Loading...
HomeMy WebLinkAboutLos Altos Hills Newcomers Club 05.17.2023StateFarm • STATE FARM GENERAL INSURANCE COMPANY AMENDED AUG 4 2023 11 A STOCK COMPANY WITH HOME OFFICES IN BLOOMINGTON, ILLINOIS DECLARATIONS P Box 2915 Boomrngton IL 61702-2915 Addl Insured -Section II Only M -02-32413-F1380 F N 000211 3123 THE TOWN OF LOS ALTOS HILLS, ITS ELECTIVE AND APPOINTED ti OFFICERS, EMPLOYEES, AND VOLUNTEERS 26379 W FREMONT RD LOS ALTOS HLS CA 94022-2624 8 0 cn a Illll�lll�l�llls�"I'1�11111����"IIIII�I�II'I�I'I�"III'I"�II'Illl Businessowners Policy Policy Number 97 -EA -D221-9 Policy Period Effective Date Expiration Date 12 Months MAY 17 2023 MAY 17 2024 The policy period beggins and ends at 12:01 am standard time attire premisesTocation. Named Insured LOS ALTOS, LOS ALTOS HILLS NEWCOMERS CLUB Automatic Renewal - If the policy period is shown as 12 months, this policy will be renewed automatically subjectto the premiums, rules and forms in effect for 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: NOT FOR PROFIT 501(C)(7) Reason for Declarations: Your policy is amended AUG 4 2023 ADDITIONAL INSURED ADDED FORM CMP -4860.1 ADDED Endorsement Premium Discounts Applied: Renewal Year Claim Record None Prepared C SEP re Copyright, State Farm Mutual Automobile Insurance Company, 2008 CMP -4000 20 2023 Includes copyrighted material of Insurance Services Office, Inc., with its permission. 001240 290 Al Continued on Reverse Side of Page N Page 1 of 6 DECLARATION'S0I Buslness'owners'Policy for TH E'T0'WN-`0'F' LOS ALTOS HILLS Policy u-EAw 221w „ g ' j,:0LR I 'fir U _ : • Loeatl �. ` j1 + ' ' mil of Insu, Limit. Insures NuM001' Seasonal', ' .Described'. Prom, Ise Will r Increase i 't� ,.erson 'ert. Pro.y, ,.,..Pro ert ...., ... M�u1tpy'�....:. .. 111gggppp�pp Pf} - lo M yea .. ..... •. 250% LOS ALTOS HL$'CA 94022,263 s 'tl � f N date,of this o't"IC '.� � Umff f]'nsur .n s�i " � �r��� {���""°' � i. I I+ . i� ,t limit utIr�fl t� nCoverage, . gg,wQTQN-.� `I ON :.pill 11111,101014o W. C . - Inflation Coverage Index.,, N/�, CoV C shat r Price, , I �,9 A eib., - 299.2 CTI `T°M Basid Deductible. ..Special, Deductibles: I�r�,ySecuritiesM arid,Equipmentreak $500 Other til ma apply - refer �� ►I� � Prepared i SEP 2 202 o right, State Farm+ Mutual ��t�►��r�r�l� e In �rwigo Gorr�l��,a�y► 008 �Cl/I d 4 Includes {yr Ii.ted material of Insu'ranc S i i : � e, In-c.,x with its permission. 001240,' Continued on Net Page StateFarm � �� v��m DECLARATIONS (CONTINUED) nmPolicy for THE TOWN OFLOS ALTOS HILLS, Policy Number 97 -EA -D221-9 RA, SECTIQN I - EXTENSIONS OF COVERAGE - LIMIT OF INSURANCE - EACH DESCRIBED PREMISES The coveragesand corresponding limits shown below h/ separately toeach described premises shown |mthese Declarations, | indicated "See Schedule." If a coverage does nothave mcorresponding limit shown be|mxx. but has "Included" indicated, please refer to that policy provision for an explanation mfthat coverage. L|K8|T OF COVERAGE INSURANCE Accounts Receivable On Premises $10.000 Off Premises 85.000 Arson Reward $5.000 Collapse Included Damage ToNon-Owned Buildings From Theft, Burglary {}rRobbery Coverage BLimit Debris Removal 25Y4ofcovered loss Equipment Breakdown Included Fire Department Service Charge $2.500 Fire Extinguisher Systems Recharge Expense $5'000 Forgery [)rAlteration $10.000 Glass Expenses Included Increased Cost Of Construction And Demolition Costs (applies only when buildings are 10% insured nna 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 Businen'Pereona|Proporty(app|i000n|yif\hiopn|icyprovideS $100.000 Coverage B - Business Personal Property) Newly Acquired Or Constructed Buildings (applies only if this policy provides $250.000 Coverage A -Buildings) Prepared SEP 282023 t,Copyright, State Farm Mutual Automobile Insurance Company, z00v Includes =py,inh�dm�,,in|�|nsomow5omimvO8iwi�hspermi=inn CMP -4000' Inc., 001241 290 Continued on Reverse Side of Page Page 3 of 6 ECL T NUED)., i ss s11C. for THE TOWN OF LOS ALTO$ HILLSJ Policy, r � w 221,* Ordinance r Law. Eip nt.. Coverage Included Outdoor Property lrsrl.nl tp pre rt Per ,,n•.I Pr r ),., ,. r Pr'r r ��. `r art ! .. .. w ... .. '�' Pr�l� rtt lnV5 r�n v l 000 Pres ry t1 n f Pr .r Days Property- f Others (applies only to, those premises provided Coverage B _ Business $21500_ Pr.nl P'rp'rt Signs 5 Val0able Papers , .n r tin- Premises 4101000, remises, $5.00 DEQ I I M 1 IA "w P,ER'POLICY , f,CO " LI I NINSURAC OF The . ,v. coarresponding limits .. below_ �ill ��� r ! , r • '' ' descri.Preas' In, these Tl rations, ... LIMIT OF INSURANCECOVERAGE L I n m Ani . r, . p ns t� l sI n ~ 1 11� nth §ECTION,I,l -,.LIABILITY- -1 LIMITO ! ... 1 Coverage L - Business Liabiiit$41000,000 Prepare SEP 28 2023 ! Copyright, State ertn I utLial Autornobile Insurdnne Company, 008 MP - Includes uop�yrighted material o Insurances Services Office, Inns with Its p�ermissioil, 001241 Continued on Next .Page Fags 4 Statehrm • " DECLARATIONS (CONTINUED) Businessowners Policy for THE TOWN OF LOS ALTOS HILLS, Policy Number 97 -EA -D221-9 Coverage M - Medical Expenses (Any One Person) - 0" Damage To Premises Rented To You AGGREGATE LIMITS s Products/Completed Operations Aggregate General Aggregate $5,000 $300,000 LIMIT OF INSURANCE $8,000,000 $8,000,000 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 -4101 Businessowners Coverage Form GMP -4860.1 *AI Design Person Org FE -6999.3 Terrorism Insurance Cov Notice CMP -4260.1 Amendatory Endorsement -CA CMP -4705.2 Loss of Income & Extra Expense CMP -4709 Money and Securities CMP -4804 Addl Insd Club Members CMP -4261 Amendatory Endorsement FD -6007 Inland Marine Attach Dec * New Form Attached Prepared SEP 28 2023 Cc Copyright, State Farm Mutual Automobile Insurance Company, 2008 CMP -4000 Includes copyrighted material of Insurance Services Office, Inc., with its permission. C 001242 290 Continued on Reverse Side of Page Page 5 of 6 N Statefarm • STATE FARM GENERAL INSURANCE COMPANY 11 A STOCK COMPANY WITH HOME OFFICES IN BLOOMINGTON, ILLINOIS INLAND MARINE ATTACHING DECLARATIONS P Box 2915 B oomrngton IL 61702-2915 Named Insured LOS ALTOS, LOS ALTOS HILLS NEWCOMERS CLUB ATTACHING INLAND MARINE Policy Number 97 -EA -D221-9 Policy Period Effective Date Expiration Date 12 Months MAY 17 2023 MAY 17 2024 The policy period begins and ends at 12:01 am standard time at the premises Tocation. 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 -8739 Inland Marine Conditions FE -6271 Amendatory Endorsement FE -8746 Inland Marine Computer Prop See Reverse for Schedule Page with Limits Prepared 2023 © Copyright, State Farm Mutual Automobile Insurance Company, 2008 SEP re SEP 2 7 Includes copyrighted material of Insurance Services Office, Inc., with its permission. FD -001243 538-686 a.2 05-31-2811 (o1f323: StateFarm 97 -EA -D221-9 001244 • ••o THIS ENDORSEMENT CHANGES THE POLICY PLEASE READ IT CAREFULLY CMP -4$60.1 ADDITIONAL INSURED — DESIGNATED PERSON OR ORGANIZATION VA. This endorsement modifies insurance provided under the following: BUSINESSOWNERS COVERAGE FORM SCHEDULE g Policy Number: 97 -EA -D221-9 b a Named Insured: LOS ALTOS, LOS ALTOS HILLS Name And Address Of Additional Insured Person Or Organization: THE TOWN OF LOS ALTOS HILLS, ITS ELECTIVE AND APPOINTED OFFICERS EMPLOYEES, AND VOLUNTEERS 26379 W FREMONT RD LOS ALTOS HLS CA 94022-2698 SECTION II — WHO IS AN INSURED of SECTION II — LIABILITY is amended to in- clude, as an additional insured, any person or organization shown in the Schedule, but only with respect to liability for "bodily injury", "property damage" or "personal and advertis- ing injury" caused, In whole or