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HomeMy WebLinkAboutCOI - Scott Lopatin - Expires 2024-03-10Statem eFFar W STATE FARM GENERAL INSURANCE COMPANY 11 A STOCK COMPANY WITH HOME OFFICES IN BLOOMINGTON, ILLINOIS DECLARATIONS AMENDED MAY 202023 B9comington IL 61702-2915 Named Insured M-02-2045-FB95 F W 000254 3123 LOPATIN, SCOTT 110 ESMERALDA DR SANTA CRUZ CA 95060-1916 �'I:.Il�llr:III�I�II::'IIII�'III'Illll'1:1"::�I�::III�I'Illill�l Policy Number 97-CP-Z503-4 Policy Period Effective Date Expiration Data 12 Months MAR 10 2023 MAR 10 2024 The pall y period be?ins and ends at 12:01 am standard time pal premises ocation. Agent and Mailing Address RN LUKITO PO BOX 31007 SAN FRANCISCO CA 94131-0007 PHONE: (415) 282-5558 Apartment 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: Endorsement Premium Discounts Applied: Renewal Year Years in Business Claim Record Your policy is amended MAY 20 2023 INSURED NAME AND/OR ADDRESS CHANGE None MAY 16 ' K3 GILROY UP' CLERK'S OFFICE This policy may include buildingg code upgrade coverage. Refer to the Important Notice for possible terms, limits, conditions, or resfrictions. Prepared APR 24 2023 T Copyright State Form Mutual Automobile Insurance Company, 2008 CMP-4000 Includes copyrighted material of Insurance Services Office, Inc., with its permission. 001602 290 1 Continued on Reverse Side of Page Page 1 of 7 N 1Y DECLARATIONS (CONTINUED) Apartment Policy for LOPATIN SCOTT Policy Number 97-CP-Zb03-4 SECTION I - PROPERTY SCHEDULE Location Location of Limit of Insurance* Limit of Insurance* Number Described Premises Coveragge A - Coveragge B - Buildi"ngs Business Personal Property 001 132-134 COLERIDGE ST $ 1,043,100 No Coverage SAN FRANCISCO CA 94110-5113 * 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 COVE RAGE INDEXES) Inflation Coverage Index: SECTION I - DEDUCTIBLES 309.4 Basic Deductible $5,000 Special Deductibles: Employee Dishonesty $250 Equipment Breakdown $2,500 Lock Replacement $100 Other deductibles may apply - refer to policy. Prepared APR 24 2023 b Copyright, State Farm Mutual Automobile Insurance Company, 2008 CMP-4000 Includes copyrighted material of Insurance Services Office, Inc., with its permission. 001602 Continued on Next Page Page 2 of 7 StateFarm ®® DECLARATIONS (CONTINUED) Apartment Policy for LOPATIN, SCOTT Policy Number 97-CP-Z503-4 SECTION I - EXTENSIONS OF COVERAGE - LIMIT OF INSURANCE - EACH DESCRIBED PREMISES 11 8 The coverages and corresponding limits shown below apply separately to each described premises shown in these 8 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. (no COVERAGE Collapse Damage To Non -Owned Buildings From Theft, Burglary Or Robbery Debris Removal Equipment Breakdown Fire Department Service Charge Fire Extinguisher Systems Recharge Expense Glass Expenses Increased Cost Of Construction And Demolition Costs (applies only when buildings are insured on a replacement cost basis) 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 Preservation Of Property 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. 001603 290 Continued on Reverse Side of Page N LIMIT OF INSURANCE Included Coverage B Limit 25% of covered loss Included $5,000 $5, 000 Included 10% $100,000 $250,000 Included 30 Days Page 3 of 7 DECLARATIONS (CONTINUED) Apartment Policy for LOPATIN, SCOTT Policy Number 97-CP-Z503-4 SECTION I -EXTENSIONS OF COVERAGE - LIMIT OF INSURANCE - EACH COMPLEX The coverages and corresponding limits shown below apply separately to each complex as described in the policy. LIMIT OF COVERAGE INSURANCE Accounts Receivable On Premises $50,000 Off Premises $15,000 Arson Reward $5,000 Forgery Or Alteration $10,000 Lock Replacement $5,000 Money Orders And Counterfeit Money $1,000 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 Property Of Others (applies only to those premises provided Coverage B - Business $2,500 Personal Property) Signs $2,500 Tenant Move Back Expenses $15,000 Valuable Papers And Records On Premises $10,000 Off Premises $5,000 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. 