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HomeMy WebLinkAboutCAG2024-526 - Insurance Certificate - Gordon Thomas Honeywell - 11/20/24 State Farm STATE FARM FIRE AND CASUALTY COMPANY AMENDED JAN 18 2025 A STOCK COMPANY WITH HOME OFFICES IN 8LOOMINGTON, ILLINOIS DECLARATIONS e�oBay 2915 IL 61702 29i5 Policy Number 98-GY-1097-9 Addl Insured-Section II Only Policy Period Effective Date Exppiration Date M-15-216E-FBE1 F U 12 Months NOV 20 2024 NOV 20 2025 001467 3123 The poli y period beggins and ends at 12:01 am standard CITY OF KENT time att�e premises iocatlon. 220 4TH AVE S KENT WA 98032-5838 Named Insured GORDON THOMAS HONEYWELL GOVERNMENTAL AFFAIRS LLC II"II�I�IIIIII'IIIIIIIII�I'II��I'lll��l�'I'�'I'll'�Ill'lll�"I�� s 0 0 �s 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 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: LLC Reason for Declarations: Your policy is amended JAN 18 2025 ADDITIONAL INSURED ADDED PREMIUM ADJUSTMENT FORM CMP-4786 ADDED Endorsement Premium None Discounts Applied: Renewal Year Years in Business Enclosed Building Protective Devices Claim Record Prepared 2$2025 ©Copyright,State Farm Mutual Automohile Insurance Company,2008 JAN JAN 28 Includes copyrighted material of Insurance Services Office,Inc.,with its permission. 01093 CM 00 290 Al Continued on Reverse Side of Page Page 1 of 6 N 530-0110 u.2 05-31-2011(A3231c) DECLARATIONS(CONTINUED) Office Policy for CITY OF KENT Policy Number 98-GY-1097-9 i SECTION 1- PROPERTY SCHEDULE Number Location of Limit of Insurance* Limit of Insurance* Seasonal Described Increase- Premises Coverage A- Coverage B - Business Buildings Business Personal Personal Property Property 001 1201 PACIFIC AVE STE 2100 No Coverage $ 62,700 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 INDEMES1 Cov A- Inflation Coverage Index: N/A Cov B - Consumer Price Index: 314.8 SECTION I- DEDUCTIBLES Basic Deductible $1,000 Special Deductibles: Money and Securities $250 Employee Dishonesty $250 Equipment Breakdown $1,000 Other deductibles may apply- refer to policy. Prepared JAN 28 2025 O Copyright,State Farm Mutual Automobile Insurance Company,2008 CMP-4000 Includes copyrighted material of Insurance Services Office,Inc.,with its permission. 010933 Continued on Next Page Page 2 of 6 StateFarm U • •® DECLARATIONS(CONTINUED) Office Policy for CITY OF KENT Policy Number 98-GY-1097-9 SECTION I - EXTENSIONS OF COVERAGE - LIMIT OF INSURANCE- EACH DESCRIBED PREMI—SEE $ 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, �o but has "Included" indicated,please refer to that policy provision for an explanation of that coverage. LIMIT OF COVERAGE INSURANCE Accounts Receivable On Premises $50,000 Off Premises $15,000 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 J Debris Removal 25%of covered loss r Equipment Breakdown Included Fire Department Service Charge $5,000 Fire Extinguisher Systems Recharge Expense 2 $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) $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 Q 2025 Copyright,State Farm Mutual Automobile Insurance Company,2008 JAN 28 JAN 28 00 Includes copyrighted material of Insurance Services Office,Inc.,with its permission. CM 010934 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 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 $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 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 Loss Of Income And Extra Expense Actual Loss Sustained- 12 Months Prepared JAN 28 2025 Q Copyright,State Farm Mutual Automobile Insurance Company,2008 CMP-4000 Includes copyrighted material of Insurance Services Office,Inc.,with its permission. 010934 Continued on Next Page Page 4 of 6 StateFa%An • *®° DECLARATIONS(CONTINUED) Office Policy for CITY OF KENT Policy Number 98-GY-1097-9 SECTION II - LIABILITY s LIMIT OF g COVERAGE INSURANCE Coverage L - Business Liability $3,000,000 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 $6,000,000 General Aggregate $6,000,000 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 ©Copyright,State Farm MLItUal Automobile Insurance Company,2008 JAN 28 2025 JAN 28 00 Includes copyrighted material of hisurance Services Office,Inc.,with its permission. CM 010935 290 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 I 1 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. 6�(-7.1,-7r Secretary President Prepared JAN 28 2025 O Copyright,State Farm Mutual Automobile Insurance Company,2008 CMP-4000 Includes copyrighted material of Insurance Services Office,linc.,with its permission. 010935 290 Page 6 of 6 N StateFarm STATE FARM FIRE AND CASUALTY COMPANY Ll A STOCK COMPANY WITH HOME OFFICES IN BLOOMINGTON, ILLINOI5 INLAND MARINE ATTACHING DECLARATIONS 9?Box 21 IL 61702 29i5 Policy Number 98-GY-1097-9 Named Insured Policy Period Effective Date Expiration Date M-15-216E-FBE1 F U 12 Months NOV 20 2024 NOV 20 2025 The poli y period beggins end ends at'12:01 am standard GORDON THOMAS HONEYWELL time at e premises Tocataon. GOVERNMENTAL AFFAIRS LLC _,_ 0 d 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 Mortga gee/Li enholder written notice in compliance with the policy provisions or as required bylaw. Annual Policy Premium Included The above Premium Amount is included in the Policy Premium shown on the Declarations. r J J J J r 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 Oc AN 28 2025 Copyright,State Farm Mutual Automobile hisurance Company,2008 J AN 287 Includes copyrighted material of Insurance Services office,Inc.,with its permission. FD-010936 530 686u.2 65-31-2611 l01(3232c1 98-GY-1097-9 s 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 S 500 Included Loss of Income and Extra Expense S 25,000 Included Prepared OTHER LIMITS AND EXCLUSIONS MAY APPLY- REFER TO YOUR POLICY JAN 28 2025 O Copyright,State Farm Mutual Automobile Insurance Company,zom FD-6007 Includes copyrighted material of Insurance Services Office,Inc.,with its permission. 010936 530-606 a.2 05-314011 1003233ul