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HomeMy WebLinkAboutCOI - Applied Survey Research, Inc. - Expires 2022-11-16W CV W O N Z W N QOa UZ Z <wU Lh w W LL J U Q - 0 p E'04 �F-O IL wm 2� g `-'', N (�� oo C -0 Z v)wZ CC �a �� f- LL o =OZ LL�pCO ro W JWW W J M C ��moo >� N� LLj wp ~Qt- Oa;NN vZ 3 0 C) ZWCC� CD W N �:� W J Q z >- co 75 O x i> Ej; n- cn cn 0 a_Z (D � > w CC m O v z OoLLr FF co o O c= ZQOQ a of)a CD-C � �� aDY3>1 2 o = a to O J � U Q tn r Ir L > Q)w co co_�oN CM N Q= vNM�°p� ��(DQ) > w O C- �nvD�a va)-0>� ¢ W E- 4x o = co o wZ 0 c 3:0 WZW 0 o_ a E- _ Z W w- Z CL � CD o c LL j eca�co t/» = aVQUZzo E _j?Z W WO w �, 0- u 1-4 _ U O oC C� C'3 Z N= WF- - — U n.>aaw o,a � L occa L- UQ rn H~LL Z LL W \O - W U M p F- O o W o� g — =_ 3 0_ � � W --1 N oHW O Z C.) 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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/Lien holder written notice in compliance with the policy provisions or as required by law. Entity: Corporation Reason for Declarations: Your policy is amended NOV 16 2021 ADDITIONAL INSURED DELETED PREMIUM ADJUSTMENT FORM CMP-4786.1 DELETED Endorsement Premium Decrease Discounts Applied: Renewal Year Years in Business Enclosed Building Protective Devices Claim Record Other items shown are effective with the policy's 2021 renewal �1 Prepared NOV 17 2021 Copyright, State Farm Mutual Automobile Insurance Company, 2008 CMP-4000 Includes copyrighted material of Insurance Services Office, Inc., with its permission. 002294 190 Al Continued on Reverse Side of Page Page 1 of 7 N DECLARATIONS (CONTINUED) Office Policy for CITY OF GILROY Policy Number . 97-CJ-N707-0 SECTION 1- 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 $ 24,700 25% SAN JOSE CA 95126-1752 002 55 PENNY LN STE 101 No Coverage $ 57,500 25% WATSONVILLE CA 95076-6017 003 5440 PARK DR STE 104 No Coverage $ 1,200 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. SECTION I - INFLATION COVERAGE INDEXIES) Cov A - Inflation Coverage Index: Cov B - Consumer Price Index: SECTION I - DEDUCTIBLES Basic Deductible $500 NIA 273.0 Prepared NOV 17 2021 �V Copyright, State Farm Mutual Automobile Insurance Company, 2008 CMP-4000 Includes copyrighted material of Insurance Services Office, Inc., with its permission. 002294 Continued on Next Page Page 2 of 7 State Farm 0 f' DECLARATIONS (CONTINUED) Office Policy for CITY OF GILROY Policy Number 97-CJ-N707-0 Special Deductibles: f Money and Securities $250 Employee Dishonesty Equipment Breakdown $500 s Other deductibles may apply - refer to policy. 0 0 6 F: C (na $250 SECTION I - EXTENSIONS OF COVERAGE - LIMIT OF INSURANCE - EACH DESCRIBED PREMISES U 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 NOV 17 2021 Cc Copyright, State Farm Mutual Automobile Insurance Company, 2008 CMP-4000 Includes copyrighted material of Insurance Services Office, Inc., with its permission. 002295 190 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 Money And Securities (On Premises) See Schedule 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) Ordinance Or Law - Equipment Coverage Included Outdoor Property See Schedule Personal Effects (applies only to those premises provided Coverage B - Business $5,000 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 See Schedule Personal Property) Signs See Schedule Unauthorized Business Card Use $5,000 Valuable Papers And Records On Premises See Schedule Off Premises See Schedule SECTION 1- 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 NOV 17 2021 © Copyright, State Farm Mutual Automobile Insurance Company, 200E CMP-4000 Includes copyrighted material of Insurance Services Office, Inc., with its permission. 002295 Continued on Next Page Page 4 of 7 StateFarm a,, - DECLARATIONS (CONTINUED) El 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 s0002 Accounts Receivable (On Premises) $50,000 o Accounts Receivable (Off Premises) $15,000 (no 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 NOV 17 2021 C 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 002296 190 Continued on Reverse Side of Page N Page 5 of 7 DECLARATIONS (CONTINUED) Office Policy for CITY OF GILROY Policy Number 97-CJ-N707-0 Loss Of Income And Extra Expense SECTION II - 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-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-4786.1 Addl Insd Owners Lessee Sched CMP-4788.1 Addl Insd Mgrs Lessor of Prem Prepared NOV 17 2021 O Copyright, State Farm Mutual Automobile Insurance Company, 2008 CMP-4000 Includes copyrighted material of Insurance Services office, Inc., with its permission. 002296 Continued on Next Page Page 6 of 7 StateFarm 65) DECLARATIONS (CONTINUED) 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 s o FD-6007 Inland Marine Attach Dec 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. *Mte_ rn. 4 0 W**_ C4 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.aov/01-consumers Prepared NOV 17 2021 CMP-4000 © Copyright, State Farm Mutual Automobile Insurance Company, 2008 Includes copyrighted material of Insurance Services Office, Inc., with its permission. 002297 190 Page 7 of 7 N StateFarm 05) 09 ' STATE FARM GENERAL INSURANCE COMPANY ❑ A STOCK COMPANY WITH HOME OFFICES IN BLOOMINGTON, ILLINOIS INLAND MARINE ATTACHING DECLARATIONS a S �o Pp �ox 8539?� Ric ardson, 75085-3925 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 2021 NQV 20 2022 The poli y period begins and ends at 12:01 am standard time atle premises T0cation. 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 NOV 17 2021 T,Copyright, State Farm Mutual Automobile Insurance Company, 2008 FD-6007 Includes copyrighted material of Insurance Services Office, Inc., with its permission. 002298 530 586 a.2 05 31 2011 Io113232e1 97-CJ-N707-0 ATTACHING INLAND MARINE SCHEDULE PAGE ATTACHING INLAND MARINE ENDORSEMENT LIMIT OF NUMBER COVERAGE INSURANCE FE-8745 Inland Marine Computer Prop 5 25j,000 Loss of Income and Extra Expense $ 25 , 0 0 0 Prepared NOV 17 2021 FD-6007 002298 DEDUCTIBLE AMOUNT $ 500 OTHER LIMITS AND EXCLUSIONS MAY APPLY - REFER TO YOUR POLICY O Copyright, State Farm Mutual Automobile Insurance Company, 200E Includes copyrighted material of Insurance Services Office, Inc., with its permission. ANNUAL PREMIUM Included Included 530-666 e.2 05 31 2011 1013133cI