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HomeMy WebLinkAboutLos Altos Hills Newcomers Club 05.17.2025State Farm Insurance PO Box 2915 Bloomington, !L 61702-2915 AT2 001009 1200 01 THE TOWN OF LOS ALTOS HILLS, 1 M -W 26379 W FREMONT RD LOS ALTOS HLS CA 94022-2624 o� o� s o,II��II�e�ll�ll�l���lllil�l�ll�l��11��1��lll�'Illl'�II�IIIs111�1� O M State. Farm, State Farm General Insurance Company Policy number: 97-AP-AO55-3 Effective date: May 17, 2025 Policy period: 12 months Expiration date: May 17, 2026 The policy period begins and ends at 12:01 am standard time at the premises location. BUSINESSOWNERS POLICY Automatic renewal - If the State Farm® policy period 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 Mortgagee/Lienholder written notice in compliance with the policy provisions or as required by law. NAMED INSURED LOS ALTOS, LOS ALTOS HILLS NEW ENTITY Nonprofit POLICY PREMIUM This is not a bill. if an amount is due, then a separate statement will be sent prior to the due date. The premium(s) shown below is the 12 months premium(s) for the characteristics of the policy as described in this Declarations. Premium: $615.00 Total Premium: $615.00 Discounts applied: Business Experience Rating Renewal Discount Years in Business IMPORTANT MESSAGE(S) Notice - Information concerning changes in your policy language is included, Please call your agent if you have any questions. Policy number. 97-AP-AO55-3 © Copyright, State Farm Mutual Automobile Insurance Company, 2008 CMP Dec 3P CA CMP.4000 Prepared: February 26, 2025 Page 1 of 5 1009482 2012 153090 212 11-16-2024 11 SECTION I - PROPERTY SCHEDULE Location Location of described premises Limit of Insurance* Limit of Insurance* Seasonal Increase - number Coverage A - Coverage B - Business Business Personal Property Buildings Personal Property 001 13721 LA PALOMA RD No Coverage $2,100 25% LOS ALTOS HLS CA 94022-2639 * 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 Gov B - Consumer Price Index: 315.7 SECTION I — DEDUCTIBLES BASIC DEDUCTIBLE $500 SPECIAL DEDUCTIBLES: Equipment Breakdown: $500 Money and Securities: $250 Other deductibles may apply - refer to policy. SECTION I — EXTENSIONS OF COVERAGE - LIMITOF INSURANCE - EACH DESCRIBED PREMISES 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, but has `Included" indicated, refer to that policy provision for an explanation of that coverage. Coverage Limit of Insurance Accounts Receivable On Premises $10,000 Off Premises $5,000 Arson Reward $5,000 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 $2,500 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 insured on a 10% replacement cost basis) Money Orders and Counterfeit Money $1,000 Policy number. 97-AP-AO55-3 Page 2 of 5 © Copyright, State Farm Mutual Automobile Insurance Company, 2008 CMP -4000 I SECTION II - LOCATION SCHEDULE Location Location of described premises number 001 13721 LA PALOMA RD LOS ALTOS HLS CA 94022-2639 Policy number: 97-AP-AO55-3 Page 3 of 5 O Copyright, State Farm Mutual Automobile Insurance Company, 2008 CMP -4000 Coverage Limit of Insurance r Money and Securities On Premises $5,000 Off Premises $2,000 8� d o M Newly Acquired Business Personal Property (applies only if this policy provides Coverage B - Business $100,000 Personal Property) Newly Acquired or Constructed Buildings (applies only if this policy provides Coverage A - Buildings) $250,000 Ordinance or Law - Equipment Coverage Included Outdoor Property $5,000 Personal Effects (applies only to those premises provided Coverage B - Business Personal Property) $2,500 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 Personal Property) $2,500 Signs $2,500 Valuable Papers and Records On Premises $10,000 Off Premises $5,000 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 of Insurance Loss of Income and Extra Expense 12 Months Actual Loss Sustained SECTION II - LOCATION SCHEDULE Location Location of described premises number 001 13721 LA PALOMA RD LOS ALTOS HLS CA 94022-2639 Policy number: 97-AP-AO55-3 Page 3 of 5 O Copyright, State Farm Mutual Automobile Insurance Company, 2008 CMP -4000 Coverage Coverage L - Business Liability Per Occurrence Coverage M - Medical Expenses Damage to Premises Rented to You Aggregate Limits General Aggregate Products/Completed Operations Aggregate Limit of Insurance $4,000,000 $5,000 Any One Person $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 * CMP -4260.2 Amendatory Endorsement (California) * CMP -4587 Exclusion - Silica or Silica -Related Dust CMP -4705.2 Loss of Income and Extra Expense CMP -4709 Money and Securities CMP -4804 Additional Insured - Club Members * CMP -4860.2 Additional Insured - Designated Person or Organization FD -6007 Inland Marine Attaching Declarations FE -6999.3 Policyholder Disclosure Notice of Terrorism Insurance Coverage *New Form Attached SCHEDULE OF ADDITIONAL INTEREST(S) Interest type: Designated Person or Organization Endorsement number: CMP -4860.2 Loan number: N/A THE TOWN OF LOS ALTOS HILLS, ITS ELECTIVE AND APPOINTED OFFICERS, EMPLOYEES, AND VOLUNTEERS 26379 W Fremont Rd Los Altos Hls CA 94022-2624 FULL NAMED INSURED Named Insured: LOS ALTOS, LOS ALTOS HILLS NEWCOMERS CLUB Policy number: 97-AP-AO55-3 © Copyright, State Farm Mutual Automobile