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Home My WebLink AboutCOI - Special K Productions - Expires 2022-09-01StateFarm STATE FARM GENERAL INSURANCE COMPANY A STOCK COMPANY WITH HOME OFFICES IN BLOOMINGTON, ILLINOIS RENEWAL DECLARATIONS 10F 0 4 S 0 0 Pp hoxardson8539, R 75085-3925 Ric Addl Insured -Section II Only AT2 000272 3125M-02-6868-FBFF F N CITY OF GILROY 7351 ROSANNA ST GILROY CA 95020-6141 �I��I��I�I��I��IIII'III'Il�lll��lll�l�llll��'I�IIII��IIII Businessowners Policy Policy Number 97-68-13286-6 Policy Period Effective Date Expiration Date 12 Months SEP 1 2021 SLAP 1 2022 The poli y period beggins and ends at 12:01 am standard time at le premises To cation. Named Insured ALI, KENYATTA DBA SPECIAL K PRODUCTIONS 3687 ROCKY CREEK CT SAN JOSE CA 95148-1421 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. 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 $ 376.00 Prepared JUN 17 2021 C Copyright, State Farm Mutual Automobile Insurance Company, 2008 CMP-4000 Includes copyrighted material of Insurance Services Office, Inc., with its permission. 001539 294 Al Continued on Reverse Side of Page Page 1 of 7 N RENEWAL DECLARATIONS (CONTINUED) Businessowners Policy for CITY OF GILROY Policy Number 97-138-13286-6 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 3687 ROCKY CREEK CT No Coverage $ 1,800 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 COVERAGE INDEX(ES) Cov A - Inflation Coverage Index: Cov B - Consumer Price Index: SECTION I - DEDUCTIBLES N/A 267.1 Basic Deductible $1,000 Special Deductibles: Money and Securities $250 Equipment Breakdown $1,000 Other deductibles may apply - refer to policy. Prepared JUN 17 2021 O Copyright, State Farm Mutual Automobile Insurance Company, 2008 CMP-4000 Includes copyrighted material of Insurance Services Office, Inc., with its permission. 001539 Continued on Next Page Page 2 of 7 State farm o ) RENEWAL DECLARATIONS (CONTINUED) Businessowners Policy for CITY OF GILROY Policy Number 97-138-13286-6 SECTION I - EXTENSIONS OF COVERAGE - LIMIT OF INSURANCE - EACH DESCRIBED PREMISES 0 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, N but has "Included" indicated, please refer to that policy provision for an explanation of that coverage. 0 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 JUN 17 2021 Cc` Copyright, State Farm Mutual Automobile Insurance Company, 2008 CMP-4000 Includes copyrighted material of Insurance Services Office, Inc., with its permission. 001540 294 Continued on Reverse Side of Page Page 3 of 7 N RENEWAL DECLARATIONS (CONTINUED) Businessowners Policy for CITY OF GILROY Policy Number 97-138-6286-6 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 JUN 17 2021 C Copyright, State Farm Mutual Automobile Insurance Company, 2008 CMP-4000 Includes copyrighted material of Insurance Services Office, Inc., with its permission. 001540 Continued on Next Page $3,000,000 Page 4 of 7 state Farm 5 RENEWAL DECLARATIONS (CONTINUED) Businessowners Policy for CITY OF GILROY Policy Number 97-138-6286-6 Coverage M - Medical Expenses (Any One Person) Damage To Premises Rented To You c AGGREGATE LIMITS 0 s Products/Completed Operations Aggregate 0 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 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-4787 Waiver of Trans Rgt of Recov CMP-4709 Money and Securities CMP-4705.2 Loss of Income & Extra Expense CMP-4860.1 Al Design Person Org CMP-4795.1 Addl Insd Designated Premises CMP-4260.1 Amendatory Endorsement -CA CMP-4261 Amendatory Endorsement FD-6007 Inland Marine Attach Dec * New Form Attached Prepared JUN 17 2021 C Copyright, State Farm Mutual Automobile Insurance Company, 2008 CMP-4000 Includes copyrighted material of Insurance Services Office, Inc., with its permission. 001541 294 Continued on Reverse Side of Page N Page 5 of 7 RENEWAL DECLARATIONS (CONTINUED) .�Y Businessowners Policy for CITY OF GILROY Policy Number 97-138-13286-6 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. *VW� rn. 40WOL C.-1�4.44 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.ce.gov/01-consumers Prepared JUN 17 2021 Q Copyright, State Farm Mutual Automobile Insurance Company, 2008 CMP-4000 Includes copyrighted material of Insurance Services Office, Inc., with its permission. 001541 Continued on Next Page Page 6 of 7 C � 0 ti � m c� O 0 0) c� o m a m ca "v CC W -a a 0 C O v) C o — C o o o�'o ca U U� 0CD •co E a 0 E CD"c� N a E .. �, cm c �_ ° cD CL E o - CD � �m E cq Z L0 '-'U N N C O p co ca co Z C O cn L. 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N >. mL roC �a)wo.N -C �ii a-N a-o �° 3 4) /J/�'�Camo m�Nw V N (A C -0 (� O cd NO �CD OU O T C\l NU� Q E�acl OoZ oEcd y v ow m cm �.0 M a ��ULtn UO �> p o "o 'o -v -` CD a r ZLLao .- am on- oz �/ f 0000--1S-50f+0 StateFarm 0 o ti STATE FARM GENERAL INSURANCE COMPANY E A STOCK COMPANY WITH HOME OFFICES IN BLOOMINGTON, ILLINOIS INLAND MARINE ATTACHING DECLARATIONS P4 goxardson, 8539 f� 3 75085-925 Ric Named Insured M-02-6868-FBFF F N ALI, KENYATTA DBA SPECIAL K PRODUCTIONS 3687 ROCKY CREEK CT SAN JOSE CA 95148-1421 a 0 S 0 In 0 ATTACHING INLAND MARINE Policy Number 97-138-13286-6 Policy Period Effective Date Ex 'ration Date 12 Months SEP 1 2021 SLAP 1 2022 The poli y period beans and ends at12:01 am standard time at premises oration. 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 JUN 17 2021 ' Copyright, State Farm Mutual Automobile Insurance Company, 2008 FD-6007 Includes copyrighted material of insurance Services Office, Inc., with its permission. 001543 530 605 a.2 05-31 2011 1032320 97-B8-Be86-6 ATTACHING INLAND MARINE SCHEDULE PAGE ATTACHING INLAND MARINE ENDORSEMENT LIMIT OF NUMBER COVERAGE INSURANCE FE-8745 Inland Marine Computer Prop $ 25 , 0 0 0 Loss of Income and Extra Expense $ 25 , 0 0 0 Prepared JUN 17 2021 FD-6007 001543 DEDUCTIBLE AMOUNT $ 500 OTHER LIMITS AND EXCLUSIONS MAY APPLY - REFER TO YOUR POLICY T Copyright, State Farm Mutual Automobile Insurance Company, 2008 Includes copyrighted material of Insurance Services Office, Inc., with its permission. ANNUAL PREMIUM Included Included 530.685 a.2 05-31-2011 (olf32330