100 * 000. RENEWAL DECLARATIONS Policy Number 97-BY-X604-7

Size: px

Start display at page:

Download "100 * 000. RENEWAL DECLARATIONS Policy Number 97-BY-X604-7"

Karen James
5 years ago
Views:

1 StateFarm State Farm Fire and Casualty Company A Stock Company With Home Offices in Bloomington Po Box Richardson, TX Named Insured AT FOUR SEASONS HOMEOWNERS ASSOCIATION SW VILLAGE LN BEAVERTON OR Illinois 9L-15-02D5-FAE0 F M RENEWAL DECLARATIONS Policy Number 97-BY-X604-7 Policy Period Effective Date Expiration Date 12 Months DEC DEC The policy period begins and ends at 12:01 am standard time at your mailing address as shown. O o r- Y- O C0 o Entity: Corporation COMMERCIAL LIABILITY UMBRELLA POLICY Automatic Renewal - If the policy period is shown as 12 months, this policy will be renewed automatically upon payment of the renewal premium when due subject to the premiums, rules and forms in effect for each succeeding policy period. If this policy is terminated we will give you written notice in compliance with the policy provisions or as required by law. Coverage(s) Coverage L - Business Liability (Each Occurrence) Coverage L - Business Liability (Annual Aggregate) Limits of insurance $ 4, 000,000 $ 4, 000,000 Self-Insured Retention $ 10,000 Coverage Business Liability Employers Non-Owned Auto Liability Required Underlying Insurance Schedule Bodily Injury (Per Occurrence) Bodily Injury (Annual Aggregate) Property Damage (Per Occurrence and Annual Aggregate) --or-- Bodily Injury and Property Damage (Per Occurrence) Bodily Injury and Property Damage (Annual Aggregate) Bodily Injury and Property Damage (Each Occurrence) Bodily Injury and Property Damage (Annual Aggregate) -or- Bodily Injury (Each Person/Each Accident) Property Damage (Each Accident) -or-- Bodily Injury and Property Damage (Each Accident) Minimum Underlying Limits $!i 500,000 A 1, 000, 000 ioo; ooo I 500,000 / $ S 500,000 A $ 1, 000,000 $ 500,000 A 1,000 * 000 $ 500, * ,000 ; Forms & Endorsements Commercial Umb Coverage Form Terrorism Insurance CovTJotice Amendment of Who Is an insured Exclusion - Lead Poisoning Amendatory Endorsement CU-2100 FE CU-2385 CU-2339 CU-2237 Policy Premium $ 1, * New Form Attached Other limits and exclusions may apply - refer to your policy Continued on Reverse CU-2000 OR BRENNAN AGENCY INC I (503) E J6 '!> Copyright, State Farm Mutual Automobile Insurance Company, 2008, (O112941C> i r

2 97-BY-X M 0568 Continued from Front Coverage Required Underlying Insurance Schedule Minimum Underlying Limits Hired Auto Liability 500,000 1, 000 ) 000 ~or~ Bodily Injury (Each Person/Each Accident) 500,000 / $ 500,000 Property Damage (Each Accident) ti 100,000 -or- Bodily Injury and Property Damage (Each Accident) $ 500,000 Your policy consists of these Declarations, the Commercial Liability Umbrella Coverage Form, and any other forms and endorsements that apply. This policy is issued by the State Farm Fire and Casualty 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 Fire and Casualty Company has caused this policy to be signed by its President and Secretary at Bloomington, Illinois. m. Secretary President Copyright, Stale Farm Mutual Automobile insurance Company, (o1f2942c)

