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HomeMy WebLinkAboutCAG2023-647 - Insurance Certificate - Living Well Kent - 08/30/24 StateFarm STATE FARM FIRE AND CASUALTY COMPANY AMENDED AUG 31 2024 Q A STOCK COMPANY WITH HOME OFFICES IN BLOOMINGTON, ILLINOIS DECLARATIONS gFBoy 2915 Policy Number 98-CK-U326-2 ommgton IL 61702-2915 Addl Insured-Section 11 Only Policy Period Effective Date Expiration Date M-15-194E-FACD F N 12 Months AUG 30 2024 AUG 30 2025 001332 3123 The poll y period begins and ends at 12:01 am standard CITY OF KENT time at e premises location. 400 W GOWE ST KENT WA 98032-6019 Named Insured LIVING WELL KENT COLLABORATIVE I 'I'Ill'Il"IIIII'Illl"'I'�IIII'llll'Illlllll'Il'I'I'Illllillllll s 0 �s Businessowners 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 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. Entity: Corporation Reason for Declarations: Your policy is amended AUG 31 2024 ADDITIONAL INSURED ADDED PREMIUM ADJUSTMENT FORM CMP-4860 ADDED Endorsement Premium None Discounts Applied: Renewal Year Years in Business Protective Devices Claim Record Prepared O 02 2024 Copyright,State Farm Mutual Automobile Insurance Company,2008 OCT OCT 02 00 Includes copyrighted material of Insurance Services Office,Inc.,with its permission. CMP009696 290 Al Continued on Reverse Side of Page Page 1 of 6 N 530-606 a.2 05-31-2011 Wf32i DECLARATIONS(CONTINUED) Businessowners Policy for CITY OF KENT Policy Number 98-CK-U326-2 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 10605 SE 240TH ST STE 232 No Coverage $ 2,100 25% KENT WA 98031-4903 *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: 314.1 SECTION I - DEDUCTIBLES Basic Deductible $1,000 Special Deductibles: Money and Securities $250 Equipment Breakdown $1,000 Other deductibles may apply - refer to policy. Prepared OCT 02 2024 C0 Copyright,State Farm Mutual Automobile Insurance Company,2008 CMP-4000 Includes copyrighted material of Insurance Services Office,Inc.,with its permission. 009696 Continued on Next Page Page 2 of 6 StateFarm i�. DECLARATIONS(CONTINUED) Businessowners Policy for CITY OF KENT Policy Number 98-CK-U326-2 a. SECTION! 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. co 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 2024 n Copyright,State Farm Mutual Automobile Insurance Company,2008 OCT re OCT 02 0 Includes copyrighted material of Insurance Services Office,Inc.,with its permission. CMP009697 290 Continued on Reverse Side of Page Page 3 of 6 N DECLARATIONS(CONTINUED) Businessowners Policy for CITY OF KENT Policy Number 98-CK-U326-2 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 Water Damage, Other Liquids, Powder Or Molten Material Damage Included 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 LIMIT OF INSURANCE Loss Of Income And Extra Expense Actual Loss Sustained- 12 Months SECTION 11- LIABILITY r LIMIT OF COVERAGE INSURANCE ;- Coverage L- Business Liability $2,000,000 Prepared OCT 02 2024 O Copyright,State Farm Mutual Automobile Insurance Company,2008 CMP-4000 Includes copyrighted material of Insurance Services Office,Inc.,with its permission. 009697 Continued on Next Page Page 4 of 6 StateFarm i DECLARATIONS(CONTINUED) Businessowners Policy for CITY OF KENT Policy Number 98-CK-U326-2 Coverage M - Medical Expenses (Any One Person) $5,000 M1 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-4102 Businessowners Coverage Form CMP-4860 *Al Design Person Org FE-6999.3 Terrorism Insurance Cov Notice CMP-4247.2 Amendatory Endorsement CMP-4705.2 Loss of Income & Extra Expnse CMP-4709 Money and Securities CMP-4779 Employers Liability CMP-4804 Addl Insd Club Members CMP-4786 Addl Insd Owners Lessee Sched CMP-4787 Waiver of Trans Rgt of Recov CMP-4572 Amendment of Premium Cond CMP-4561.4 Policy Endorsement CMP-4797 Addl Insd Controlling Interest CMP-4788 Addl Insd Mgrs Lessor of Prem FE-3661 Actual Cash Value Endorsement FD-6007 Inland Marine Attach Dec " New Form Attached Prepared 02 2024 (0 Copyright,State Farm Mutual Automobile Insurance Company,2008 OCT OCT 02 0 Includes copyrighted material of Insurance Services Office,Inc.,with its permission. CMP009698 290 Continued on Reverse Side of Page Page 5 of 6 N DECLARATIONS(CONTINUED) Businessowners Policy for CITY OF KENT Policy Number 98-CK-U326-2 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. �1 r: Secretary President - Prepared OCT 02 2024 c0 Copyright,State Farm Mutual Automobile Insurance Company,2008 CMP-4000 Includes copyrighted material of Insurance Services Office,Inc.,with its permission. 009698 290 Page 6 of 6 N STATE FARM FIRE AND CASUALTY PANY ,5tateFarrn A STOCK COMPANY WITH HOME OFFICES INBLOOMINGTON, ILLINOIS INLAND MARINE ATTACHING DECLARATIONS •®. P Box 2915 Policy Number 98-CK-U326-2 BRaotnrngton IL 6 1 702-29 15 Named Insured Policy Period Effective Date Expiration Date M-15-194E-FACD F N 12 Months AUG 30 2024 AUG 30 2025 The policy period begins and ends at 12:01 am standard LIVING WELL KENT COLLABORATIVE time atthe premises location. 0 0 0 0 �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 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-8724 Inland Marine Conditions FE-8744.1 Inland Marine Computer Prop See Reverse for Schedule Page with Limits Prepared 02 2024 ©Copyright,State Farm Mutual Automobile Insurance Company,2008 OCT OCT 0 7 Includes copyrighted material of Insurance Services Office,Inc„with its permission. 009699 530-688 a.2 05-31-2011 lotf3232c1 98-CK-U326-2 ATTACHING INLAND MARINE SCHEDULE PAGE ATTACHING INLAND MARINE ENDORSEMENT LIMIT OF DEDUCTIBLE ANNUAL NUMBER COVERAGE INSURANCE AMOUNT PREMIUM - FE-8744.1 Inland Marine Computer Prop S 25, 000 $ 500 Included Loss of Income and Extra Expense 5 25, 000 Included Prepared OTHER LIMITS AND EXCLUSIONS MAY APPLY- REFER TO YOUR POLICY OCT 02 2024 O Copyright,State Farm Mutual Automobile Insurance Company,2008 FD-6007 Includes copyrighted material of Insurance Services Office,Inc.,with its permission. 009699 536-666 a.2 05-31-2M11 iv1f32330