for an explanation of that coverage. LIMIT OF COVERAGE INSURANCE Accounts Receivable On Premises $10,000 Off Premises $5,000 Arson Reward $5,000 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 $2,500 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) $2,000 Money And Securities (On Premises) $5,000 Money Orders And Counterfeit Money $1,000 Newly Acquired Business Personal Property (applies only if this policy provides $100,000 Coverage B - Business Personal Property) Newly Acquired Or Constructed Buildings (applies only if this policy provides $250,000 Coverage A - Buildings) Prepared APR 24 2023 © Copyright, State Farm Mutual Automobile Insurance Company, 2008 CMP-4000 Includes copyrighted material of Insurance Services Office, Inc., with its permission. 002223 290 Continued on Reverse Side of Page Page 3 of 6 N DECLARATIONS (CONTINUED) Businessowners Policy for CITY OF GILROY Policy Number 97-138-13286-6 Ordinance Or Law - Equipment Coverage Included Outdoor Property $5,000 Personal Effects (applies only to those premises provided Coverage B - Business $2,500 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 $2,500 Personal Property) Signs $2,500 Valuable Papers And Records On Premises $10,000 Off Premises $5,000 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 Loss Of Income And Extra Expense LIMIT OF INSURANCE Actual Loss Sustained - 12 Months SECTION II - LIABILITY LIMIT OF COVERAGE INSURANCE Coverage L - Business Liability Prepared Cc 24 2023 Copyright, State Farm Mutual Automobile Insurance Company, 2008 CMP-4000 Includes copyrighted material of Insurance Services Office, Inc., with its permission. 002223 Continued on Next Page $3,000,000 Page 4 of 6 StateFarm O DECLARATIONS (CONTINUED) 11 Businessowners Policy for CITY OF GILROY Policy Number 97-138-13286-6 Coverage M - Medical Expenses (Any One Person) W"XME . 2§1 Damage To Premises Rented To You AGGREGATE LIMITS 0 Products/Completed Operations Aggregate (nO General Aggregate $5,000 $300,000 LIMIT OF INSURANCE $6,000,000 $6,000,000 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-4860.1 "AI Design Person Org CMP-4787 *Waiver of Trans Rgt of Recov FE-6999.3 Terrorism Insurance Cov Notice CMP-4788.1 Addl Insd Mgrs Lessor of Prem CMP-4786.1 Addl Insd Owners Lessee Sched CMP-4709 Money and Securities CMP-4705.2 Loss of Income & Extra Expense CMP-4795.1 Addl Insd Designated Premises CMP-4260.1 Amendatory Endorsement -CA CMP-4261 Amendatory Endorsement FD-6007 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 Prepared APR 24 2023 C Copyright, State Farm Mutual Automobile Insurance Company, 2008 CMP-4000 Includes copyrighted material of Insurance Services Office, Inc., with its permission. 002224 290 Continued on Reverse Side of Page Page 5 of 6 N DECLARATIONS (CONTINUED) Businessowners Policy for CITY OF GILROY Policy Number 97-B8-B286-6 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. *M�G rn. 0� 404*- C,444/# 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.1nsurance.ca.aov/01-consumers Prepared APR 24 2023 0 Copyright, State Farm Mutual Automobile Insurance Company, 2008 CMP-4000 Includes copyrighted material of Insurance Services Office, Inc., with its permission. 002224 290 Page 6 of 6 N StateFarm STATE FARM GENERAL INSURANCE COMPANY El A STOCK COMPANY WITH HOME OFFICES IN BLOOMINGTON, ILLINOIS INLAND MARINE ATTACHING DECLARATIONS Po Box 2915 Bloomington IL 61702-2915 Named Insured M-02-6868-FBFF F N ALI, KENYATTA DBA SPECIAL K PRODUCTIONS ATTACHING INLAND MARINE Policy Number 97-138-13286-6 Policy Period Effective Date Expiration Date 12 Months SEP 1 2022 SEP 1 2023 The poll y period begins and ends at 12:01 am standard time at a 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 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-6271 Amendatory Endorsement FE-8739 Inland Marine Conditions FE-8745 Inland Marine Computer Prop See Reverse for Schedule Page with Limits Prepared APR 24 2023 O Copyright, State Farm Mutual Automobile Insurance Company, 2008 FD-6007 Includes copyrighted material of Insurance Services Office, Inc., with its permission. 002225 h30 586 a.2 05 31 2011 1013232c y r 00-t$zaa-u ATTACHING INLAND MARINE SCHEDULE PAGE ATTACHING INLAND MARINE ENDORSEMENT LIMIT OF DEDUCTIBLE ANNUAL NUMBER COVERAGE INSURANCE AMOUNT PREMIUM FE-8745 Inland Marine Computer Prop S 2 5, 0 0 0 5 500 Included Loss of Income and Extra Expense S 2 5, 0 0 0 Included Prepared APR 24 2023 FD-6007 002225 OTHER LIMITS AND EXCLUSIONS MAY APPLY - REFER TO YOUR POLICY �9) 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 101132330