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HomeMy WebLinkAboutAD18-257 - Insurance Certificate - Gordon Thomas Honeywell Government Affairs LLC - Amended Policy - 11/20/2023 StateFarm STATE FARM FIRE AND CASUALTY COMPANY AMENDED OCT 2 20?3 U A STOCK COMPANY WITH HOME OFFICES IN BLOOMINGTON, ILLINOIS DECLARATIONS ® Po BoX 2915 Policy Number 98-GY-1097-9 Bloomington IL 6 1 702-29 15 Addl Insured-Section 11 Only Policy Period Effective Date - Expiration Date M-15-216B-FBE1 F U 12 Months NOV 20 2023 NOV 20 2024 001956 3123 The policy period begins and ends at12:01 am standard CITY OF KENT time at the premises location. 220 4TH AVE S _. ---- KENT WA 98032-5838 Named Insured GORDON THOMAS HONEYWELL GOVERNMENTAL AFFAIRS LLC 0 d �o Office Policy Automatic Renewal- If the policy period is shown as 12 months,this policy will be renewed automatically subject to the premiums,rules and farms in effect for each succeeding policy period.If this policy is terminated,we will give you and the Mortgagee/Lien hold er written notice in compliance with the policy provisions or as required by law. Entity: LLC Reason for Declarations: Your policy is amended OCT 2 2023 ADDITIONAL INSURED ADDE_� PREMIUM ADJUSTMENT FORM CMP-4786 ADDED Other items shown are effective with the policy's 2023 renewal Endorsement Premium None Discounts Applied: Renewal Year Years in Business Enclosed Building Protective Devices Claim Record i I Prepared 2023 ©Copyright,State Farm Mutual Automobile Insurance Company,2008 NOV re NOV 0700 Includes copyrighted material of Insurance Services Office,Inc.,with its permission. CMP014444 290 Al Continued on Reverse Side of Page Page 1 of 6 N s3n.fighnjj as-33-2011(olf323i[:f Office Policy for CITY OF KENT DECLARATIONS(CONTINUED) Policy Number 98-GY-1097-9 SECTION 1- PROPERTY SCHFnl[1LF_ Location Location of Limit of Insurance* Limit of Insurance* Seasonal Number Described Increase- Premises Coveratge A- Coverage B - Business Buildings Business Personal Personal Property Property 001 1201 PACIFIC AVE STE 2100 No Coverage $ 61,100 25% TACOMA WA 98402-4314 *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 INDEMES) Cov A- Inflation Coverage Index: N/A Cov B - Consumer Price Index: 307.0 SECTION I- DEDUCTIBLES Basic Deductible $1,000 Special Deductibles: Money and Securities $250 Employee Dishonosty $250 Equipment Breakdown $1,000 Other deductibles may apply - refer to policy. Prepared NOV 07 2023 T Copyright,State Farm Mutual Automobile Insurance Company,2008 CMP-4000 InGlUdes copyrighted material of Insurance Services office,Inc.,with its permission. 014444 Continued on Next Page Page 2 of 6 l StateFarm LI W W. DECLARATIONS(CONTINUED) Office Policy for CITY OF KENT Policy Number 98-GY-1097-9 SECTION] EXTENSIONS OF COVERAGE LIMITOF 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. U)o LIMIT OF COVERAGE INSURANCE Accounts Receivable $50,000 On Premises $15,000 Off Premises 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 o Fire Department Service Charge $5,000 Fire Extinguisher Systems Recharge Expense $5,000 n Forgery Or Alteration $10,000 Glass Expenses Included i Costs (applies only when buildings are 10% And Demolition y Increased Cost Of Construction ( pp 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 n 07 2023 Copyright.State Farm Mutual Automobile Insurance Company,2008 NOV NOV 0700 Includes copyrighted material of Insurance Services Office,Inc.,with its permission. 01444 CM 290 Continued on Reverse Side of Page Page 3 of 6 N DECLARATIONS(CONTINUED) Office Policy for CITY OF KENT Policy Number 98-GY-1097-9 Ordinance Or Law- Equipment Coverage Included Outdoor Property $5,000 Personal Effects (applies only to those premises provided Coveraae B- Business *Ps o n n 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 Water Damage, Other Liquids, Powder Or Molten Material Damage Included E TI N I- EXTENSIONS OF COVERAGE --LIMIT OF IN§URANCE 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 LIMIT OF INSURANCE Dependent Property- Loss Of Income $5,000 Employee Dishonesty $10,000 Utility Interruption - Loss Of Income $10,000 Loss Of Income And Extra Expense Actual Loss Sustained- 12 Months Prepared NOV 07 2023 O Copyright,State Farm Mutual Automobile Insurance Company,2008 CMP-4000 Includes copyrighted material of Insurance Services Office,Inc.,with its permission. 