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HomeMy WebLinkAboutCOI - Applied Survey Research, Inc. - Expires 2024-08-28StateFarm STATE FARM GENERAL INSURANCE COMPANY O O'O 0 0 0 A STOCK COMPANY WITH HOME OFFICES IN BLOOMINGTON, ILLINOIS Poo Box 2 Bloomington915 IL 61702-2915 Addl Insured -Section II Only M-02-2551-FC05 F U 000347 3123 CITY OF GILROY ITS OFFICERS EMPLOYEES & REPRESENTATIVES 7351 ROSANNA ST GILROY CA 95020-6141 1"ll'IIIIIIIIIIIIIIUIII1IIII'Illllll'1'IIIIIIIIIIIIIIIIIIIIi"' DECLARATIONS AMENDED JUL 20 2023 Policy Number 97-CJ-N707-0 Policy Period Effective Date Expiration Date 12 Months NOV 20 2022 NOV 20 2023 The policy period begins and ends at 12:01 am standard time atthe premises Tocation. Named Insured APPLIED SURVEY RESEARCH INC Office 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 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: Corporation Reason for Declarations: Your policy is amended JUL 20 2023 ADDITIONAL INSURED DELETED PREMIUM ADJUSTMENT FORM CMP-4791.1 DELETED Endorsement Premium None Discounts Applied: Renewal Year Years in Business Enclosed Building Protective Devices Claim Record Prepared AUG 21 2023 CMP-4000 002012 290 Al CO Copyright, State Farm Mutual Automobile Insurance Company, 2008 Includes copyrighted material of Insurance Services Office, Inc., with its permission. Continued on Reverse Side of Page Page 1 of 7 N DECLARATIONS (CONTINUED) Office Policy for CITY OF GILROY Policy Number 97-C.1-N707-0 SECTION I. PROPERTY SCHEDULE Mal,..,10,110MOVINI.IMMIN.00•••••11•0•1•IVI Location Location of Limit of Insurance* Limit of Insurance* Seasonal Number Described Increase - Premises Coverage A - Coverage B - Business Buildlings Business Personal Personal Property . Property • V AV 1MIIMV.V4. 001 1871 THE ALAMEDA STE 180 No Coverage $ 26,800 25% SAN JOSE CA 95126-1752 002 55 PENNY LN STE 101 No Coverage $ 62,400 25% WATSONVILLE CA 95076-6017 003 5440 PARK DR STE 104 No Coverage $ 1,400 25% ROCKLIN CA 95765-5580 * As of the effective date of this policy, the LiMit of Insurance as shown in�Iude any 'mane in the limit due to Inflation Coverage. SECTION I - INFLATION cpvp:tp iftpec(E.f,. Cov A - Inflation Coverage Index: N/A Cov B Consumer Price Index: 296,3 SECTION I - DEDUCTIBLES Basic Deductible $500 Prepared AUG 21 2023 (0 Copyright, State Form Mutual Automobile Insurance Company, 2008 CMP-4000 moues copyrighted material of Insurance Sericee Office, inc., with its permission. 002012 Continued on Next Page Page 2 of 7 StateFarm 00 DECLARATIONS (CONTINUED) Office Policy for CITY OF GILROY Policy Number 97-CJ-N707-0 Special Deductibles: reiMoney and Securities Equipment Breakdown 0 0 0 (no $250 Employee Dishonesty $250 $500 Other deductibles may apply - refer to policy. 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, but has "Included" indicated, please refer to that policy provision for an explanation of that coverage. COVERAGE Accounts Receivable On Premises Off Premises LIMIT OF INSURANCE See Schedule See Schedule Arson Reward $5,000 Back -Up Of Sewer Or Drain See Schedule 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 Increa.sed Cost Of Construction And Demolition Costs (applies only when buildings are 10% insured on a replacement cost basis) Money And Securities (Off Premises) See Schedule Prepared AUG 21 2023 CMP-4000 002013 290 N © Copyright, State Farm Mutual Automobile Insurance Company, 2008 Includes copyrighted material of Insurance Services Office, Inc., with its permission. Continued on Reverse Side of Page Page 3 of 7 DECLARATIONS (CONTINUED) Office Policy for CITY OF GILROY Policy Number 97-DJ-N7O7-CI 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 - EXTENSIONS OF COVVIAGE - 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 AUG 21 2023 0 Copyright, State Farm Mutual Automobile Insurance Company, 2,008 CMP-4000 Includes copyrighted material of Insurance Services Office, Inc., with its permission. 002013 Continued on Next Page Page 4 of 7 StateFarm 00 0 0 0 Lc ‘..5 DECLARATIONS (CONTINUED) 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 0002 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 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. LIMIT OF COVERAGE INSURANCE Dependent Property - Loss Of Income $5,000 Employee Dishonesty $10,000 Utility Interruption - Loss Of Income $10,000 Prepared AUG 21 2023 CMP-4000 002014 290 N © Copyright, State Farm Mutual Automobile Insurance Company, 2008 Includes copyrighted material of Insurance Services Office, Inc., with its permission. Continued on Reverse Side of Page Page 5 of 7 DECLARATIONS (CONTINUED) Office Policy for CITY OF GILROY Policy Number 97-CJ-N707-0 Loss Of Income And Extra Expense Actual Loss Sustained - 12 Months SECTION II . LIABILITY 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 Incrn CMP-4786.1 Addl Insd Owners Lessee Schad CMP-4788.1 Addl lnsd Mgrs Lessor of Prom Prepared AUG 21 2023 Copyright, State Farm Mutual Automobile Insurance Company, 2000 CMP-4000 includes copyrighted material of Insurance Sorvicee ()Moo, Inc., with its permission. 002014 Continued on Next Page Page 6 of 7 StateFarm 0 0-0 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 FD-6007 Inland Marine Attach Dec wa mo 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. 4 44,01114.. 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 AUG 21 2023 CMP-4000 002015 290 N CO Copyright, State Farm Mutual Automobile Insurance Company, 2008 Includes copyrighted material of Insurance Services Office, Inc., with its permission. Page 7 of 7 97-CJ-N707-0 002015 State Farm 0 0 0 0 COO STATE FARM GENERAL INSURANCE COMPANY A STOCK COMPANY WITH HOME OFFICES IN BLOOMINGTON, ILLINOIS INLAND MARINE ATTACHING DECLARATIONS Po BoX 2915 Bloomington IL 61702-2915 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 Expiration Date 12 Months NOV 20 2022 NOV 20 2023 The policy period begins and ends at 12:01 am standard time atthe 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 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 AUG 21 2023 FD-6007 002016 O Copyright, State Farm Mutual Automobile Insurance Company, 2008 Includes copyrighted material of Insurance Services Office, Inc., with its permission. 530-666 a.2 65 31-2011 1o163232c1 97-CJ.N707-0 ATTACHING INLAND MARINE SCHEDULE PAGE ATTACHING INLAND MARINE ENDORSEMENT LIMIT OF DEDUCTIBLE ANNUAL NUMBER COVERAGE INSURANCE AMOUNT PREMIUM FE-8745 Inland Marine Computer Prop 25000 500 Included Loss of Income and Extra Expense 2 5 000 Included Prepared AUG 21 2023 FD-6007 002016 OTHER LIMITS AND EXCLUSIONS MAY APPLY - REFER TO YOUR POLICY Copyright, State Form Mutual Automobile Insurance Company, 2D08 Includes copyrighted materiel of Insurance SCIViCBS Office, Inc., with its permission. Eill-U06 u,2 (15-:11-2011 (o1fal3301