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HomeMy WebLinkAboutCOI - Sobel Communications - Expires 2023-01-15StateFarm STATE FARM GENERAL INSURANCE COMPANY Vf A STOCK COMPANY WITH HOME OFFICES IN BLOOMINGTON, ILLINOIS RENEWAL DECLARATIONS O Rfcf aordfon 9TX 75085-3925 Addl Insured -Section II Only AT2 000399 3125M-02-23OF-FB14 F U CITY OF GILROY 7351 ROSANNA ST GILROY CA 95020-6141 �'I'�'��I�I�I���I�I�II�IIIIII�II���I�II��IIII�'Il���ll�lll�l��lll Office Policy Policy Number 97-67-3258-0 Policy Period Effective Data Expiration Date 12 Months JAN 15 2022 JAN 15 2023 The poli y perioO beg9ins and ends at 12:01 am standard time atge premises To cation. Named Insured SOBEL, BRIAN DBA SOBEL COMMUNICATIONS 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: Individual NOTICE: Information concerning changes in your policy language is included. Please call your agent if you have any questions. POLICY PREMIUM Discounts Applied: Renewal Year Years in Business Claim Record $ 606.00 Prepared NOV 02 2021 :0 Copyright, State Farm Mutual Automobile Insurance Company, 200E CMP-4000 Includes copyrighted material of Insurance Services Office, Inc., with its permission. 002166 294 Al Continued on Reverse Side of Page Page 1 of 7 N L r111 GIfC _ M HL .l� .1n�1 1..1 RENEWAL DECLARATIONS (CONTINUED) Office Policy for CITY OF GILROY Policy Number 97-67-3258-0 SECTION I - 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 001 775 BAYWOOD DR 203 No Coverage $ 36,400 25% PETALUMA CA 94954-5500 * 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 INDEXES) Cov A - Inflation Coverage Index: Cov B - Consumer Price Index: SECTION I - DEDUCTIBLES NIA 274.3 Basic Deductible $500 Special Deductibles: Money and Securities $250 Employee Dishonesty $250 Equipment Breakdown $500 Other deductibles may apply - refer to policy. Prepared NOV 02 2021 © Copyright, State Farm Mutual Automobile Insurance Company, 200E CMP-4000 Includes copyrighted material of Insurance Services Office, Inc., with its permission. 002166 Continued on Next Page Page 2 of 7 StateFarm o RENEWAL DECLARATIONS (CONTINUED) Office Policy for CITY OF GILROY Policy Number 97-67-3258-0 0 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 us Declarations, unless indicated by "See Schedule." If a coverage does not have a corresponding limit shown below, N but has "Included" indicated, please refer to that policy provision for an explanation of that coverage. v LIMIT OF COVERAGE INSURANCE Accounts Receivable On Premises $50,000 Off Premises $15,000 Arson Reward $5,000 Back -Up Of Sewer Or Drain $15,000 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 $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) $5,000 Money And Securities (On Premises) $10,000 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 NOV 02 2021 © Copyright, State Farm Mutual Automobile Insurance Company, 2008 CMP-4000 Includes copyrighted material of Insurance Services Office, Inc., with its permission. 002167 294 Continued on Reverse Side of Page Page 3 of 7 N RENEWAL DECLARATIONS (CONTINUED) ` Office Policy for CITY OF GILROY Policy Number 97-67-3258-0 Ordinance Or Law - Equipment Coverage Included Outdoor Property $5,000 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 $2,500 Personal Property) Signs $2,500 Unauthorized Business Card Use $5,000 Valuable Papers And Records On Premises $50,000 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 Loss Of Income And Extra Expense LIMIT OF INSURANCE $5,000 $10,000 $10,000 Actual Loss Sustained - 12 Months Prepared NOV 02 2021 O Copyright, State Farm Mutual Automobile Insurance Company, 2008 CMP-4000 Includes copyrighted material of Insurance Services Office, Inc., with its permission. 