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Home My WebLink About20203283.tiff.,IaIvrarru O EYQ s I A i t rAF(M rmt ANu IAsUAL I Y COMPANY A STOCK COMPANY WITH HOME OFFICES IN BLOOMINGTON, ILLINOIS DECLARATIONS COVERAGE SUMMARY OCT 19 2020 s 0 t Ms Pp �ox 853925 R,c ardson, 75085-3925 Addl Insured -Section II Only M-26-2095-FB29 F U 003069 3123 WLED COUNTY ASSESSOR 1400 7TH AVE # NN GREELEY CO 80631-4134 II111'IIII11111111111Ii•ii11111111111111111111"111111111111 111" Office Policy Policy Number 96 -B8 -E546-2 Policy Period Effective Date Expiration Date 12 Months AUG 15 2020 AUG 15 2021 The policy period begins and ends at 12:01 am standard time atthe premisesTocation. Named Insured MARTINDALE CONSULTANTS INC 4242 N MERIDIAN AVE OKLAHOMA CITY OK 73112-2457 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 MortgageefLienholder written notice in compliance with the policy provisions or as required by law. Entity: Corporation Requested By: Policyholder Policy Premium $ 1,912.00 Discounts Applied: Renewal Year Protective Devices Sprinkler Claim Record CoMMon:GQ.+;snS 1110c1/20 Prepared OCT 19 2020 CMP-4000 028789 290 Al RECEIVED OCT 3 0 2020 WELD COUNTY ASSESSOR GREELEY, COLORADO 2020-3283 ECOQ5 © Copyright, State Farm Mutual Automobile Insurance Company, 2008 Includes copyrighted material of Insurance Services Office, Inc., with its permission, Continued on Reverse Side of Page Page 1 of 7 DECLARATIONS (CONTINUED) Office Policy for WLED COUNTY ASSESSOR Policy Number 96 -B8 -E546-2 SECTION I - PROPERTY SCHEDULE Location Location of Limit of Insurance* Limit of Insurance* Seasonal Number Described Increase - Premises Coverage A - Coverage B - Business Buildings Business Personal Personal Property Property 001 4242 N MERIDIAN AVE No Coverage $ 500,000 25% OKLAHOMA CITY OK 73112-2457 002 4853 S SHERIDAN RD STE 600 No Coverage $ 5,000 25% TULSA OK 74145-5720 * 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 INDEXES) Coy A - Inflation Coverage Index: N/A Cov B - Consumer Price Index: 259.9 SECTION I - DEDUCTIBLES Basic Deductible Special Deductibles: Money and Securities Prepared OCT 19 2020 CMP-4000 028789 $5,000 $250 Employee Dishonesty $250 © Copyright, State Farm Mutual Automobile Insurance Company, 2008 Includes copyrighted material of Insurance Services Office, Inc., with its permission. Continued on Next Page Page 2 of 7 .IiMWI %II III DECLARATIONS (CONTINUED) u Office Policy for WLED COUNTY ASSESSOR Policy Number 96 -B8 -E546-2 Equipment Breakdown $2,500 Other deductibles may apply - refer to policy. g SECTION I - EXTENSIONS OF COVERAGE - LIMIT OF INSURANCE - EACH DESCRIBED PREMISES wo 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, please refer to that policy provision for an explanation of that coverage. COVERAGE Accounts Receivable On Premises Off Premises Arson Reward Back -Up Of Sewer Or Drain Collapse Damage To Non -Owned Buildings From Theft, Burglary Or Robbery Debris Removal Equipment Breakdown Fire Department Service Charge Fire Extinguisher Systems Recharge Expense Forgery Or Alteration Glass Expenses Increased Cost Of Construction And Demolition Costs (applies only when buildings are insured on a replacement cost basis) Money And Securities (Off Premises) Money And Securities (On Premises) Money Orders And Counterfeit Money Prepared OCT 19 2020 CMP-4000 028790 290 N © Copyright, State Farm Mutual Automobile Insurance Company, 2008 Includes copyrighted material of Insurance Services Office, Inc., with its permission. LIMIT OF INSURANCE See Schedule See Schedule $5,000 See Schedule Included Coverage B Limit 25% of covered loss Included $5,000 $5,000 $10,000 Included 10% See Schedule See Schedule $1,000 Continued on Reverse Side of Page Page 3 of 7 DECLARATIONS (CONTINUED) Office Policy for WLED COUNTY ASSESSOR Policy Number 96 -B8 -E546-2 Newly Acquired Business Personal Property (applies only if this policy provides Coverage B - Business Personal Property) Newly Acquired Or Constructed Buildings (applies only if this policy provides Coverage A - Buildings) Ordinance