001603 Continued on Next Page Page 4 of 7 StateFarm iP, DECLARATIONS (CONTINUED) Apartment Policy for LOPATIN, SCOTT Policy Number 97-CP-Z503-4 im SECTION I - EXTENSIONS OF COVERAGE - LIMIT OF INSURANCE - PER POLICY g The coverages and corresponding limits shown below are the most we will pay regardless of the number of described premises shown In these Declarations. �o COVERAGE Employee Dishonesty Loss Of Income And Extra Expense LIMIT OF INSURANCE $25,000 Actual Loss Sustained - 12 Months 11 SECTION II - LIABILITY LIMIT OF COVERAGE INSURANCE Coverage L - Business Liability $1,000,000 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 $2,000,000 General Aggregate $2,000,000 Each paid claim for Liability Coverage reduces the amount of insurance we provide during the applicable annual period. Please refer to Section II - Liability in the Coverage Form and any attached endorsements. Prepared APR 24 2023 (D Copyright, State Farm Mutual Automobile Insurance Company, 2008 CMP-4000 Includes copyrighted material of Insurance Services Office, Inc., with its permission. 001604 290 Continued on Reverse Side of Page N Page 5 of 7 DECLARATIONS (CONTINUED) Apartment Policy for LOPATIN, SCOTT Policy Number 97-CP-Z503-4 Your policy consists of these Declarations, the BUSINESSOWNERS COVERAGE FORM shown below, and any other forms and endorsements that apply, including those shown below as well as those issued subsequent to the issuance of this policy. FORMS AND ENDORSEMENT_$ CMP-4101 Businessowners Coverage Form CMP-4500 Apartment Endorsement CMP-4807 Lock Replacement CMP-4502 Tenant Move Back Expenses CMP-4503.1 Heating Air Cond Loss Reimburs FE-6999.3 Terrorism Insurance Cov Notice CMP-4746.1 Hired Auto Liability CMP-4506.2 Loss of Income & Extra Expense CMP-4710 Employee Dishonesty FE-1313 Form 438bfu NS Lndr Loss Pay CMP-4260.1 Amendatory Endorsement -CA CMP-4261 Amendatory Endorsement FD-6007 Inland Marine Attach Dec SCHEDULE OF ADDITIONAL INTERESTS Interest Type: Mortgagee Endorsement #: NIA Loan Number: 225960505 FIRST REPUBLIC BANK ISAOA PO BOX 790869 SAN ANTONIO TX 78279-0869 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. 001604 Continued on Next Page Page 6 of 7 StateFarmft ❑ OiWe DECLARATIONS (CONTINUED) Apartment Policy for LOPATIN, SCOTT Policy Number 97-CP-Z503-4 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. rn. 40ow- 6041# 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 # 1-8aa-927-HELP (4357) or visit www.insurance.ca.gov/01-consumers The limit of liability for this structure (Coverage A) is based on an estimate of the cost to rebuild your residential structure, including an approximate cost for labor and materials in your area, and specific information that you have provided about your residential structure. Prepared APR 24 2023 CMP-4000 Copyright, State Farm Mutual Automobile Insurance Company, 2008 Includes copyrighted material of Insurance Services Office, Inc., with its permission. 001605 290 N Page 7 of 7 StateFarm 00) ®®_ STATE FARM GENERAL INSURANCE COMPANY El A STOCK COMPANY WITH HOME OFFICES IN BLOOMINGTON, ILLINOIS INLAND MARINE ATTACHING DECLARATIONS P Bay 29I 15 Booming on IL 61702-2915 Named Insured M-02-2045-FB95 F W LOPATIN, SCOTT 110 ESMERALDA DR •-� SANTA CRUZ CA 95060-1916 8 O O � O ATTACHING INLAND MARINE Policy Number 97-CP-Z503-4 Policy Period Effective Date Expiration Date 12 Months MAR 10 2023 MAR 10 2024 The poli y period begins and ends at 12:01 am standard time att a premises Tocation. 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 Inland Marine Conditions FE-6271 Amendatory Endorsement FE-8745 Inland Marine Computer Prop See Reverse for Schedule Page with Limits Prepared APR 24 2023 C Copyright, State Farm Mutual Automobile Insurance Company, 2008 FD-6007 Includes copyrighted material of Insurance Services Office, Inc., with its permission. 001606 530 686 a.2 05 31 2011 1013232cl 97-CP-Z503-4 ATTACHING INLAND MARINE SCHEDULE PAGE ATTACHING INLAND MARINE ENDORSEMENT LIMIT OF NUMBER COVERAGE INSURANCE FE-8745 Inland Marine Computer Prop 5 10 , 0 0 0 Loss of Income and Extra Expense S 10 , 0 0 0 Prepared APR 24 2023 FD-6007 001606 DEDUCTIBLE AMOUNT $ 500 OTHER LIMITS AND EXCLUSIONS MAY APPLY - REFER TO YOUR POLICY U Copyright, State Farm Mutual Automobile Insurance Company, 2008 Includes copyrighted material of Insurance Services Office, Inc., with its permission. ANNUAL PREMIUM Included Included 530-686 a.2 05-31-2011 1013233c1 ii M O N a U ti o� O r .� t9 O V & C ca � C O � > E O C U O C O U O � � O ,� f6 In C � C) C O O O O O C O U � � N O y CLO O O � � C fp 0 o E E C O L t0 y- - E O O O O U O V O C L � O Ln N Cr In m V) O c cu N O — `-° c, .-. aci E, o ra n U o O c O c Y CD O O E_ CL O O N U O O O � a E 83. DOOO-9090 1S U O h fn d Ln Ln