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Home My WebLink AboutCertificate of InsuranceStateFarm ow OW STATE FARM GENERAL INSURANCE COMPANY ASTOCK COMPANY WITH HOME- OFFICES 0VBLOOMINGTON, ILLINOIS RENEWAL DECLARATIONS 75085-3925 Addl Insured -Section 11 Only AT2 000288 8125 N-02-3288'FU05 F U TOWN OF LOS ALTOS HILLS ITS OFFICERS, OFFICIALS, EMPLOYEES, AGENTS, CONTRACTORS 26379 W FREMONT RD LOS ALTOS HLS,CA 94022-2624 07 Policy Number 97 -QE -4200-7 Policy Period Effective Date Expiration Date 12 Months MAY 16 2022 MAY 16 2023 The policy period begins pd ends at 12:01 am standard time atthe premises location. Named Insured LYNX TECHNOLOGIES INC AmtornmticRenewal '|fthapg0sypmriodimohovxneo12 imwntm.thio policywillbenenovxedeutomudoo|ly subjeetto the premiums, rules and forms |noffoo1fnreach succeeding policy period. |fthis policy interminated, mmwill give you and the N1o. oqea/Lenho|dorvxhttennndooin compliance with the policy provisions or as required by law. Entity: Corporation NOTICE: Information concerning changes in your pDUov language is included. Please call your agent ifyou have any questions. POLICY PREMIUM $ 1.985.00 Discounts Applied: Renewal Year Years |nBusiness 8Ddnh|er ` C|ainnR9nnnj , Prepared MAR OO2O22 (DCopyright, State FnnnIVIwmo|AotOmnb|^|000m000CmmpnnK2008 CK4p_4000 includes copyrighted material ofInsurance Services Office, |nv,with its permission, 001278 294 Al Continued on Reverse Side of Page Page 1 of 7 RENEWAL DECLARATIONS (CONTINUED) Office Policy for TOWN OF LOS ALTOS HILLS Policy Number 97 -QE -4200.7 SECTION I - PROPERTY-SCHED U6g Loc–si—yon– Location of Limit of Insurance* Limit of Insurance* Seasonal Number Described Increase - Promises Covera'oA - Coverage B - Business BulldPhgs Business Personal Personal Property Property 001 1350 41 STAVE STE 201 & 202 No Coverage $ 175,600 25% CAPITOLA CA 95010-3935 * As of the effective date of this policy, the Limit of Insurance as shown includes any increase in the limit due to Inflation Coverage. 2EQIION I - INFLATIQN gOYE0aG_E INDEX(ES) Cov A - Inflation Coverage Index: N/A Cov B - Consumer Price Index: 281.1 Basic Deductible $5,000 Special Deductibles: Money and Securities $250 Employee Dishonesty $250 Equipment Breakdown $2,500 Other deductibles may apply - refer to policy. Prepared MAR 03 2022 0 Copyright, State Farm Mutual Automobile Insurance Company, 2008 CMP -4000 Includes copyrighted material of Insurance services Office, Inc., with its permission. 001278 Continued on Next Page Page 2 of 7 StateFarm A. RENEWAL DECLARATIONS (CONTINUED) Office Policy for TOWN OF LOS ALTOS HILLS Policy Number 97 -QE -4200-7 I SECTION I - EXTENSIONS OF COVERAGE - LIMIT OF INSURANCE - EagH DESCRIBED PREMISES 0 9 The coverages and corresponding limits shown below apply separately to each described premises shown in these Declarations, unless indicated by "See Schedule." It 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. 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 Debris Removal 25% of covered loss Equipment Breakdown Included Fire Department Service Charge $5,000 Fire Extinguisher Systems Recharge Expense $6,000 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 MAR 03 2022 Oc Copyright, State Farm Mutual Automobile Insurance Company, 2008 CMP -4000 Includes Copyrighted material of Insurance Services Office, Inc„ with its permission, 001279 294 Continued on Reverse Side of Page Page 3 of 7 N RENEWAL DECLARATIONS (CONTINUED) Office Policy for TOWN OF LOS ALTOS HILLS Policy Number 97 -QE -4200-7 Ordinance Or Law - Equipment Coverage Included Outdoor Property $5,000 Personal Effects (applies only to those promises 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 $50,000 Personal Property) Signs $2,500 Unauthorized Business Card Use $5,000 Valuable Papers And Records On Premises $50,000 Off Premises $15,000 SEC ION 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 Dependent Property - Loss Of Income Employee Dishonesty Utility Interruption - Loss Of Income Loss Of Income And Extra Expense LIMIT OF INSURANCE $5,000 $10,000 $10,000 Actual Logs Sustained - 12 Months Prepared2022 MAR 0 Copyright, State Farm Mutual Automobile Insurance Company, 2008 03 CMP -4000 1110ILides copyrighted material of Insurance Services Office, Inc., with its permission. 