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HomeMy WebLinkAboutCOI - Applied Survey Research, Inc. - Expires 2024-11-20StateFarm 0105-ST--0000 0 00 STATE FARM GENERAL INSURANCE COMPANY A STOCK COMPANY WITH HOME OFFICES IN BLOOMINGTON, ILLINOIS Po Box 2915 Bloomington IL 61702-2915 Addl Insured -Section II Only AT2 000176 3125M 02 2551 FC05 F U CITY OF GILROY ITS OFFICERS EMPLOYEES & REPRESENTATIVES 7351 ROSANNA ST GILROY CA 95020-6141 IIIuIIJII1111III111111111111111I1II I1111I I111"11I1111111'111 I11 Office Policy RENEWAL DECLARATIONS Policy Number 97-CJ-N707-0 Policy Period Effective Date Expiration Date 12 Months NOV 20 2023 NOV 20 2024 The policy period begins and ends at 12:01 am standard time atthe premises Location. Named Insured APPLIED SURVEY RESEARCH INC Automatic Renewal - lithe 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. lifts 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 NOTICE: Information concerning changes in your policy language is included. Please call your agent if you have any questions. POLICY PREMIUM $ 4,367.00 Discounts Applied: Renewal Year Years in Business Enclosed Building Protective Devices Claim Record Prepared SEP 07 2023 C M P-4000 001034 294 Al 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 1 of 8 530-606 a.2 05-31.2011 1o1f32310 RENEWAL DECLARATIONS (CONTINUED) Office Policy for CITY OF GILROY Policy Number 97-CJ-N707-0 SECTION I - 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 SAN JOSE CA 95126-1752 No Coverage $ 27,700 25% 002 55 PENNY LN STE 101 WATSONVILLE CA 95076-6017 No Coverage $ 64,400 25% 003 5440 PARK DR STE 104 ROCKLIN CA 95765-5580 No Coverage $ 1,500 25% * 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: N/A Cov B - Consumer Price Index: 305.7 SECTION I - DEDUCTIBLES Basic Deductible $500 Prepared SEP 07 2023 © Copyright, State Farm Mutual Automobile Insurance Company,?_008 CMP-4000 Includes copyrighted material of Insurance Services Office, Inc., with its permission. 001034 Continued on Next Page Page 2 of 8 StateFarm 0205-ST--0000 0 CDC) RENEWAL DECLARATIONS (CONTINUED) Office Policy for CITY OF GILROY Policy Number 97-CJ-N707-0 Special Deductibles: Money and Securities Equipment Breakdown $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 Increased 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 SEP 07 2023 CMP-4000 001035 294 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 8 RENEWAL 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 I - EXTENSIONS OF COVERAGE - LIMIT OF INSURAM� - SCI1EDULE 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 SEP 07 2023 © Copyright, State Farm Mutual Automobile Insurance Company, 2008 CMP-4000 Includes copyrighted material of Insurance Services Office, Inc., with its permission. 001035 Continued on Next Page Page 4 of 8 StateFarm CYO 0305-ST--0000 RENEWAL 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 SEP 07 2023 CMP-4000 001036 294 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 8 RENEWAL 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 FE-6999.3 *Terrorism Insurance Cov Notice CMP-4819.1 Unauthorized Business Card Use 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 SEP 07 2023 © Copyright, State Farm Mutual Automobile Insurance Company, 2.008 CMP-4000 Includes copyrighted material of Insurance Services Office, Inc., with its permission. 001036 Continued on Next Page Page 6 of 8 StateFarm 0 oo 0405-ST--0000 RENEWAL DECLARATIONS (CONTINUED) Office Policy for CITY OF GILROY Policy Number 97-CJ-N7O7-0 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 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. bit 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 Sorvices Division 300 South Spring Street Los Angeles, CA 90013 Phone # 1-800-927-HELP (4357) or visit www.insurance.ca.qov/01-consumers Prepared SEP 07 2023 CMP-4000 001037 294 N 44,0042.. CA4 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 7 of 8 RENEWAL DECLARATIONS (CONTINUED) Office Policy for CITY OF GILROY Policy Number 97-CJ-N707-0 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 SEP 07 2023 CMP-4000 001037 294 N OO Copyright, State Farm Mutual Automobile Insurance Company, 2008 Includes copyrighted material of Insurance Services Office, Inc., with its permission. Page 8 of 8 StateFarm O C0 0 0 0 0 co 0 0 0 STATE FARM GENERAL INSURANCE COMPANY A STOCK COMPANY WITH HOME OFFICES IN BLOOMINGTON, ILLINOIS Po Box 2915 Bloomington IL 61702-2915 Named Insured M-02-2551-FC05 F U APPLIED SURVEY RESEARCH INC ATTACHING INLAND MARINE INLAND MARINE ATTACHING DECLARATIONS Policy Number 97-CJ-N707-0 Policy Period Effective Date Expiration Date 12 Months NOV 20 2023 NOV 20 2024 The policy period begins and ends at 12:01 am standard time atthe 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 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-8739 FE-6271 FE-8745 Inland Marine Conditions Amendatory Endorsement Inland Marine Computer Prop See Reverse for Schedule Page with Limits Prepared SEP 07 2023 FD-6007 001038 CO Copyright, State Farm Mutual Automobile Insurance Company, 2008 Includes copyrighted material of Insurance Services Office, Inc., with its permission. 530-686a.2 U5-31.2011 (o1f3232c) 97-CJ-N7O7-0 ATTACHING INLAND MARINE SCHEDULE PAGE ATTACHING INLAND MARINE ENDORSEMENT LIMIT OF DEDUCTIBLE ANNUAL NUMBER COVERAGE INSURANCE AMOUNT PREMIUM FE-8745 Inland Marine Computer Prop S 2 5, 0 0 0 S 50 0 Included Loss of Income and Extra Expense S 25,000 Included Prepared SEP 07 2023 FD-6007 001038 OTHER LIMITS AND EXCLUSIONS MAY APPLY - REFER TO YOUR POLICY 7 Copyright, State Farm Mutual Automobile Insurance Company, 2008 Includes copyrighted material of Insurance Services Office, Inc„ with its permission. 530-606 a.2 05-31-2011 1o1f3233c1