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Home My WebLink AboutRogers, Lyn A 04.02.2024SWeFarly STATE FARM GENERAL INSURANCE COMPANV 11 A STOCK COMPANY WITH HOME OFFICES IN 13LOOMINGTON, ILLINOIS RENEWAL DECLARATIONS P Box 2915 0oniington IL 61702-2915 Addl Insured -Section 11 Only AT2 000309 3125M -02 -29F3 -FLOC F N THE TOWN OF LOS ALTOS HILLS ITS ELECTIVE AND APPOINTED Policy Number—, 97rEM-Y.197-7 Polcy Period Effective Date Expiration Date 12 Wths APR 2 2024 R 2 2026 Tho poli2y periodbeins and ends at 12:01 am standard time att e premises ovation. OFFICERS, M1v1rLUTMMa a VOLUNTEERS Named Insured 26379 W FREMONT RD ROOERS, LYN A LOS ALTOS HILLS CA 94022-2624 o Offide Policy Automatic Renewal - If the policy periodis shown as 12 Tenths, this policy will be re les and renewed automatically subject to the remiums,ru forms in effectfor each succeeding policy period. 'If this policy is terminated, we will give you and the Mortgagee/Lienholsler written notice in compliance with the policy provisions or as required by law. Entity: Individual NOTICE: Information concerning changes in your policy language is included. Please call your agent if you have any questions, POLICY PREMIUM Minimum Premium Discounts Applied: Renewal Year Years in Business Claim Record $ 325.00 Prepared .1 i JAN 19 2024 oqopyiight, State Farm Mutual Automobile hisurpiwo Company, 2008 CMP -4000 Includos copyrighted material of instiranc'o Services Office, Inc., with its permission, 001772 294 Al Continued on Reverse Side of Page N Page 1 of 7 530-000u.206-31-20111o1f32310 � SECT ON I. 1NELATI-0-N-COVERAGE INDEX ES - Cov A A Inflation Coverage Index: N/A Cov B - Consumer Price Index: 307.8 I AAW 001 ► I n 01 Basle Deductible $1,000 Special Deductibles. Money and Securities $250 Employee Dishonesty $250 Equipment Breakdown $1,000 Other deductibles may apply - refer to policy. Prepared - JAN 19 2024 CMP -4000 001772 c� Copyright, State Farm Mutual Automahile Insurance Company, 2009 Inoludes copyrighted material of Insurance Services Office, Inc., with its permission. Continued on Next Page Page 2 of 7 Location Location of Limit of Insurance* Limit of Insurance* Seasonal Number Described Increase - Promises Covera A - Coverage B - Business Build?negs Business orsonal- Personal Property Property 001 12853 NORMANDY LN No 00 'verage 1,300 25% LOS ALTOS MLS CA 94022-4649 As of.thi6';ff—eclive" po io , ffi'614WR of Insurance as shown includes any increase in the limit du date '5f'thiiFt—ol R I—aff6n—C&�erag 0. SECT ON I. 1NELATI-0-N-COVERAGE INDEX ES - Cov A A Inflation Coverage Index: N/A Cov B - Consumer Price Index: 307.8 I AAW 001 ► I n 01 Basle Deductible $1,000 Special Deductibles. Money and Securities $250 Employee Dishonesty $250 Equipment Breakdown $1,000 Other deductibles may apply - refer to policy. Prepared - JAN 19 2024 CMP -4000 001772 c� Copyright, State Farm Mutual Automahile Insurance Company, 2009 Inoludes copyrighted material of Insurance Services Office, Inc., with its permission. Continued on Next Page Page 2 of 7 StateFaren _ _ _ ❑ ®� RENEWAL DECLARATIONS (CONTINUED) Office Policy for THE TOWN OF Las ALTOS HILLS Policy Number 97 -EM -Yl 97.7 1 S CTIO ' I TEN IONS F C VERAGE - LIMIT OF'IN URANCE - EACH DES_ Ib D P E IS S 0 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, R but has "Included" indicated, please refer to that policy provision for ars explanation, of that coverage. , LIMIT,OF,. , COVERAGE INSURANCE Accounts Receivable On Premises $50,000 Off Premises $15,000. Arson Reward $5;0.00 Back -Up Of Sewer Or Drain ;$15100.0 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 Servioe 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 100/0; 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 JAN 19 2024 0 Copyright, State Farm Mutual AIItoinobile htstirance Company, 2008 CMP -4000 Includes copyrighted material of Insurance Services Office, Inc., with its permission, 001773 294 Continued on'Reverse Side of Page Page ,_3 of 7 N RENEWAL DECLARATIONS (CONTINUED) Office Policy for THE TOWN OF LOS - ALTOS HILLS m Polley Nuor 97 -EM -Y197.7 Ordinance Or Law - Equipment Coverage Included Outdoor Property $5,000 Personal Effects (applies only to those premises provided.Cove rage. B Rosiness $5'00Q Personal Property) Personal Property Off Premises, $16'000 Pollutant Clean Up And Removal $10,000 Preservation Of Property 30 Days Property Of Others (applies only to those premises provided Coverage 0 Business $2,500 Personal Property) signs $2,500 Unauthorized Business Card Use $5,000 Valuable Papers And Records On Promises $50,000 Off Promises $15,000 §EQj10N'.1-_EXTENE IONS OF COVERA_GE_-_LIMI_TiMV_SU86,N0 - PER POLICY The coverages and corresponding limits shown below are the most wq will pay regardless of the number 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 Prepared JAN 19 2024 OMP -4000 001773 LIMIT OF