StateFarm STATE dHl> A STOCK COMPANY Boxfourseasonshoa.net/images/Insurance_Declarations_2016.pdf · Dallas,TX 75379-9100 Named Insured dHl> RENEWAL DECLARATIONS Policy Number 97-BX-B223-1
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□StateFarm STATE FARM FIRE AND CASUALTY COMPANYA STOCK COMPANY WITH HOME OFFICES IN BLOOMINGTON, ILLINOIS
P.O. Box 799100Dallas, TX 75379-9100
Named Insured
dHl> RENEWAL DECLARATIONS
97-BX-B223-1Policy Number
Effective DateDEC 1 2015
Expiration DateDEC 1 2016
Policy Period12 MonthsThe policy period begins and ends at 12:01 am standardtime atthe premises location.
J-15-9E74-FAE0 F VAT2002099 3125
FOUR SEASONS HOMEOWNERSASSOCIATIONP0 BOX 2105BEAVERTON OR 97075-2105 Agent and Mailing Address
SCOTT BRENNAN14475 SW ALLEN BLVD STE CBEAVERTON OR 97005-4418
Residential Community Association PolicyAutomatic Renewal - If the policy period is shown as 12 months , this policy will be renewed automatically subjectto the premiums, rules andforms in effect for each succeeding policy period. If this policy is terminated, we will give you and the Mortgagee/Lienholder written notice incompliance with the policy provisions or as required by law.
Entity: Corporation
NOTICE: Information concerning changes in your policy language is included. Please call your agentif you have any questions.
□StateFam M 12899A>,- RENEWAL DECLARATIONS (CONTINUED)
Residential Community Association Policy tor FOUR SEASONS HOMEOWNERSPolicy Number 97-BX-B223-1
SECTION I - DEDUCTIBLES
$1,000Basic Deductible
Special Deductibles:
Money and SecuritiesEquipment Breakdown
$
$250$250$1,000
Employee Dishonesty
Other deductibles may apply - refer to policy.
SECTION I - EXTENSIONS OF COVERAGE ■ LIMIT OF INSURANCE - EACH DESCRIBED PREMISES
The coverages and corresponding limits shown below apply separately to each described premises shown in theseDeclarations, 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.
LIMIT OFINSURANCE
Included
Coverage B Limit
25% of covered loss
Included
$5,000
$5,000
Included
10%
COVERAGE
Collapse
Damage To Non-Owned Buildings From Theft, Burglary Or Robbery
Debris Removal
Equipment Breakdown
Fire Department Service Charge
Fire Extinguisher Systems Recharge Expense
Glass Expenses
Increased Cost Of Construction And Demolition Costs (applies only when buildings areinsured on a replacement cost basis)
Newly Acquired Business Personal Property (applies only if this policy providesCoverage B - Business Personal Property)
Newly Acquired Or Constructed Buildings (applies only if this policy providesCoverage A - Buildings)
Residential Community Association Policy for FOUR SEASONS HOMEOWNERSPolicy Number 97-BX-B223-1
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 ofdescribed premises shown in these Declarations.i
§
LIMIT OFINSURANCECOVERAGE
IncludedBack-Up of Sewer or Drain
Employee Dishonesty
Loss Of Income And Extra Expense
$100,000
Actual Loss Sustained - 12 Months
SECTION II - LIABILITY
LIMIT OFINSURANCECOVERAGE
$1,000,000
$10,000
$300,000
$2,000,000
LIMIT OFINSURANCE
$2,000,000
$2,000,000
$2,000,000
Coverage L - Business Liability
Coverage M - Medical Expenses (Any One Person)
Damage To Premises Rented To You
Directors And Officers Liability
AGGREGATE LIMITS
Products/Completed Operations Aggregate
General Aggregate
Directors and Officers Aggregate
Each paid claim for Liability Coverage reduces the amount of insurance we provide during the applicableannual period. Please refer to Section II - Liability in the Coverage Form and any attached endorsements.
RENEWAL DECLARATIONS (CONTINUED)Residential Community Association Policy for FOUR SEASONS HOMEOWNERSPolicy Number 97-BX-B223-1
Your policy consists of these Declarations, the BUSINESSOWNERS COVERAGE FORM shown below, and any otherforms and endorsements that apply, including those shown below as well as those issued subsequent to theissuance of this policy.
Businessowners Coverage Form•"Terrorism Insurance Cov NoticeResidential Community AssocHired Auto LiabilityAmendatory EndorsementLoss of Income & Extra ExposeMoney and SecuritiesDirectors & Officers LiabilityEmployee DishonestyInland Marine Attach Dec* New Form Attached
This policy is issued by the State Farm Fire and Casually Company.