Or Law - Equipment Coverage Outdoor Property Personal Effects (applies only to those premises provided Coverage B - Business Personal Property) Personal Property Off Premises Pollutant Clean Up And Removal Preservation Of Property Property Of Others (applies only to those premises provided Coverage B - Business Personal Property) Signs Unauthorized Business Card Use Valuable Papers And Records On Premises Off Premises Water Damage, Other Liquids, Powder Or Molten Material Damage SECTION I - EXTENSIONS OF COVERAGE - LIMIT OF INSURANCE - SCHEDULE $100,000 $250,000 Included See Schedule $5,000 $15,000 $10,000 30 Days See Schedule See Schedule $5,000 See Schedule See Schedule Included The coverages and corresponding limits shown below apply only to the described premises as shown. LOCATION COVERAGE LIMIT OF INSURANCE 0001 Signs $2,500 Back -Up Of Sewer Or Drain $15,000 Money And Securities (On Premises) $10,000 Money And Securities (Off Premises) $5,000 Property Of Others (applies only to those premises provided Coverage B - Business $2,500 Personal Property) Accounts Receivable (On Premises) $50,000 Accounts Receivable (Off Premises) $15,000 Prepared OCT 19 2020 CMP-4000 028790 ® Copyright, State Farm Mutual Automobile Insurance Company, 2008 Includes copyrighted material of Insurance Services Office, Inc., with its permission. Continued on Next Page Page 4 of 7 JLa'rrarn► u S th o 00 DECLARATIONS (CONTINUED) Office Policy for WLED COUNTY ASSESSOR Policy Number 96 -B8 -E546-2 Outdoor Property $5,000 Valuable Papers and Records (On Premises) $50,000 Valuable Papers and Records (Off Premises) $15,000 0002 Signs $2,500 Back -Up Of Sewer Or Drain $15,000 Money And Securities (On Premises) $10,000 Money And Securities (Off Premises) $5,000 Property Of Others (applies only to those premises provided Coverage B - Business $2,500 Personal Property) Accounts Receivable (On Premises) $50,000 Accounts Receivable (Off Premises) $15,000 Outdoor Property $5,000 Valuable Papers and Records (On Premises) $50,000 Valuable Papers and Records (Off Premises) $15,000 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 Dependent Property - Loss Of Income Employee Dishonesty Utility Interruption - Loss Of Income Loss Of Income And Extra Expense SECTION II - LIABILITY LIMIT OF INSURANCE $5,000 $10,000 $10,000 Actual Loss Sustained - 12 Months COVERAGE Coverage L - Business Liability Prepared OCT 19 2020 CMP-4000 028791 290 LIMIT OF INSURANCE $1,000,000 © Copyright, State Farm Mutual Automobile Insurance Company, 2008 Includes copyrighted material of Insurance Services Office, Inc., with its permission. Continued on Reverse Side of Page Page 5 of 7 DECLARATIONS (CONTINUED) Office Policy for WLED COUNTY ASSESSOR Policy Number 96 -B8 -E546-2 Coverage M - Medical Expenses (Any One Person) Damage To Premises Rented To You AGGREGATE LIMITS Products/Completed Operations Aggregate General Aggregate $10,000 $300,000 LIMIT OF INSURANCE $2,000,000 $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. FORMS AND ENDORSEMENTS CMP-4100 Businessowners Coverage Form CMP-4561.1 Policy Endorsement CMP-4236.1 Amendatory Endorsement CMP-4574 Legal Action Against Us CMP-4705.2 Loss of Income & Extra Expnse CMP-4710 Employee Dishonesty CMP-4746.1 Hired Auto Liability CMP-4819.1 Unauthorized Business Card Use CMP-4706 Back -Up of Sewer or Drain CMP-4704.1 Dependent Prop Loss of Income CMP-4709 Money and Securities CMP-4703.1 Utility Interruption Loss Incm FE -6999.2 Terrorism Insurance Coy Notice FE -3650 Actual Cash Value Endorsement CMP-4786 Addl Insd Owners Lessee Sched CMP-4788 Addl Insd Mgrs Lessor of Prem FD -6007 Inland Marine Attach Dec Prepared OCT 19 2020 CMP-4000 028791 © Copyright, State Farm Mutual Automobile Insurance Company, 2008 Includes copyrighted material of Insurance Services Office, Inc., with its permission. Continued on Next Page Page 6 of 7 Jaaecrai III A® DECLARATIONS (CONTINUED) u 0 0 0 th F- 0 fl)o Office Policy for WLED COUNTY ASSESSOR Policy Number 96 -B8 -E546-2 This policy is issued by the State Farm Fire and Casualty 