001279 Continued on Next Page Page 4 of 7 StateFar►n A. RENEWAL DECLARATIONS (CONTINUED) Office Policyfor TOWN OF LOS ALTOS MILLS Policy Numer 97 -QE -4200.7 SECTION ll - LIABILITY COVERAGE Coverage L - Business Liability Coverage M - Medical Expenses (Any One Person) Damage To Premises Rented To You AGGREGATE LIMITS Products/Completed Operations Aggregate General Aggregate LIMIT OF INSURANCE $2,000,000 $5,000 $000,000 LIMIT OF INSURANCE Excluded $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. FQRMS AND E DORSEMENTS CMP -4101 Businessowners Coverage Form FE -6999.3 *Terrorism Insurance Cov Notice CMP -4714 Excl data Processing and Prog CMP -4845 Excl Product Comp Operatn Liab CMP -4786.1 Addl Insd Owners Lessee Sched CMP -4787 Waiver of Trans Rgt of Recov CMP -4819.1 Unauthorized Business Card Use CMP -4698 Back -Up of Sewer or Drain CMP -4704.1 Dependent Prop Loss of Income CMP -4710 Employee Dishonesty CMP -4709 Money and Securities CMP -4703.1 Utility Interruption Loss Inem CMP -4705.2 Loss of Income & Extra Expense u Prepared MAR 03 2022 Copyright, State Farm Mutual Automobile Insurance Company, 2008 CMP -4000 Includes copyrighted material of Insurance Services Office, Inc., with its permission, 001280 294 Continued on (Reverse Side of Page Page 5 of 7 N RENEWAL. DECLARATIONS (CONTINUED) Office Policy for TOWN OF LOS ALTOS HILLS Policy Number 97 -QE -4200.7 CMP -4260.1 Amendatory Endorsement -CA CMP -4261 Amendatory Endorsement FD -6007 Inland Marine Attach Dec Now Form Attached This policy is issued by the State Farm General Insurance 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 General Insurance Company has caused thio policy -to be signed by its President and Secretary at Bloomington, Illinois. C4 secretary President IMPORTANT NOTICE: California law requires us to provide you with Information for filing complaints with the State Insurance Department regarding the coverage and service provided under this policy. Your agent's name and contact information are provided on the front of This documenti, Another option is to reach out by mail or phone directly to: $into FarmP Executive Customer Service PO Box 2320 Bloomington IL 61702 Phone # 1-800-$TATEFARM (1.500-782.8332) Department of Insurance complaints should be filed only after you and State Farm or your agent or other company representative have failed to reach a satisfactory agreement on a problem, California Department of Insurance Consumer Services Division 300 South Spring Street Los Angeles, CA 90013 Phone # 1 -800 -927 -HELP (4357) orvisit www.iiisuraiici!.oa.gov/O,l -consumers, Prepared MAR 03 2022 Copyright, State Farin WittinI Automobile hisLirailoo Cornpany, 2000 CMP -4000 hickidos copyrighted inaterial of Insurance Services Office, Inc., with its permission, 001280 . Continued on Next Page Page 6 of 7 StateFarm A" RENEWAL DECLARATIONS (CONTINUED) Office Policy for TOWN OF LOS ALTOS HILLS Policy Number 97 -QE -4200-7 0 NOTICE TO POLICYHOLDER: For a comprehensive description of coverages and forms, please refer to your policy. Policy changes requested before the "Date Prepared", which appear on this notice, are effective on the Renewal Date 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 MAR 03 2022 CMP -4000 001281 294 N Ou Copyright, State Farm Mutual Automobile Insurance Company, 2000 1110ILides copyrighted material Of Insurance Services Office, lim, with its permission, Page 7 of 7 001281 StateFarm A. MW STATE FARM GENERAL INSURANCE COMPANY ❑ A STOCK COMPANY WITH HOME OFFICES IN BLOOMINGTON, ILLINOIS INLAND MARINE: ATTACHING DECLARATIONS 'hardsnn Rgf� 75085-3925 Named Insured LYNX TECHNOLOGIES INC M-02-3269-FC05 F U Policy Number 97 -QE -4200-7 Policy Period Effective Date Expiration Date 12 Months MAY 16 2022 MAY 16 2023 The poli y period begins 4nd ends at 12:01 am standard time att�ie premises location. 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 -6271 Amendatory Endorsement FE -8739 Inland Marine Conditions FE -8745 Inland Marine Computer Prop See Reverse for Schedule Page with Limits Prepared MAR 03 2022 Copyright, State Farm Mutual Automobile hlsurance Company, 2008 FD -6007 Includes copyrighted material of Insurance Services Office, Ina, with its permission. 001282 630-U85a.2 05-31-2U11 1032320 97 -QE -4200-7 ATTACHING INLAND MARINE SCHEDULE PAGE ATTACHING INLAND MARINE ENDORSEMENT LIMIT OF DEDUCTIBLE ANNUAL NUMBER COVERAGE INSURANCE AMOUNT PREMIUM FE -8745 Inland Marine Computer Prop 25,000 r 500 Included Loss of Income and Extra Expense $ 25,000 Include d Prepared MAR 03 2022 FD -6007 0012£32 OTHER LIMITS AND EXCLUSIONS MAY APPLY - REFER TO YOUR POLICY @ Gopyright, State Farm Mutual AUtOITION1e Insurance Galnpany, 2008 Includes copyrighted material of Insurance Services Office, Inc., with its permission. US 0-68U u.2 UU-31-2011 1olf3233c1