002167 Continued on Next Page Page 4 of 7 StateFarm Ui® ' RENEWAL DECLARATIONS (CONTINUED) T�% Office Policy for CITY OF GILROY Policy Number 97-67-3258-0 SECTION II - LIABILITY Q 4 $ LIMIT OF COVERAGE INSURANCE 0 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 FE-6999.3 *Terrorism Insurance Cov Notice CMP-4713.1 Excl Testing Consulting E&O CMP-4788.1 Addl Insd Mgrs Lessor of Prem CMP-4819.1 Unauthorized Business Card Use CMP-4698 Back -Up of Sewer or Drain CMP-4704.1 Dependent Prop Loss of Income CMP-4710 Employee Dishonesty CMP-4709 Money and Securities CMP-4703.1 Utility Interruption Loss Incm CMP-4705.2 Loss of Income & Extra Expense CMP-4786.1 Addl Insd Owners Lessee Sched CMP-4260.1 Amendatory Endorsement -CA Prepared NOV 02 2021 M Copyright, State Farm Mutual Automobile Insurance Company, 2008 CMP-4000 Includes copyrighted material of Insurance Services Office, Inc., with its permission. 002168 294 Continued on Reverse Side of Page Page 5 of 7 N RENEWAL DECLARATIONS (CONTINUED) Office Policy for CITY OF GILROY Policy Number 97-67-3258-0 CMP-4787 Waiver of Trans Rgt of Recov CMP-4261 Amendatory Endorsement 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. *WM-e- M. 4000C 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.gov/01-consumers Prepared NOV 02 2021 © Copyright, State Farm Mutual Automobile Insurance Company, 2008 CMP-4000 Includes copyrighted material of insurance Services Office, Inc., with its permission. 002168 Continued on Next Page Page 6 of 7 State Farm 5 - , 0 0 RENEWAL DECLARATIONS (CONTINUED) Office Policy for CITY OF GILROY Policy Number 97-67-3258-0 NOTICE TO POLICYHOLDER: For a comprehensive description of coverages and forms, please refer to your policy. Policy changes requested before the "Date Prepared", which appear on this notice, are effective on the Renewal Date of this policy unless otherwise indicated by a separate endorsement, binder, or amended declarations. Any coverage forms attached to this notice are also effective on the Renewal Date of this policy. Policy changes requested after the "Date Prepared" will be sent to you as an amended declarations or as an endorsement to your policy. Billing for any additional premium for such changes will be mailed at a later date. If, during the past year, you've acquired any valuable property items, made any improvements to insured property, or have any questions about your insurance coverage, contact your State Farm agent. Please keep this with your policy. Prepared NOV 02 2021 CMP-4000 @ Copyright, State Farm Mutual Automobile Insurance Company, 2000 Includes copyrighted material of Insurance Services Office, Inc., with its permission. 002169 294 N Page 7 of 7 State Farm STATE FARM GENERAL INSURANCE COMPANY Q A STOCK COMPANY WITH HOME OFFICES IN BLOOMINGTON, ILLINOIS INLAND MARINE ATTACHING DECLARATIONS (0 COD R1c Pp foxardson, 853' 75085-3925 Policy Number 97-67-3258-0 Named Insured Policy Period Effective Date Expiration Date M-02-23OF-FB14 F U 12 Months JAN 15 2022 JAN 15 2023 The poli y period begins and ends at 12:01 am standard SOBEL, BRIAN time atge premises To cation. DBA SOBEL COMMUNICATIONS a ATTACHING INLAND MARINE 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/Lien holder 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 NOV 02 2021 CC Copyright, State Farm Mutual Automobile Insurance Company, 2008 FD-6007 Includes copyrighted material of Insurance Services Office, Inc., with its permission. 