3 StaieFarm m GO STATE FARM FIRE AND CASUALTY COMPANY A STOCK COMPANY WITH HOME OFFICES IN BLOOMINGTON, ILLINOIS ^ Bicfiardson Named Insured FOUR SEASONS HOMEOWNERS ASSOCIATION SW VILLAGE LN BEAVERTON OR M-15-02D5-FAE0 F V DECLARATIONS Policy Number Policy Period 12 Months 97-BX-B223-1 Effective Date DEC Expiration Date DEC The policy period begins and ends at 12:01 am standard time atthe premises location. Agent and Mailing Address BRENNAN AGENCY INC SW ALLEN BLVD STE C BEAVERTON OR PHONE : 1503) Residential Community Association Policy Automatic Renewal - If the policy period is shown as 12 months, this policy will be renewed automatically subject to 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 NOTICE: Information concerning changes in your policy language is included. Please call your agent if you have any questions. POLICY PREMIUM $ 5, Discounts Applied: Renewal Year Claim Record I E J5 Copyright, State Farm Mutual Automobile Insurance Company, 2008 Continued on Reverse Side of Page Page 1 of 6 fi'jii. GUG *i nṙ *n *jnn inim it. -i

4 M DECLARATIONS (CONTINUED) Residential Community Association Policy for FOUR SEASONS HOMEOWNERS Policy Number 97-BX-B223-1 SECTION I - PROPERTY BLANKET Coverage A - Buildings Coverage B - Business Personal Property Limit of Insurance* $ 289,200 $ 9,000 Location Number Location of Described Premises SW VILLAGE LANE BEAVERTON OR AUXILIARY STRUCTURES Location Number 001A 001B 001C CLUBHOUSE LARGE POOL KIDDIE POOL Description * 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 INDEXfESI Inflation Coverage Index: Copyright, State Farm Mutual Automobile Insurance Company, 2008 Includes copyrighted material of Insurance Services Office,Inc., with its permission. Continued on Next Page Page 2 of 6

5 SiaieFarm m D;Q DECLARATIONS {CONTINUED) Residential Community Association Policy for FOUR SEASONS HOMEOWNERS Policy Number 97-BX-B223-1 M SECTION I - DEDUCTIBLES Basic Deductible $1,000 Special Deductibles: Money and Securities Equipment Breakdown $250 $1,000 Employee Dishonesty $250 Other deductibles may apply - refer to policy. SECTION I - EXTENSIONS OF COVERAGE LIMIT OF - 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 "" indicated, please refer to that policy provision for an explanation of that coverage. COVERAGE LIMIT OF Collapse Damage To Non-Owned Buildings From Theft, Burglary Or Robbery Debris Removal Equipment Breakdown Fire Department Service Charge Fire Extinguisher Systems Recharge Expense Glass Expenses Increased Cost Of Construction And Demolition Costs (applies only when buildings are insured on a replacement cost basis) Newly Acquired Business Personal Property (applies only if this policy provides Coverage B - Business Personal Property) Newly Acquired Or Constructed Buildings (applies only if this policy provides Coverage A - Buildings) Coverage B Limit 25% of covered loss 10% $100,000 $250, E Copyright, State Farm Mutual Automobile Insurance Company, 20D8 Continued on Reverse Side of Page Page 3 of 6

6 DECLARATIONS (CONTINUED) Residential Community Association Policy for FOUR SEASONS HOMEOWNERS Policy Number 97-BX-B223-1 M Ordinance Or Law - Equipment Coverage Preservation Of Property Water Damage, Other Liquids, Powder Or Molten Material Damage 30 Days SECTION i - EXTENSIONS OF COVERAGE - LIMIT OF - EACH COMPLEX The coverages and corresponding limits shown below apply separately to each complex as described in the policy. Accounts Receivable On Premises Off Premises Arson Reward Forgery Or Alteration COVERAGE Money And Securities (Off Premises) Money And Securities (On Premises) Money Orders And Counterfeit Money Outdoor Property Personal Effects (applies only to those premises provided Coverage B - Business Personal Property) Personal Property Off Premises Pollutant Clean Up And Removal Property Of Others (applies only to those premises provided Coverage B - Business Personal Property) Signs Valuable Papers And Records On Premises Off Premises LIMIT OF $50,000 $15,000 $10,000 $10,000 $1,000 $2,500 $15,000 $10,000 $2,500 $2,500 $10, Copyrighț State Farm Mutual Automobile Insurance Company,2008 Continued on Next Page Page 4 of 6

