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HomeMy WebLinkAboutCAG2023-647 - Insurance Certificate - Living Well Kent Collaborative - 8/30/24 Statefarm STATE FARM FIRE AND CASUALTY COMPANY AMENDED JAN 2 2g25 ❑ nm A STOCK COMPANY WITH HOME OFFICES IN BLOOMINGTON, ILLINOIS DECLARATIONS P0 Box 2915 Policy Number 98-CK-U326-2 Bloomington IL 61702-2915 Addl Insured-Section II Only Policy Period Effective Date-- Expiration Date M-15-194B-FACD F N 12 Months AUG 30 2024 AUG 30 2025 001628 3123 The oli y period begins and ends at 12:01 am standard CITY OF KENT tlme aotl iy premises location. 400 W GOWE 5T _ . KENT WA. 98032-6019 Named Insured � LIVING WELL KENT COLLABORATIVE 1111111��,111��111111..II'IIIIIII Jill 11111111111111111111l111l111 0 v,a 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 JAN 2 2025 ADDITIONAL INSURED ADDED PREMIUM ADJUSTMENT FORM CMP-4860 ADDED Endorsement Premium None Discounts Applied: Renewal Year Years in Business Protective Devices Claim Record Prepared JAN 30 2025 ©Copyright,State Farm Mutual Automobile Insurance Company,2008 CMP-4000 Includes copyrighted material of Insurance Services Office,Inc.,with its permission. 011664 290 Al Continued on Reverse Side of Page Page 1 of 6 1 N 530 606 a.2 05 31-2011 toIt3231c1 DECLARATIONS(CONTINUED) Businessowners Policy for CITY OF KENT Policy Number 98-CK-U326-2 E TI N I- PR P RTY SCHEDULE Location Location of Limit of Insurance* Limit of Insurance* Seasonal Number Described Increase- Premises Coveragge A- Coverage B- Business Buildrr gs 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 INDEXES) 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 JAN 30 2025 Copyright,State Farm Mutual Automobile Insurance Company,2000 CMP-4000 Includes copyrighted material of Insurance Services Office,Inc„with its permission. 011664 Continued on Next Page Page 2 of 6 SrateFawm WI I i DECLARATIONS (CONTINUED) Businessowners Policy for CITY OF KENT Policy Number 98-CK-U326-2 ISECTION I- EXTENSIONS OF COVERA E - LIMIT OF IN SURANCE EACH DE RIDED PREMISES S 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 LIMIT OF Accounts Receivable INSURANCE On Premises Off Premises $10,000 Arson Reward $5,000 Collapse $5,000 Included Damage To Non-Owned Buildings From Theft, Burglary Or Robbery Debris Removal Coverage B Limit 2 Equipment Breakdown 5%of covered loss Fire Department Service Charge Included Fire Extinguisher Systems Recharge Expense $2,500 Forgery Or Alteration $5,000 Glass Expenses $10,000 Included Increased Cost Of Construction And Demolition Costs (applies only when buildings are insured on a replacement cost basis) 10% Money And Securities (Off Premises) Money And Securities (On Premises) $2,000 Money Orders And Counterfeit Money $5,000 $1,000 Newly Acquired Business Personal Property(applies only if this policy provides Coverage B - Business Personal Property) $100,000 Newly Acquired Or Constructed Buildings (applies only if this policy provides Coverage A - Buildings) $250,000 Prepared JAN 30 2025 O Copyright,State Farm Mutual Automobile Insurance Company,2008 CMP-4000 Includes copyrighted material of Insurance Services Office,Inc.,with its permission. 011665 290 N Page Continued on Reverse Side of Pa Page 3 of 6 DECLARATIONS(CONTINUED) Policy Numberrs Policygg CK-U326 2KENT Included Ordinance Or Law- Equipment Coverage $5,000 Outdoor Property $2,500 Personal Effects (applies only to those premises provided Coverage B - Business Personal Property) $15,000 Personal Property Off Premises $10,000 Pollutant Clean Up And Removal 30 Days Preservation Of Property $2,500 Property Of Others (applies only to those premises provided Coverage B - Business Personal Property) $2,500 Signs Valuable Papers And Records $10,000 On Premises $5,000 Off Premises - Included Water Damage, Other Liquids, Powder Or Molten Material Damage SECTION I- E ENSION§OF COVERAGE- LIMIT OF INSURANCE- PER LI Y 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 INSURANCE COVERAGE Actual Loss Sustained- 12 Months Loss Of Income And Extra Expense SECTIONit- LIABILITY LIMIT OF INSURANCE COVERAGE $2,000,000 Coverage L- Business Liability Prepared Cc Copyright,State Farm Mutual Automobile Insurance Company,2008 JAN 30 2025 Includes copyrighted material of Insurance Services Office,htc.,with its permission. CMP-4000 Page 4 of 6 Continued on Next Page 011665 StateFarm � CI DECLARATIONS(CONTINUED) Businessowners Policy for CITY OF KENT Policy Number 98-CK-U326-2 Coverage M - Medical Expenses (Any One Person) Damage To Premises Rented To You $5,000 I $300,000 AGGREGATE LIMITS LIMIT OF Products/Completed Operations Aggregate INSURANCE General Aggregate $4,000,000 $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, an 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 *AI 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 JAN 30 2025 ©Copyright,State Farm Mutual Automobile Insurance Company,2008 CMP-4000 Includes copyrighted material of Insurance Services Office,Inc.,with its permission. 011666 290 N Continued on Reverse Side of Page Page 5 of 6 DECLARATIONS(CONTINUED) Businessowners policy 9t r CITY U3 OF 2KENT Policy Number 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, 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. v4u" j- wtz` President Secretary Prepared q Copyright,State Farm Mutual Automobile Insurance Company,2008 JAN 30 2025 Includes copyrighted material of Insurance Services Office,Inc.,with its permission. CMP-4000 Page 6 of 6 011666 290 N StateFarm STATE FARM FIRE AND CASUALTY COMPANY �o A STOCK COMPANY WITH HOME OFFICES IN BLOOMINGTON, ILLINOIS INLAND MARINE ATTACHING DECLARATIONS B�oom°ing o1n IL 6 1 702-29 15 ffo ber 98-CK-U326-2 Named Insured od Effective Date Ex iration Date M-15-194B-FACD F N pp LIVING WELL KENT COLLABORATIVEAUG 30 2024 AUG 30 2025 period be ins and ends at 12:01 am standard premises�ocatlon. I S Q 0 ATTACHING INLAND MARINE Automatic Renewal-If the olic p y 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/Lien holder 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 JAN 30 2025 Q Copyright,State Farm Mutual Automobile Insurance Company,2008 FD-6007 Includes copyrighted material of Insurance Services Office,Inc.,with its permission. 011667 538-686 u.2 95-31 2011(01f3232c1 98-CK-U326-2 ATTACHING INLAND MARINE SCHEDULE PAGE ATTACHING INLAND MARINE LIMIT OF DEDUCTIBLE PREMIUM ENDORSEMENT COVERAGE INSURANCE AMOUNT NUMBER $ 25, 000 $ 500 Included FE-8744.1 Inland Marine Computer Prop 25 ,000 Include d Loss of Income and Extra Expense $ OTHER LIMITS AND EXCLUSIONS MAY APPLY-REFER TO YOUR POLICY Prepared O Copyright,State Farm Mutual AIItOmohlle Insurance Company,2008 JAN 30 2025 Includes copyrighted material of Insurance Services Office,Inc.,with its permission. FD-6007 530-606 0.2 05 31 2011(o1F 011667