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HomeMy WebLinkAboutCAG2019-136 - Insurance Certificate - Education with Purpose for Pacific Islanders - 4/25/25 5tateFarm STATE FARM FIRE AND CASUALTY COMPANY A STOCK COMPANY WITH HOME OFFICES IN BLOOMINGTON, ILLINOIS RENEWAL DECLARATIONS BoBoym g9on IL 6i702 2915 Policy Number 98-CO-P804-2 Addl Insured-Section II Only Policy Period Effective Date Expiration Date AT2 M-15-194B-FACD F U 12 Months APR 20 2025 APR 20 2026 001727 3125 The poll y period beg9ins and ends at 12:01 am standard CITY OF KENT HOUSING & HUMAN time att�ie premises cation. SERVICES ,_•• 220 4TH AVE S Named Insured KENT WA 98032-5838 EDUCATION WITH PURPOSE FOR PACIFIC ISLANDERS (NON PROFIT) 0 1111111111l 1111111111111'Lb �I��I"��I""Isllll�l��l� 0 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: NON PROFIT NOTICE: Information concerning changes in your policy language is included. Please call your agent if you have any questions. RECEIVED POLICY PREMIUM $ 325.00 Minimum Premium Discounts Applied: LIAR 5 203 Renewal Year Years in Business Protective Devices CITY OF KENT Claim Record CITY CLERK Prepared 24 2025 ©Copyright,State Farm Mutual Automobile Insurance Company,2008 FEB FEB 4000 InCllldes copyrighted material of Insurance Services Office,Inc.,with its permission. CMP-012531 294 Al Continued on Reverse Side of Page Page 1 of 7 N 530-5e6 al 05 31-2011 10132310 RENEWAL DECLARATIONS (CONTINUED) Office Policy for CITY OF KENT HOUSING & HUMAN Policy Number 98-CO-P804-2 SECTION I- PROPERTY SCHEDULE Location r Location of Limit of Insurance* Limit of Insurance* Seasonal NumbeDescribed Increase- Premises Coverage A- Coverage B- Business Buildings Business Personal Personal Property Property 001 1615 W SMITH ST APT G104 No Coverage $ 32,400 25% KENT WA 98032-4310 "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 INDEX(ES) Cov A- Inflation Coverage Index: N/A Cov B - Consumer Price Index: 317.7 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 FEB 24 2025 ©Copyright,State Farm Mutual Automobile Insurance Company,2008 CMP-4000 Includes copyrighted material of Insurance Services Office,Inc.,with its permission. 012531 Continued on Next Page Page 2 of 7 StateFarm u • ••- RENEWAL DECLARATIONS(CONTINUED) Office Policy for CITY OF KENT HOUSING & HUMAN Policy Number 98-CO-P804-2 „ ,r SECTION I EX3',ENZIONS QF COVERAGE - LIMIT OF INSURANCE - EACH DESCRIBED PREMISES g 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, N but has "Included" Indicated, please refer to that policy provision for an explanation of that coverage. 0 LIMIT OF COVERAGE INSURANCE Accounts Receivable On Premises $ ,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 Debris Removal 25% of covered loss Equipment Breakdown Included Fire Department Service Charge $5,000 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) $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 ©24 2025 Copyright,State Farm Mutual Automobile Insurance Company,2008 FEB FEB 4000 20 Includes copyrighted material of Insurance Services Office,Inc.,with its permission. 012532 294 Continued on Reverse Side of Page Page 3 of 7 N RENEWAL DECLARATIONS (CONTINUED) Office Policy for CITY OF KENT HOUSING & HUMAN Policy Number 98-CQ-P804-2 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. COVERAGE LIMIT OFINSURANCE 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 FEB 24 2025 O Copyright,State Farm Mutual Automobile Insurance Company,2008 CMP-4000 Includes copyrighted material of Insurance Services Office,Inc.,with its permission., 012532 Continued on Next Page Page 4 of 7 StateFarm • • �~ RENEWAL DECLARATIONS (CONTINUED) Office Policy for CITY OF KENT HOUSING & HUMAN Policy Number 98-CQ-P804-2 SECTION II- LIABILITY LIMIT OF COVERAGE INSURANCE L6 Coverage L- Business Liability $2,000,000 Coverage M - Medical Expenses (Any One Person) $10,000 Damage To Premises Rented To You $1,000,000 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 FE-6999.3 *Terrorism Insurance Cov Notice CMP-4819.1 Unauthorized Business Card Use CMP-4247.2 Amendatory Endorsement CMP-4572 Amendment of Premium Cond CMP-4561.4 Policy Endorsement CMP-4705.2 Loss of Income & Extra Expnse CMP-4710 Employee Dishonesty CMP-4709 Money and Securities CMP-4706 Back-Up of Sewer or Drain CMP-4704.1 Dependent Prop Loss of Income CMP-4703.1 Utility Interruption Loss Incm CMP-4788 Addl Insd Mgrs Lessor of Prem Prepared r7 24 2025 Copyright,State Farm Mutual Automobile hisurance Company,2008 FEB FEB 40 0 Includes copyrighted material of Insurance Services Office,Inc.,with its permission. 012533 294 Continued on Reverse Side of Page Page 5 of 7 N RENEWAL DECLARATIONS (CONTINUED) Office Policy for CITY OF KENT HOUSING & HUMAN Policy Number 98-CO-P804-2 CMP-4860 Al Design Person Org CMP-4787 Waiver of Trans Rgt of Recov FE-3661 Actual Cash Value Endorsement FD-6007 Inland Marine Attach Dec * 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.`I' p/ Secretary President Prepared FEB 24 2025 ©Copyright,State Farm Mutual Automobile Insurance Company,2008 CMP-4000 Includes copyrighted material of Insurance Services Office,Inc„with its permission. 012533 Continued on Next Page Page 6 of 7 StateFarm u m •® RENEWAL DECLARATIONS (CONTINUED) Office Policy for CITY OF KENT HOUSING & HUMAN Policy Number 98-CO-P804-2 N NOTICE TO POLICYHOLDER; For a comprehensive description of coverages and forms, please refer to your policy. s Policy changes requested before the "Date Prepared",which appear on this notice, are effective on the Renewal Date N of this policy unless otherwise indicated by a separate endorsement, binder, or amended declarations. Any coverage forms attached to -this notice are also effective on the Renewal Date of this policy. Policy changes requested after the "Date Prepared"will be sent to you as an amended declarations or as an endorsement to your policy. Billing for any additional premium for such changes will be mailed at a later date. If,during the past year, you've acquired any valuable property items, made any improvements to insured property, or have any questions about your insurance coverage, contact your State Farm agent. Please keep this with Your policy. Prepared 2 2025 O Copyright,State Farm Mutual Automobile Insurance Company,2008 FEB FEB 4000 Includes copyrighted material of Insurance Services Office,Inc.,with its permission. CMP-012534 294 Page 7 of 7 N vv �.wt r�v�r-L 012534 StateFarm STATE FARM FIRE AND CASUALTY COMPANY 11 s � A STOCK COMPANY WITH HOME OFFICES IN BLOOMINGTON, ILLINOIS INLAND MARINE ATTACHING DECLARATIONS g?Boungton IL 6i702 2915 Policy Number 98-CO-P804-2 Named Insured Policy Period Effective Date Expiration Date M-15-194B-FACE) F U 12 Months APR 20 2025 APR 20 2026 The oli y period begins and ends at 12:01 am standard EDUCATION WITH PURPOSE time atre premises location. FOR PACIFIC ISLANDERS CNON PROFIT) 0 0 0 N 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. 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 FEB24 2025 O Copyright,State Farm Mutual Automobile Insurance Company,2008 FEB 24 Includes copyrighted material of Insurance Services Office,Inc.,with its permission. 012535 53U-000u2 05-31.2011(o1f3232c) av-vw rvvr G 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 5 2 5, 0 0 0 $ 500 Included Loss of Income and Extra Expense S 25,000 Included Prepared OTHER LIMITS AND EXCLUSIONS MAY APPLY- REFER TO YOUR POLICY FEB 24 2025 D Copyright,State Farm Mutual Automobile Insurance Company,2008 FD-6007 Includes copyrighted material of Insurance Services Office,Inc„with its permission. 012535 530-666 u.2 05-31.2011(03233c