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HomeMy WebLinkAboutCAG2023-647 - Insurance Certificate - Living Well Kent Collaboration - 8/30/24 StateFarm STATE FARM FIRE AND CASUALTY COMPANY AMENDED JAN 28 2025 Ll A STOCK COMPANY WITH HOME OFFICES IN BLOOMINGTON, ILLINOIS DECLARATIONS •r: B?oom°1ng9on IL 6i702 29i5 Policy Number 98-CK-U326-2 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 001387 3123 The poll y period begins and ends at 12:01 am standard CITY OF KENT time att.�ie premises location. 400 W GOWE ST KENT WA 98032-6019 Named Insured LIVING WELL KENT COLLABORATIVE III'111111111111111111111111�11�11111��1��11�1111�1�1�11���11'III 8 0 0 �o 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 28 2025 ADDITIONAL INSURED ADDED PREMIUM ADJUSTMENT FORM CMP-4786 ADDED Endorsement Premium Increase $ 44.00 Discounts Applied: Renewal Year Years in Business Protective Devices Claim Record Prepared ©12 2025 Copyright,State Farm Mutual Automobile Insurance Company,2008 FEB CMP12 00 20 Includes copyrighted material of Insurance Services Office,Inc.,with its permission. 008468 290 Al Continued on Reverse Side of Page Page 1 of 6 N 536-666a.2 65-31-2611(ON2310 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 INDEMES1 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 FEB 12 2025 n Copyright,State Farm Mutual Automobile Insurance Company,2008 CMP-4000 Includes copyrighted material of Insurance Services Office,Inc.,with its permission. 008468 Continued on Next Page Page 2 of 6 StateFarm A. DECLARATIONS(CONTINUED) Businessowners Policy for CITY OF KENT Policy Number 98-CK-U326-2 SECTION I EXTCN§IONS 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, �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 $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 12 2025 n Copyright,State Farm Mutual Automobile Insurance Company,2008 FEB FEB 12 20 Includes copyrighted material of Insurance Services Office,Inc.,with its permission. 00 008469 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 it - LIABILITY COVERAGE LIMIT OF INSURANCE Coverage L- Business Liability $2,000,000 Prepared FEB 12 2025 n Copyright,State Farm Mutual Automobile Insurance Company,2008 CMP-4000 Includes copyrighted material of Insurance Services Office,Inc.,with its permission. 008469 Continued on Next Page Page 4 of 6 StateeFFarm L W DECLARATIONS(CONTINUED) Businessowners Policy for CITY OF KENT Policy Number 98-CK-U326-2 Coverage M - Medical Expenses (Any One Person) $5,000 ON Damage To Premises Rented To You $300,000 LIMIT OF AGGREGATE LIMITS INSURANCE s 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-4786 *Addl Insd Owners Lessee Sched CMP-4787 *Waiver of Trans Rgt of Recov 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-4860 Al Design Person Org 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 NOTICE: INFORMATION CONCERNING CHANGES IN YOUR POLICY LANGUAGE IS INCLUDED. PLEASE CALL YOUR AGENT IF YOU HAVE ANY QUESTIONS. * New Form Attached Prepared 1 2025 @ Copyright,State Farm Mutual Automobile Insurance Company,2008 FEB FEB 2 20 Includes copyrighted material of Insurance Services Office,Inc.,with its permission. 00 008470 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.vw Secretary President Prepared FEB 12 2025 ©Copyright,State Farm Mutual Automobile Insurance Company,2008 CMP-4000 Includes copyrighted material of Insurance Services Office,Inc„with its permission. 008470 290 Page 6 of 6 N StateFarm STATE FARM FIRE AND CASUALTY COMPANY A STOCK COMPANY WITH HOME OFFICES IN BLOOMINGTON, ILLINOIS INLAND MARINE ATTACHING DECLARATIONS e0om°/ngvn IL 1a1702 2915 Policy Number 9$-CK-11326-2 Named Insured Policy Period Effective Date Expiration Date M-15-194E-FACD F N 12 Months AUG 30 2024 Al]G 30 2025 The policy period beggins qnd ends at 12:01 am standard LIVING WELL KENT COLLABORATIVE time atthe premises Tocatton. 0 0 0 0 a �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 FEB12 2025 ©Copyright,State Farm Mutual Automobile Insurance Company,2008 FEB 12 Includes copyrighted material of Insurance Services Office,Inc.,with its permission. 008471 5306136a.2 05-31-2011(01t323201 W-UK-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 FEB 12 2025 cc Copyright,State Farm Mutual Automobile Insurance Company,2008 FD-6007 Includes copyrighted material of Insurance Services Office,Inc.,with its permission. 008471 536-686a.2 05-31-2411 Io113233c