014445 Continued on Next Page Page 4 of 6 StateFarm L 1 DECLARATIONS (CONTINUED) Office Policy for CITY OF KENT Policy Number 98-GY-1097-9 W." , SECTION II - LIABILITY �---- LIMIT OF s g COVERAGE INSURANCE: Coverage L - Business Liability $1,000,000 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 $2,000,000 General Aggregate $2,000,000 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-4102 Businessowners Coverage Form CMP-4786 *Addl Insd Owners Lessee Sched CMP-4787 *Waiver of Trans Rgt of Recov CMP-4247.2 Amendatory Endorsement FE-6999.3 Terrorism Insurance Cov Notice CMP-4706 Back-Up of Sewer or Drain CMP-4721 Ex Personal Advertising Injury CMP-4779 Employers Liability CMP-4788 Addl Insd Mgrs Lessor of Prem CMP-4819.1 Unauthorized Business Card Use CMP-4704.1 Dependent Prop Loss of Income CMP-4710 Employee Dishonesty CMP-4709 Money and Securities Prepared 07 2023 ©Gopyright,State Farm Mutual Automobile Insurance Company,2008 NOV NOV 07 Includes copyrighted material of Insurance Services Office,Inc.,with its permission. 01444 CM 290 00 Continued on Reverse Side of Page Page 5 of 6 N DECLARATIONS(CONTINUED) Office Policy for CITY OF KENT Policy Number 98-GY-1097-9 CMP-4703.1 Utility Interruption Loss Incm CMP-4705.2 Loss of Income & Extra Expnse CMP-4765.1 Excl Empl Non-Owned Auto Liab CMP-4572 Amendment of Premium Cond CMP-4561.4 Policy Endorsement CMP-4860 Al Design Person Org CMP-4785 Addl Ins Owners Lessee Blkt CMP-4802 Addl Insd Lessor of Leased Eqp FE-3661 Actual Cash Value Endorsement FD-6007 Inland Marine Attach Dec NOTICE: INFORMATION CONCERNING CHANGES IN YOUR POLICY LANGUAGE IS INCLUDED. PLEASE CALL YOUR AGENT IF YOU HAVE ANY QUESTIONS, * 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 Prepared NOV 07 2023 Cc)Copyright,State Farm Mutual Automobile Insurance Company,2008 CMP-4000 Includes copyrighted material of Insurance Services office,Inc.,with its permission. N14446 290 Page 6 of 6 StateFarm STATE FARM FIRE AND CASUALTY COMPANY A STOCK COMPANY WITH HOME OFFICES IN BLOOMINGTON, ILLINOIS INLAND MARINE ATTACHING DECLARATIONS Po Box 2915 Policy Number 98-GY-1097-9 Bloomington IL 6 1 702-29 15 Named Insured Policy Period Effective Date Exppiration Date M-15-216E-FBE1 F U 12 Months NOV 20 2023 NOV 20 2024 The poll y period begins and ends at 12:01 am standard GORDON THOMAS HONEYWELL time t e premises location. GOVERNMENTAL AFFAIRS LLC 0 0 d 0 4 cA o 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 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 Amountis included in the Policy Premium shown on the Declarations. J Your policy consists of these Declarations,the INLAND MARINE CONDITIONS shown below,and any other forms and endorsements that i apply,including those shown below as well as those issued subsequent to the issuance of this policy. Forms,Options,and Endorsements FE-8724 Inland Marine Conditions FE-8744.1 Inland Marine Computer Prop See Reverse for Schedule Page with Limits Prepared © 07 2023 Copyright,State Farm Mutual Automobile Insurance Company,2008 NOV NOV 0 7 Includes copyrighted material of Insurance Services Office,Inc.,with its permission. 014447 530-606a.2 05-31-2011(o1i3232c 1 9U-UY-1U97-9 ATTACHING INLAND MARINE SCHEDULE PAGE ATTACHING INLAND MARINE CMnnDCCR II-[M I nrn11rTIRl C Aninn[AI LIY1J lJI1V LIYILIYI LI�AIT�C —L V.I IuLI- ni IM-1- NUMBER COVERAGE INSURANCE AMOUNT PREMIUM FE-8744.1 Inland Marine Computer Prop S 25, 000 $ 500 Included Loss of Income and Extra Expense S 25,000 Included Prepared OTHER LIMITS AND EXCLUSIONS MAY APPLY-REFER TO YOUR POLICY NOV 07 2023 n Copyright,State Farm Mutual Automobile Insurance Company,2008 FD-6007 Includes copyrighted material of Insurance Services Office,Inc.,with its permission. 014447 536-6660.2 65-31-2011 tolt32330