Participating Policy
You are entitled to participate In a distribution of the earnings of the company as determined by our Board of Directors inaccordance 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 andSecretary at Bloomington, Illinois.
□StateFarm M 12899A RENEWAL DECLARATIONS (CONTINUED)
Residential Community Association Policy for FOUR SEASONS HOMEOWNERS97-BX-B223-1Policy Number
$
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.Policy changes requested after the "Date Prepared” will be sent to youyour 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 anyquestions about your insurance coverage, contact your State Farm agent.
as an amended declarations or as an endorsement to
Please keep 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 limitequal to the estimated replacement cost of your structure. Replacement cost estimates are available from building contractorsand replacement cost appraisers, or, your agent can provide an estimate from Xactware, Incfusing information you provideabout your structure. We can accept the type of estimate you choose as long as it provides a reasonable level of detail aboutyour structure. State Farmÿdoes not guarantee that any estimate will be the actual future cost to rebuild your structure. Higherlimits are available at higher premiums. Lower limits are also available, as long as the amount of coverage meets ourunderwriting requirements. We encourage you to periodically review your coverages and limits with your agent and to notify usof any changes or additions to your structure.
□StateFarm STATE FARM FIRE AND CASUALTY COMPANYA STOCK COMPANY WITH HOME OFFICES IN BLOOMINGTON, ILLINOIS
Dal!as0fx975379-9100
INLAND MARINE ATTACHING DECLARATIONSdH§L97-BX-B223-1Policy Number
Expiration DateDEC 1 2016
am standard
Effective DateDEC 1 2015
Policy Period12 MonthsThe policy period begins and ends at 12:01time at the premises location.
J-15-9E74-FAE0 F V
Named Insured
FOUR SEASONS HOMEOWNERSASSOCIATIONP0 BOX 2105BEAVERTON OR 97075-2105
1A'-OubI
ATTACHING INLAND MARINEAutomatic Renewal - If the policy period is shown as 12 months , this policy will be renewed automatically subjectto the premiums, rules andforms in effectfor each succeeding policy period. If this policy is terminated, we will give you and the Mortgagee/Lienholder written notice incompliance with the policy provisions or as required by law.
Annual Policy Premium 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 thatapply, including those shown below as well as those issued subsequentto the issuance of this policy.
Forms, Options, and Endorsements
Inland Marine ConditionsAmend of Inland Marine CondtnsInland Marine Computer Prop
In accordance with the Terrorism Risk Insurance Act of 2002 as amended and extended by the TerrorismRisk Insurance Program Reauthorization Act of 2015, this disclosure is part of your policy.
FE-6999.2 POLICYHOLDER DISCLOSURE NOTICE OF TERRORISM INSURANCE COVERAGEm ry 1, 2017; 82% beginning on January 1,81% beginning on January 1, 2019; and
;Coverage for acts of terrorism is not excludedfrom your current policy. However your policydoes contain other exclusions which may be ap¬plicable,You areRisk Insurance Act, as amended in 2015, the def¬inition of act of terrorism has changed. As definedin Section 102(1) of the Act: The term "act of ter¬rorism" means any act that is certified by the Sec¬retary of the Treasury— in consultation with theSecretary of Homeland Security, and the AttorneyGeneral of the United States— -to be an act of ter¬rorism; to be a violent act or an act that is dan¬gerous to human life, property, or infrastructure;to have resulted in damage within the UnitedStates, or outside the United States in the case ofcertain air carriers or vessels or the premises of aUnited States mission; and to have been commit¬ted by an individual or individuals as part of aneffort to coerce the civilian population of the UnitedStates or to influence the policy or affect the con¬duct of the United States Government by coer¬cion. Under this policy, any covered lossesresulting from certified acts of terrorism may bepartially reimbursed by the United States Gov¬ernment under a formula established by the Ter¬rorism Risk Insurance Act, as amended. Underthe formula, the United States Governmentgenerally reimburses 85% through 2015; 84%beginning on January 1, 2016; 83% beginning onFE-6999.2
Janua2018;80% beginning on January 1, 2020 of coveredterrorism losses exceeding the statutorily estab¬lished deductible paid by the insurance companyproviding the coverage. The Terrorism Risk insur¬ance Act, as amended, contains a $100 billioncap that limits U.S. Government reimbursementas well as insurers’ liability for losses resultingfrom certified acts of terrorism when the amountof such losses exceeds $100 billion in any onecalendar year. If the aggregate insured losses forall insurers exceed $100 billion, your coveragemay be reduced.There is no separate premium charged to coverinsured losses caused by terrorism. Your insur¬ance policy establishes the coverage that existsfor insured losses. This notice does not expandcoverage beyond that described in your policy.THIS IS YOUR NOTIFICATION THAT UNDERTHE TERRORISM RISK INSURANCE ACT, ASAMENDED, ANY LOSSES RESULTING FROMCERTIFIED ACTS OF TERRORISM UNDERYOUR POLICY MAY BE PARTIALLY REIM¬BURSED BY THE UNITED STATES GOVERN¬MENT AND MAY BE SUBJECT TO A $100BILLION CAP THAT MAY REDUCE YOUR COV¬ERAGE.