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 Fire and Casualty Company has caused this policy to be signed by its President and Secretary at Bloomington, Illinois. )11 Secretary President Note: For your protection, the law of your state requires the following to appear on this form: WARNING: Any person who knowingly, and with intent to injure, defraud or deceive any insurer, makes any claim for the proceeds of an insurance policy containing any false, incomplete or misleading information is guilty of a felony. Prepared OCT 19 2020 CMP-4000 028792 290 N © Copyright, State Farm Mutual Automobile Insurance Company, 2008 Includes copyrighted material of Insurance Services Office, Inc., with its permission. Page 7 of 7 3raretarm STATE FARM FIRE AND CASUALTY COMPANY A STOCK COMPANY WITH HOME OFFICES IN BLOOMINGTON, C7 C>' D ILLINOIS INLAND MARINE ATTACHING DECLARATIONSu S 0 0 th P25. Richardson,ixBox 75085-3925 Named Insured M-26-2095-FB29 F U MARTINDALE CONSULTANTS INC 4242 N MERIDIAN AVE OKLAHOMA CITY OK 73112-2457 ATTACHING INLAND MARINE Policy Number 96 -B8 -E546-2 Policy Period Effective Date Expiration Date 12 Months AUG 15 2020 AUG 15 2021 The polipy period begins and ends at 12:01 am standard time atthe 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 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 Premium $ 240.00 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 -8743.1 FE -8739 FE -8256 Inland Marine Computer Prop Inland Marine Conditions Amendatory Endorsement See Reverse for Schedule Page with Limits Prepared OCT 19 2020 FD -6007 028793 © Copyright, State Farm Mutual Automobile Insurance Company, 2008 Includes copyrighted material of Insurance Services Office, Inc., with its permission. 530-5866.2 05-31-2011 (o113232c av-ov-GJYV-L ATTACHING INLAND MARINE SCHEDULE PAGE ATTACHING INLAND MARINE ENDORSEMENT NUMBER COVERAGE FE -8743.1 Inland Marine Computer Prop Loss of Income and Extra Expense Prepared OCT 19 2020 FD -6007 028793 LIMIT OF DEDUCTIBLE ANNUAL INSURANCE AMOUNT PREMIUM $ 50,000 $ 500 $ 240.00 $ 25,000 Included OTHER LIMITS AND EXCLUSIONS MAY APPLY - REFER TO YOUR POLICY © Copyright, State Farm Mutual Automobile Insurance Company, 2008 Includes copyrighted material of Insurance Services Office, Inc., with its permission. 538-686 6.2 85-31-2811 Io113233c1 JiaLarann 96 -B8 -E546-2 0 028794 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. CMP-4786 U Page 1 of 1 CMP-4786 ADDITIONAL INSURED - OWNERS, LESSEES, OR CONTRACTORS (Scheduled) This endorsement modifies insurance provided under the following: BUSINESSOWNERS COVERAGE FORM SCHEDULE Policy Number: 96-68-E546-2 Named Insured: MARTINDALE CONSULTANTS INC 4242 N MERIDIAN AVE OKLAHOMA CITY OK 73112-2457 Name And Address Of Additional Insured Person Or Organization: WLED COUNTY ASSESSOR 1400 7TH AVE # NN GREELEY CO 80631-4134 1. 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 inju- ry", "property damage", or "personal and ad- vertising injury" caused, in whole or in part, by: a. Ongoing Operations (1) Your acts or omissions; or (2) The acts or omissions of those acting on your behalf; in the performance of your ongoing opera- tions for that additional insured; or CM P-4786 ©, Copyright, State Farm Mutual Includes copyrighted material of Insure b. Products -Completed Operations "Your work" performed for that additional insured and included in the "products - completed operations hazard". 2. Any insurance provided to the additional in- sured shall only apply with respect to a claim made or a "suit" brought for damages for which you are provided coverage. 3. Primary Insurance. The insurance afforded the additional insured shall be primary insur- ance. Any insurance carried by the additional insured shall be noncontributory with respect to coverage provided by you. There will be no refund of premium in the event this endorsement is cancelled. All other policy provisions apply. Automobile Insurance Company, 2008 rice Services Office, Inc., with its permission. 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