INSURANCE $5,000 $10,000 $10,000 Actual Loss Sustained - 12 Months 0 Copyright, State Farm Mutil al,Automobilo Iii6iifppoo Company, 2008 111olutlos oopyrighterl. in ate ri a I of I iisurnn a a Services offipp, Ino, with its permission, Continued on Next Page Page 4 of 7 Stateftm �a RENEWAL DECLARATIONS (CONTINUED) Office Policy for THE TOWN OF LOS ALTOS HILLS Policy Number 97 -EM -Y197-7 SECTION 11- LIABILITY LIMIT OF s COVERAGE INSURANCE Coverage L - Business Liability $1,000,000 Coverage M - Medical Expenses (Any One Person) $5,000 Damage To Premises Rented 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 weprovide during the applicable annual period. Please refer to Section I) 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 FE -6599.3 *Terrorism Insurance Cov Notice CMP -4815.1 Unauthorized Business Card Use CMP -4260.1 Amendatory Endorsement -CA CMP -4261 Amendatory Endorsement GMP -4705.2 Loss of Income & Extra Expense CMP -4710 Employee Dishonesty 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 Incur CMP -4713.1 Excl Testing Consulting E&O CMP -4795.1 Addl Insd Designated Premises Prepared JAN 19 2024 (0 Copyright, State Farm Mutual Automobile Insurcnce Company, 2008 CMP -4000 111CIL IGS copyrighted material of insurance Services Offiaa, Inc„ with its permission. 001774 294 Continued on Reverse Side of Page Page 5 of 7 N RENEWAL. DECLARATIONS (CONTINUED) Office Policyy for THE TOWN OF Los ALTOS MILLS Policy Num er 97 -EM -Yl 97-7 CMP -4786.1 Addl Insd Owners Lessee Sched CMP -4787 Waiver of "trans Rgt of Recov FD -6007 Inland Marine Attach Dec * New 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 this policy to be signed by its President and Secretary at Bloomington, Illinois, ec(ary' President IMPORTANT NOTICE: i California low requires ua 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 thls document: Another option Is to reach out by rnall or phone directly to: State FarO Exocutiye: Customer Service. PO Bo+x 2320 I Bloomington IL 131702 Phone # 1.800-STATEFARM (1.800-782.8332) 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 Sorvloos (Division 30o South Spring Street Los Angeles, CA 900.1 Phone #1 -800-927-HELP (8397) or visit ww.insu ance. a.. ov 01-c $ ars Prepared JAN 19 2024 0) Copyright, State Farm Mutual Automobile Insurance Company, 2008 CMP -4000 Includes copyrighted material of Insurance Services ,Office, (nc., with its permission. 001774 Continued on Next Page Page 6 of 7 StateFar►n '®®® RENEWAL DECLAMATIONS (CONTINUED) Office Policy for THE TOWN OF LOS ALTOS HILLS Policy Number 97 -EM -Y197-7 NOTICE TO POLICYHOLDER: O For a comprehensive description of coverages and farms, please refer to your policy. Policy changes requested before the "Date Prepared", which appear on this notice, are effective on the Renewal Date q 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 Form agent. Please keep this with your policy. Prepared JAN 19 2024 CMP -4000 001775 294 N @ Copyright, State Farm Mutual ALROMOhlle InSUranee Gomi7any, 2008 Includes copyrighted material of Insurance Services Office, Inc., with its permission, C Page '7 of 7 97 -EM -Y19747 001775 4tateFarnj A. STATE FARM GENERAL INSURANCE COMPANY El A STOCK COMPANY WITH HOME OFFICES IN BLOOMINGTON, ILLINOIS I,NLAND MARINE ATTACHING DECLARATIONS 9Foo'M0i`i'n'g't0'n'1L 61702-2915 Named Insured ROGERS, LYN A M-02-29F3-FBOC F N Policy Numbor 97 -EM -Y197-7 Pol cy Porlod Efloctivo Dato Expiration Date 12 Wths APR 2 2024 APR 2 2025 Tho polify period begins Qnd ends at 12:01 am standard tim p atte promises location. ATTACHING INLAND MARINE Automatic Ranowal - if the policy poriod is shown as 12 months, this policy will be renewed automatically subject to the premiums, rules and forms in effect for each succeeding policy period. If this policy is terminated, we will give you and the M ortga gee/Lien holder 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 subsequeritto the issuance of this policy. Forms, Options, and Endorsements FE -8739 Inland Marine Conditions FE -6271 Amendatory Endorsement FE -8745 Inland Marine Computer Prop See Reverse for Schedule Page with Limits Prepared JAN 19 2024 06 Copyright State Farm Mutual Automobile Insurance Compaq, 2008 FD -6007 InGlUdes copyrighted material of insurance Servicos'Offiop, Inc„ With its permission. 001776 630-633 u.2 66-31-2011 (032320 1 97-M-Y197e7 ATTACHING INLAND MARINE SCHEDULE PAGE ATTACHING INLAND MARINE ENDORSEMENT LIMIT OF DEDUCTIBLE ANNUAL NUMBER COVERAGE INSURANCE AMOUNT PREMIUM FE -8745 Inland Marine Computer Prop S 25,000 500 Included Lass of income and Extra Expense 25,000 Include d OTHER LIMITS AND EXCLUSIONS MAY APPLY - REFER TO YOUR POLICY Prepared JAN 19 2024 (0 Gopyright, State Farm MutuaIAutamobiIs Insurance Compeny,2000 FD -6007 Includes copyrighted material of Insurance Services Office, lna,with its permission. 001776 680-M u.2 05-31-20111003200