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Home My WebLink AboutRogers, Lyn A 04.02.2023SfateFarm STATE FARM GENERAL INSURANCE COMPANY A STOCK COMPANY WI`fHHOME OFFICES IN BLOOMINGTON, ILLINOIS RENEWAL DECLARATIONS oo"mofngt on ILon IL 61702.2915 Addl Insured -Section II Only AT2 001017 3126M-02-29F3-FBOC F N THE TOWN OF LOS ALTOS HILLS ITS ELECTIVE AND APPOINTED 7 Policy Number 97 -EM -Y197-7 . Policy Period Effective Date Ex�ppiration Date 12 Months APR 2 2023 APR 2 2024 The poli .y period be ins and ends at 17_:01 am standard time alle prernises ocatlon. OFFICERS, EMPLOYEES N VOLUNTEERS Named Insured ' 26379 W FREMONT RA ROOERS, LYN A LOS ALTOS HILLS CA 94022-2624 p ,Ilnr �inllnn�irll�IIIII�I��Iilhlililllllillll�ni��ilili�� w 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 bylaw. , Entity: Individual , NOTICE: Information concerning changes in your policy language is included. Please call your agent if you have any questions. POLICY PREMIUM $ 331.00 Prepared JAN 17 2023 n Gopyright, State Farm Mutual Automobile Insurance Company, 2008 CMP -4000 Includes copyrighted material of Insurance Services Office, Inc., with its permission. 006206 294 Al Continued on Reverse Side of Page Page 1 of 7 N 1 590.906 u.2 06-31.2011 (032310 RENEWAL DECLARATIONS (CONTINUED) office Polic or THE TOWN OF LOS ALTO HILLS Policy Num9jTO r 97-EIVl-Y197,-7 4CTION-1- -PROPERTY SCU.J.D.,,JL ....... --- Location Location of Limit of Insurance* Limit of Insurance* Seasonal Number, Described Increase - Promises Covers A - Coverage B ® Business Buildings Business orsonal' Personal Property Property 001 12853 NORMANDY LN No Coverage 1,200. 25% LOS ALTOS HLS CA 94022-4649 As of the effective date of this po icy, the Ilimit of Insurance as shown includes any increase in iWlimit dud C6Inflation —Oove rage. SEc'nON. 1-11NIFLATION CO +5iE IN DEVES) Coy A - Inflation Coverage Index: N/A Coy B - Consumer Price Index: 298.0 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 JAIN 17 2023 0 Copyright, State Form Mutual ALItOmobija Insurance Gornpany,2008 OMP -4000 Includes copyrighted material of Insurance Services Office, III c., with its permission. 006206 Continued on Next Page Page 2 of 7 StateFarm , • ®®' RENEWAL DECLARATIONS (CONTINUED) Office Policy for THE TOWN OF LOS ALTOS HILLS Policy Number 97 -EM -Y!97.7 Prepared JAN 17 2023 (0 Copyright, State Form Mutual Automobile Insurance Company, 2008 CMP -4000 Includes copyrighted material of Insurance Services Office, Inc., with its permission. 006207294 Continued on Reverse Side of Page N Page 3 of 7 SECTION I EXTENSIONS OF LIMIT OF INSURANCE - EACH DESCRIBED P EM ISE The coverages and corresponding lirnita shown below apply separately to each described premises shown In. these i Declarations, unless Indicated �y'"S ae Schedule." If a coverage does not have a corresponding limit shown below, { p 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 $15100Q 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 Urnit Debris Removal 25% of covered loss Equipment Breakdown included Fire Department Service Charge $5,000 Fire Extinguisher Systems Recharge Expense $5,000 j 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) l Money And Securities (Off Premises) $6,000 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 i Coverage B - Business Personal Property) Newly Acquired' Or Constructed buildings (applies only if this policy provides $250,000 { Coverage A - Buildings) Prepared JAN 17 2023 (0 Copyright, State Form Mutual Automobile Insurance Company, 2008 CMP -4000 Includes copyrighted material of Insurance Services Office, Inc., with its permission. 006207294 Continued on Reverse Side of Page N Page 3 of 7 RENEWAL DECLARATIONS: (CONTI NU ED) Office Polleg for THE TOWN OF LOS ALTOS HILLS Policy Num or 97 -EM -Y197-7 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 Promises $15,000 Pollutant Clean Up AndRemoval $10,000 Pr6servation Of Property 30 Days Property Of Others (applies only to those premises provided Coverage B - Business $2,500 Personal Property) Signs $2,600 Unauthorized Business Card Use $5,000 Valuable Papers And Records On Promise,*, $50,000 Off Promises $15,000 PEtTI0ftLn.F--)(T.E �-10AaDLQQXERAGE_--L M -j IT OF INSURANCE - PER POLI The coverages and corresponding limits shown below are the most we will pay rogardless of the nurhber of described promises 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 $6,000 110,000 Actual Loss Sustained 12 Months Prepared JAN 17 2023 Oc Copyright, State Farm Mutual Automobile Insurance Company, ooa CMP -4000 111CILides copyrighted material of Insurance Services Office, Inc,with its permission. 