7 <Jfe, DECLARATIONS (CONTINUED) StateFarm M Residential Community Association Policy tor FOUR SEASONS HOMEOWNERS Policy Number 97-BX-B223-1 SECTION I - EXTENSIONS OF COVERAGE - LIMIT OF 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 Back-Up of Sewer or Drain Employee Dishonesty Loss Of Income And Extra Expense LIMIT OF $100,000 Actual Loss Sustained - 12 Months SECTION II - LIABILITY COVERAGE LIMIT OF Coverage L - Business Liability Coverage M - Medical Expenses (Any One Person) Damage To Premises Rented To You $1,000,000 $10,000 $300,000 Directors And Officers Liability AGGREGATE LIMITS Products/Compieted Operations Aggregate General Aggregate Directors and Officers Aggregate 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. $2,000,000 LIMIT OF $2,000,000 $2,000,000 $2,000, E Copyright, State Farm Mutual Automobile Insurance Company, 200B Continued on Reverse Side of Page Page 5 of 6

8 DECLARATIONS (CONTINUED) Residential Community Association Policy for FOUR SEASONS HOMEOWNERS Policy Number 97-BX-B223-1 M 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. w FORMS AND ENDORSEMENTS CMP-4100 CMP CMP CMP CMP FE-3650 FE CMP-4555 CMP-4508 CMP-4814 CMP-4710 FD-6007 Businessowners Coverage Form Policy Endorsement Amendatory Endorsement Loss of income & Extra Expnse Hired Auto Liability Actual Cash Vlue Endorsement Terrorism Insurance Cov Notice Residential Community Assoc Money and Securities Directors & Officers Liability Employee Dishonesty Inland Marine Attach Dec * New Form Attached This policy is issued by the State Farm Fire and Casualty 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 Fire and Casualty Company has caused this policy to be signed by its President and Secretary at Bloomington, Illinois. Secretary President e Copyright, State Farm Mutual Automobile Insurance Company, 2008 Page 6 of 6

9 StateFarm STATE FARM FIRE AND CASUALTY COMPANY lfell RJIA m A STOCK COMPANY WITH HOME OFFICES IN BLOOMINGTON, ILLINOIS INLAND MARINE ^1Rir ATTACHING DECLARATIONS %tcfiardson?f% Named Insured FOUR SEASONS HOMEOWNERS ASSOCIATION SW VILLAGE LN BEAVERTON OR M-15-O2D5-FAE0 F V Policy Number Policy Period 12 Months 97-BX-B223-1 Effective Date DEC The policy period begins and ends at 12:01 time atthe premisestocation. Expiration Date DEC am standard 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 Moitgagee/Lienholder written notice in compliance with the policy provisions or as required by law. Annual Policy Premium 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 FE-8739 FE-6867 "Inland Marine Computer Prop Inland Marine Conditions Amend of Inland Marine Condtns "New Form Attached See Reverse for Schedule Page with Limits FD Copyright, State Farm Mutual Automobile Insurance Company, 2008 includes copyrighted material of Insurance Services Office, Inc., with its permission B {o1f3232cj

10 97-BX-B223-1 M ATTACHING INLAND MARINE SCHEDULE PAGE ATTACHING INLAND MARINE ENDORSEMENT NUMBER COVERAGE LIMIT QF DEDUCTIBLE AMOUNT ANNUAL PREMIUM FE Inland Marine Computer Prop $ 1 0, Loss of Income and Extra Expense $ 1 0, $ 500 I n c l u d e d I n c l u d e d FD OTHER LIMITS AND EXCLUSIONS MAY APPLY - REFER TO YOUR POLICY Copyright, State Farm Mutual Automobile Insurance Company,2008 SSe-lifiBu.Z Iu1f3333c)

PHONE: (435) Residential Community Association Policy

PHONE: (435) Residential Community Association Policy STATE FARM FIRE AND CASUALTY COMPANY A STOCK COMPANY WITH HOME OFFICES IN BLOOMINGTON, ILLINOIS RENEWAL DECLARATIONS 3 Ravinia Drive Atlanta GA 30346-2117 Policy Number 94-BD-S537-1 0108-ST--0001 Named