002170 530 685 a.2 05 31 2011 1olf3232c ATTACHING INLAND MARINE SCHEDULE PAGE ATTACHING INLAND MARINE ENDORSEMENT LIMIT OF NUMBER COVERAGE INSURANCE FE-8745 Inland Marine Computer Prop S 2 5, 0 0 0 Loss of Income and Extra Expense 5 2 5, 0 0 0 Prepared NOV 02 2021 FD-6007 002170 DEDUCTIBLE AMOUNT $ 500 OTHER LIMITS AND EXCLUSIONS MAY APPLY - REFER TO YOUR POLICY © Copyright, State Farm Mutual Automobile Insurance Company, 2008 Includes copyrighted material of Insurance Services Office, Inc., with its permission. ANNUAL PREMIUM Included Included 530 686a.2 05-31-2011 10932330 '44 �� CERTIFICATE OF LIABILITY INSURANCE 710/25(MM/DD1YYYY)=1 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in Ileu of such endorsements . PRODUCER FEDERATED MUTUAL INSURANCE COMPANY HOME OFFICE: P.O. BOX 328 CONTACT CLIENT CONTACT CENTER PHONAME: AJCNNo Ext : 888 333 4949 FA�iIC No : 507 446 4664 ADDRESS: CLIENTCONTACTCENTER FEDINS.COM CMfATONNA, MN 55060 INSURERIS) AFFORDING COVERAGE NAIC # INSURER A: FEDERATED MUTUAL INSURANCE COMPANY 13935 INSURED 395-180-3 INSURER B: C AND B LANDSCAPE INC. CALIFORNIA LANDSCAPE PO BOX 2683 INSURER C: INSURER D: GILROY, CA 95021-2683 INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: 43 REVISION NUMBER: 0 THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN. THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS. EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR T TYPE OF INSURANCE DL INSR SUBR WVD POLICY NUMBER POLICY EFF MMIDDJYYYY POLICY EXP MMIDD/YYYY LIMITS A X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE ❑X OCCUR N N 9161831 12115/2021 12/1512022 EACH OCCURRENCE $1,000,000 DAMAGE TO RENTED 11SES Ea ccurroncol $100,000 MED EXP (Any one person) EXCLUDED PERSONAL 6 ADV INJURY $1,000,000 G N'L AGOR GATE LIMIT APPLIES PER: POLICY SECT ❑ LOC OTHER: GENERAL AGGREGATE $2,000,000 PRODUCTS - COMP/OP AOO $2,000,000 A AUTOMOBILE X LIABILITY ANY AUTO OWNED AUTOS ONLY AUTEODSULED HIRED AUTOS ONLY NON -OWNED AUTOS ONLY N N 9161831 12/15/2021 12/15/2022 COMBINED SINGLE LIMIT a atelden $1,000,000 BODILY INJURY (Per person) BODILY INJURY (Per accidont) PROPERTY DAMAGE craccldent A X I UMBRELLA LIAB EXCESS LIAR X OCCUR CLAIMS -MADE N N 9161832 12/15/2021 12/1512022 EACH OCCURRENCE $4,000,000 AGGREGATE $4,000,000 DEO I I RETENTION WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y / N AIIY PROPRIETORIPARTNERIEXECUTIVE — OFFICERIMEMBER EXCLUDED? ` (Mandatory in NH) It yes, describe under DESCRIPTION OF OPERATIONS below N I A PER STATUTE ER OTH, E.L. EACH ACCIDENT E.L. DISEASE - EA EMPLOYEE E.L DISEASE - POLICY LIMIT DESCRIPTION OF OPERATIONS 1 LOCATIONS I VEHICLES (ACORD 101. Additional Remarks Schedule, may be stInched if more space is required) JOB NAME: ROGER'S RESIDENCE AT 7690 SANTA THERESA DR. GILROY CALIFORNIA 95020 CERTIFICATE HOLDER CANCELLATION 395-180-3 CITY OF GILROY 7351 ROSANNA ST GILROY, CA 95020-6141 430 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE O 1988-2015 ACORD CORPORATION. All rights reserved. ACORD 26 (2018l03) The ACORD name and logo are registered marks of ACORD 395-180-3 43 #BWNDHBS BCKM-03 - 0110 #XMW0021 XXXXXXX5# CITY OF GILROY 7351 Rosanna St Gilroy, CA 95020-6141