Insurance Company, 2008 CMP -4000 Page 4 of 5 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 o M at Bloomington, Illinois. cbaj- 1-�� President NOTICE TO POLICYHOLDER: kvt"� Secretary For a comprehensive description of coverage 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 beep this with your policy. Your coverage amount.... It is up to you to choose the coverage and limits that meet your needs. We recommend that you purchase a coverage limit equal to the estimated replacement cost of your structure, Replacement cost estimates are available from building contractors and replacement cost appraisers, or, your agent can provide an estimate from Xactware, Inc. using information you provide about your structure. State Farm does not guarantee that any estimate will be the actual future cost to rebuild your structure, Higher limits are available at higher premiums, Lower limits are also available, as long as the amount of coverage meets our underwriting requirements. We encourage you to periodically review your coverages and limits with your agent and to notify us of any changes or additions to your structure. Policy number: 97-AP-AO55-3 © Copyright, State Farm Mutual Automobile Insurance Company, 2008 CMP -4000 Page 5 of 5 a State Farm Insurance PO Box 2915 Bloomington, IL 61702-2915 THE TOWN OF LOS ALTOS HILLS, 1 26379 W FREMONT RD LOS ALTOS HLS CA 94022-2624 State Farm General Insurance Company Policy number: 97-AP-AO55-3 Effective date: May 17, 2025 Policy period: 12 months Expiration date: May 17, 2026 The policy period begins and ends at 12.01 am standard time at the premises location. ATTACHING INLAND MARINE. Automatic renewal - If the State Farm° policy period 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 Mortgagee/Llen 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. FULL NAMED INSURED Named Insured: LOS ALTOS, LOS ALTOS HILLS NEWCOMERS CLUB I 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 subsequent to the issuance of this policy. FORMS, OPTIONS AND ENDORSEMENTS FE -6271 Amendatory Endorsement (California) FE -8739 Inland Marine Conditions FE -8745 Inland Marine Computer Property Form See below for schedule page with limits ATTACHING INLAND MARINE SCHEDULE PAGE Endorsement Coverage Limit of insurance Deductible amount Annual premium number FE -8745 Inland Marine Computer Property Form $25,000 $500 Included Loss of Income and Extra Expense $25,000 Included Other limits and exclusions may apply - refer to your policy. Policy number, 97-AP-AO55-3 @ Copyright, State Farm Mutual Automobile Insurance Company, 2008 CIM Att Dec; 3P GA FD -6007 Page 1 of 1 1009481 2002 153039 202 03-06-2021 I CTIA IP -4860.2 Page 1 of 2 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE, READ IT CAREFULLY. LDDITIONAL INSURED' DESIGNATED PERSON, OR'ORGANIZATIO N 1"'his endorsement modifies insurance provided under the following-. BUSINESSOWNERS COVERAGE FORM U) c) cd SCHEDULE 3 PolicyNumbe ' 'r:' - 97 AP'A055, Named Insured: LOS ALTOS, LOS ALTOS HILLS NEWCOMERS CLUB 0 Name, And Address Of Additional, Insured: Pers' n Or Organization.,. THE TOWN OF LOS ALTOS HILLS, ITS ELECTIVE AND APPOINTEDOFFICERS,, EMPLOYE'ES, AND VOLUNTEERS 26379 W Fremont Rd Los Altos His CA 94022-2624 SECTION 11 —WHO IS AN INSURED 'of �SECTI.ON'11,-" LIABILITY is Omonded.to include,,- as'an additional insured, any person or organlzati on �,-shown �J n the.: Schedule but -only with, respect -to, Ii ability for 7"..bod illy injury",� "proper dame or or. ".Personal and ty, advertising injury" caused, in who -le or in part, by: a. - Premls'es,And ongoing o r tons Your acts or ornissions or the acts or.omissions of those acting on your behalf: (1.) In connection with your premises; orL1 (2). In the performance of your ongoing operations; or . b fro Operations Your work". performed f r.tht additional insured and includedin the !'products -completed operations hazard", However,' Paragraph 1 r above is subject to,ithio following: Tire insurano' afforded to, the additional insured onlyto th extent permitted by Ie applies e aw; dA If coverage provided to the additional insured is required by a contract or agreement, the insurance provided to the additional ............ -insured --- will_ not be- broader .than that- which- -you -are required -.by. th -con-tract or- agree-ment to -provide. for. such additional insur * ed; and 0. 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 defense or indemnity obligation by California Civil Code, Section 2782 or 27 82.,05 for your sole liability; or (2) You are required by contract or agreement to provide for such additional insured. We have no duty to defend or indemnify the additional insured under this endorsement until a claim or "suit" is tendered to us, 2. Any insurance provided to the additional insured shall only apply with respect. to a claim made or a "suit" brought for damages for which you are provided coverage. GMP.460-2 @1, Copyright-,' State Farm M*ut'ual Automobile Insurance Company, 2018 Includes copyrighted material of Insurance Services Office, Inc., with its permission. OMP -48602 Q,Copyright, State Farrn WtUal Automobi.le 1n umace C bmpan , .2018 Includes copyrighted material of lhsuran � Services. -Office,' Inc., with it .p errnl lon.