! such as an exclusion for nuclear hazard.hereby notified that under the Terrorism
COMMERCIAL LIABILITY UMBRELLA POLICYAutomatic Renewal - If the policy period is shown as 12 months, this policy will be renewed automatically upon payment ofthe renewal premium when due subject to the premiums, rules and forms in effect for each succeeding policy period. If thispolicy is terminated we will give you written notice in compliance with the policy provisions or as required by law.
Limits of Insurance$ 4,000,000$ 4,000,000
Coverage(s)Coverage L - Business Liability (Each Occurrence)Coverage L - Business Liability (Annual Aggregate)
Your policy consists of these Declarations, the Commercial Liability Umbrella Coverage Form, and any other forms andendorsements that apply.
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 inaccordance 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 andSecretary at Bloomington, Illinois.
In accordance with the Terrorism Risk Insurance Act of 2002 as amended and extended by the TerrorismRisk Insurance Program Reauthorization Act of 2015, this disclosure is part of your policy.
FE-6999.2 POLICYHOLDER DISCLOSURE NOTICE OF TERRORISM INSURANCE COVERAGE
Coverage for acts of terrorism is not excludedfrom your current policy. However your policydoes contain other exclusions which may be ap¬plicable, such as an exclusion for nuclear hazard.You are hereby notified that under the TerrorismRisk Insurance Act, as amended in 2015, the def¬inition of act of terrorism has changed. As definedin Section 102(1) of the Act: The term "act of ter¬rorism” means any act that is certified by the Sec¬retary of the Treasury— in consultation with theSecretary of Homeland Security, and the AttorneyGeneral of the United States— to be an act of ter¬rorism; to be a violent act or an act that is dan¬gerous to human life, property, or infrastructure;to have resulted in damage within the UnitedStates, or outside the United States in the case ofcertain air carriers or vessels or the premises of aUnited States mission; and to have been commit¬ted by an individual or individuals as part of aneffort to coerce the civilian population of the UnitedStates or to influence the policy or affect the con¬duct of the United States Government by coer¬cion. Under this policy, any covered lossesresulting from certified acts of terrorism may bepartially reimbursed by the United States Gov¬ernment under a formula established by the Ter¬rorism Risk Insurance Act, as amended. Underthe formula, the United States Governmentgenerally reimburses 85% through 2015; 84%beginning on January 1, 2016; 83% beginning onFE-6999.2
January 1, 2017; 82% beginning on January 1,2018; 81% beginning on January 1, 2019; and80% beginning on January 1, 2020 of coveredterrorism losses exceeding the statutorily estab¬lished deductible paid by the insurance companyproviding the coverage. The Terrorism Risk Insur¬ance Act, as amended, contains a $100 billioncap that limits U.S. Government reimbursementas well as insurers' liability for losses resultingfrom certified acts of terrorism when the amountof such losses exceeds $100 billion in any onecalendar year. If the aggregate insured losses forall insurers exceed $100 billion, your coveragemay be reduced.There is no separate premium charged to coverinsured losses caused by terrorism. Your insur¬ance policy establishes the coverage that existsfor insured losses. This notice does not expandcoverage beyond that described in your policy.THIS IS YOUR NOTIFICATION THAT UNDERTHE TERRORISM RISK INSURANCE ACT, ASAMENDED, ANY LOSSES RESULTING FROMCERTIFIED ACTS OF TERRORISM UNDERYOUR POLICY MAY BE PARTIALLY REIM¬BURSED BY THE UNITED STATES GOVERN¬MENT AND MAY BE SUBJECT TO A $100BILLION CAP THAT MAY REDUCE YOUR COV¬ERAGE.