006207 Continued on Next Page Page 4 of 7 I' StateFarm ❑ • • • ® RENEWAL DECLARATIONS (CONTINUED) Office Polio for THE TOWN OF LOS ALTOS HILLS Policy Number 97-EM-YI97-7 E TIO II - LIABILITY n LIMIT OF n COVERAGE INSURANCE h n t» Coverage L - Business Liability $1,000,000 Coverage M - Medical Expenses (Any One Person) $5,000 Damage To Premises Dented To You $300,000 LIMIT OF AGGREGATE LIMITS INSURANCE Products/Completed Operations Aggregate $2,000,000 General Aggregate $2,000,000' Each paid claim for Liability Coverage reduces the amount of insurance we provide during the applicable annual period. Please refer to Section II - Liability in the Coverage Form and any attached endorsements. Your policy consists of these declarations, the BUSINESSOWNERS COVERAGE FORM shown below, and any other forms and endorsements that apply, including those shown below as well as those issued subsequent to the issuance of this policy. FOUMB 6ND.LN ORq FNT „ CMP -4101 Businessowners Coverage Form FE -6999,3 *Terrorism Insurance Cov Notice CMP -4319.1 Unauthorized Business Card Use CMP -4260.1 Amendatory Endorsement -CA CMP -4261 Amendatory Endorsement CMP -4705.2 Loss of Income & Extra Expense CMP -4710 Employee Dishonesty j CMP -4709 Money and Securities CMP -4698 Back -Up of Sewer or Drain CMP -4704.1 Dependent Prop Loss of Income CMP -4703.1 Utility Interruption Loss Inom CMP -4713.1 Excl Testing Consulting E&O CMP -4795.1 Addl insd Designated Premises Prepared JAN 17 2023 C� copyright, State rarirn Mtl$lel Automobile Insurance Company, 2008 CMP -4000 Includes copyrighted innterial'of Insurance Services Office, Inc., with its permission. 006208 294 Continued on Reverse Side of Page Page 5 of 7 N RENEWAL DECLARATIONS (CONTINUE?) Otifie &nolle for THE TOWN OF LOS ALTOS HILLS Policy Nuliltl r 97aEM-Y'197M7 CMP -4766.1 Addl Insd Owners Lessee Sched CMP -4787 Waiver of Trans Rgt of Recov FD -6007 Inland Marina Attach Dec * New Form Attached This policy is issued by the Stats Farm General Insurance Company, Participating Policy You are ontilled 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 this policy to be signed by its President and Secretary at !Bloomington, Illinois. Secretary President IMPORTANT NOTICE: Californle law requires us toarovide you with informatlon for filing complaints with the State Insurance Department regarding the coverage and service provldo3 under anis policy. Your -agent's name and contact Information are provided on the front of this; documonf. another option Is to reabhout by mail or phone directly to: Sloffe FarrrP Executive iCustomor Service 110, Box 2320 f3toomington IL 61702 Phone # 1-800-STATEFARM (1-000-1'82.6332) Department of Insurance complaints should be filed only after you and Mate Farm oryour agent or other company repwaontative have failed to reach a satisfactory agreement on a problem. Cath ornia Department of Insurance Cot omor Services Divlslon 300 Sotmt Spring Street Los Angeles, CA 90013 Phone# 1 -800 -927 -HELP (4357) or visitw'nsurance.ca.novl01-consumers Prepared JAN 17 L2023 (D Copyright, State Farm Mutual Autoinobile Inssirance Company, 2008 CMP -4000 Includes copyrighted material of Insurance Services Office, Ino„ with its permission. G0 4Jti Continued on Next Page Page 6 of 7 StateFarm AV RENEWAL DECLARATIONS (CONTINUED) Office Policy for THE TOWN OF LOBI ALTOS HILLS Policy Number 97 -EM -Y197-7 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. 0 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 JAN 17 2023 CMP -4000 006209 294 N Oc Copyright, State Form Mutual Automobile Insurance Company, 2000 Includes copyrighted material of Insurance Services Off ice, Inc., with its permission. Page 7 of 7 006209 StateFarin , -!W OW. STATE FARM GENERAL INSURANCE COMPANY A STOCK COMPANY WITH HQMI--- OFFICES IN BLOOMINGTON, iwNols INLAND MARINE ATTACHING DECLARATIONS 1P3?ooBm0fn2g?o'n51L 61702.2015 Named Insured M-02-29F3-FBOC F N ROOERS, LYN A Policy Period Effective, Date Epiration Date 12 Months APR 2 2023 A R 2 2024 The poli period be ins arid ends at 12:01 am standard time at e premises ocation. ATTACHING INLAND MARINE Automatic Ronewal - If the policy period Is shown as 12 inonths, 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. Annual Policy Proinium 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 subsequeritto the issuance of this policy. Forms, Options, and Endorsonionts FE -8739 Inland Marine Conditions FE -6271 Amendatory Endorsement FE -8745 Inland Marine Computer Prop See Reverse for Schedule Page, with Limits Prepared JAN 17 2023 OCopyright, State Farm Mutual Automobile Insurance Company, 2000 FD -6007 Includes copyrighted material of Insurance Services Office, Inc., with its permission. 006210 630-606 u.2 06-31-2011 fol f3232c) 97 -5M -Y197-7 ATTACHING INLAND MARINE SCHEDULE PAGE ATTACHING INLAND MARINE ENDORSEMENT LIMIT OF DEDUCTIBLE ANNUAL NUMBER COVERAGE INSURANCE AMOUNT PREMIUM FE -874.5 Inland Marine Computer Prop S 25,000 Boo Included Loss of Income and Extra Expense 25,000 Included OTHER LIMITS AND EXCLUSIONS MAY APPLY - REFER TO YOUR POLICY Prepared JAN 17 2023 0) Copyright, State Farm Mutual Automobile Insurance Company, 2008 FD 007 Include s copyrighted material Of Insurance Services Office, Ina, with its permission. -6 0062,10 520-5UU u.2 05-31-2011 1o113 OM