in part, by: a. Premises And Ongoing Operations Your acts or omissions or the acts or omissions of those acting on your behalf: (1) In connection with your premises, or (2) In the performance of your ongoing operations; or b. Products -Completed Operations "Your work" performed for that additional insured and included in the "products - completed operations hazard". However, Paragraph 1. above is subject to the following: a. The insurance afforded to the additional insured only applies to the extent permit- ted by law; CMP -4860.1 Page 1 of 2 b. If coverage provided to the additional in- sured is required by a contract or agree- ment, the insurance provided to the additional insured will not be broader than that which you are required by the con- tract or agreement to provide for such ad- ditional insured; and c. If the contract or agreement between you and the additional insured is governed by California Civil Code Section 2782 or 2782.05, the insurance provided to the additional insured is the lesser of that which: (1) Is allowed for the satisfaction of a de- fense or indemnity obligation by Cali- fornia Civil Code Section 2782 or 2782.05 for your sole liability; or (2) You are required by contract or agreement to provide for such addi- tional insured. We have no duty to defend or indemnify the additional insured under this endorsement un- til a claim or "suit" is tendered to us. ©, Copyright: State Farm Mutual Automobile Insurance Company, 2013 Includes copyrighted material of Insurance Services Office, Inc.; with its permission. CONTINUED 97'.'P1m-001244, I -4860.1 Page 2 of An insurance, r r e .the,.,additi 1.nal lr°� The r r 1 r r1.r' 1; 11' ' surod ill with N rro claim r damage rrsr1e �� made 'r suit °i'"���"'enoe .",occur. +ffens'e; ,which you are provided—coverage. T, nidor. the �d'efense,� and, indemnity. of a �" Ir: � 4 I��Xrr l 1 l r � r ' ll offer l � r- N yrs whIlay : nay 1 ,ins lr n r 1 30'.wit. red t to.the s rarer a r th a 'X � : ition l insured theW' P grey e r able other rr�s r LIMITMOF IN URANCE�. ''-th r rr r I # as 6 r '." . 0,onal # "M �""� + j �"k.SECTION y N�"'� . :r. N r' l l Nw'A iA �a' i i o a � 1 B ga the � se r damages. for which,would i ,� A +w yry'q'-'f�[°, :. ,X M � ®r edby coo M. rac •'�I+RF r. . a 'r 3�a. h AV's tl,�l'�'��" de u n 1 ' r SECTIO ' , ,' coverage, ' .. .. "' - :.. .. " '� Wi l l i � d i i r l' �. iI XI N wrlM 1 1�rof th''am insurance. _ A �,tt ith r X, 19X," CX 'l,+^ t h insurance r the ad Mr 1 r . ° e:° r r rorra : r , the o, win r lace ' Available under the oicae L.imits'Of TION-41 bf Par' graph 714 Other, `� "1 lns'ar nde sly r� in OD'olerati rl�.'LIABILITY � � 1 11 X, COMMON, I CONDITIONS: p�qX•/�M�y■y� ■�q��y� X( ,ty■�j�W'.@ ■■ }(�r�Yy+ ���{@ �WXYM" N�n T.q F Intl �:i I ^�M1"rt 4T��''rM' .�+✓'•� �Y' N M r r �: - r I■ N i Y"j �t l ra �' w i : aNi A P " i Ins ron s r�r r � n ill riot :. .. ,.Declarations..r r w y. ri r r r r other in' s r- .A available r the'additional in'sur y .. P additional'�r'�rr • r�X'ed, th at'" 1 rlrl rr�lr r .. ,.. .. Pa r ;� M 1 name,! in�surw. r r: � M l r lr sr- e of GENERAL y .� �rlr rr rpt between " IN r� l.ihs� r r.s. you. and: the additional insu red - this insur"M am see t it that w 'ire notified' as,,soon s notified, � �� �« � r other"insurance. r'�a1 �"'+) r rw eelr cess ex' on i off' ... - ,.. .+' -.. ■ r ,• rn 1 .. it .. X ■ ■ k': Y r l r p� r � h t 1` l nal r r� ,.s h. old ■(amu dh be add$;jn;'y`� ��!��Jy �(��yX7�, itioeN�y�p y■p�q�y■ e as e• r r nee. r ffent took • co,o M Np r�. - ' r gill e n re a rer l u rn Irk _ 1 rIn P (2),'The"hames and a r s n lr�� this jer !o rseni ee t rs•r� ll � , r j Xl � r� r�� �'�tn ani provisions� . ill � l �r oCMP74860! 1; $ • .0, Copyright.,8 tate Farm Mutual Aub Ire r� ed•r t rc l f Incur n r , ��rv� t �� p_ � �„, th it rn�isior�X s ,