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Audrey E. Taylor Cert. of Insurance Q`O® DATE OF NOTICE: AUG 09 2023 PO Box 2368 Bloomington IL 61702-2368 CODE: 69A AT1 12 A ooioaa oosa NOTE: PLEASE NOTIFY STATE FARM AT THE CITY OF CAMPBELL ISAOA 70 N 1ST ST ADDRESS LISTED AT THE TOP, LEFT CORNER CAMPBELL CA 95008-1459 OF THIS PAGE REGARDING ANY CHANGE OF ADDRESS INFORMATION. ililiillilll'lllulilill�plldlil'llhd'I'lIlllliphphlll 0 0 0 9 F= • • 0 0 AQITOAL INSilRE�'SlC'j"E'IE Z?F.CtTVERAGE . State Farm Mutual Automobile Insurance Company 1066-FA96-A • .. NAMED INSURED: POLICY NO:• 458 1212-E30-55X COVERAGE: - TAYLOR,AUDREY E YR/MAKE/MODEL: 2008'LINCOLN SPORT WG BI AND PD LIABILITY b 2550 LAKEWEST DR STE 10 VIN/CAMPER: 2LMDU88C08BJ38537 $1 MIL N CHICO CA 95928-8419 AGENT NAME: JONI GINNO INS AGENCY INC COMPREHENSIVE $1000 DED.COLL. AGENT PHONE: (530)891-5881 ENDORSEMENT NO: 6028BU POLICY EFFECTIVE JUL 13 2023 UNTIL TERMINATED v,• POLICY MESSAGES: This policy shown above supersedes policy#4581212-55W. m The policy includes a loss payable clause protecting the additional insured's interest in the described car to the extent of the insurance b provided and subject to all policy provisions.The additional insured will be given 20 days notice if the policy is terminated. Until such notice 01 is provided,it shall be presumed that the required renewal premiums have been paid. The additional insured must notify us within 10 days of i; any change of interest or ownership coming to their attention. Failure to do so will render this policy null and void. 0 FRT waretarm STATE FARM' O'D DATE OF NOTICE: AUG 10 2023 PO Box 2368 CODE: Bloomington IL 61702-2368 50A AT1 12 A 001031 0093 N E 1LT ST NOTE: PLEASE NOTIFY STATE FARM AT THE 70CITY CAS CAMPBELL ISAOA ADDRESS LISTED AT THE TOP, LEFT CORNER prN OF THIS PAGE REGARDING ANY CHANGE OF CAMPBELL 95008-1459 ADDRESS INFORMATION. I�'III'�IIII�II�I��II��I���I�I�IIII'Illl�'��'I�I�1 1 1111111'PId 0 0 • s kDD1TI00L.INSOptetyS:N01IOE:OF State Farm Mutual Automobile Insurance Company 1066-FA96-A NAMED INSURED: POLICY NO: 458 1212-E30-55Y . • COVERAGE: TAYLOR,AUDREY E YR/MAKE/MODEL: 2008 LINCOLN SPORT WG BI AND PD LIABILITY 2550 LAKEWEST DR STE 10 VIN/CAMPER: 2LMDU88C08BJ38537 $1 MIL N CHICO CA 95928-8419 AGENT NAME: JONI GINNO INS AGENCY INC COMPREHE c $1000 DED.COLL. AGENT PHONE: (530)891-5881 SIVE ENDORSEMENT NO: 6028BU POLICY EFFECTIVE JUL 13 2023 UNTIL TERMINATED Fi POLICY MESSAGES: This policy shown above supersedes policy#4581212-55X. The policy includes a loss payable clause protecting the additional insured's interest in the described car to the extent of the insurance b provided and subject to all policy provisions.The additional insured will be given 20 days notice if the policy is terminated. Until such notice c, is provided,it shall be presumed that the required renewal premiums have been paid. The additional insured must notify us within 10 days of oany change of interest or ownership coming to their attention. Failure to do so will render this policy null and void. • • FRT OQo® DATE OF NOTICE: AUG 18 2023 PO Box 2368 CODE: Bloomington IL 61702-2368 39A AT1 12 A 000sio ooss 1STNOTE: PLEASE NOTIFY STATE FARM AT THE CITY7 OF CAMPBELL ISAOA ADDRESS LISTED AT THE TOP, LEFT CORNER CAMPBELL0 N CT OF THIS PAGE REGARDING ANY CHANGE OF CA 95008-1459 ADDRESS INFORMATION. IIILII1IIIu11IIIIIIIIIIIIIIIIIIII1IJIIIII111IIIII'I'II'IIIIIIII State Farm Mutual Automobile Insurance Company 1066 FA96 A • NAMED INSURED: POLICY NO: 458 1212-E30-55Y COVERAGE: TAYLOR,AUDREY E YR/MAKE/MODEL: 2008 LINCOLN SPORT WG El AND PD LIABILITY 2550 LAKEWEST DR STE 10 VIN/CAMPER: 2LMDU88C08BJ38537 $1 MIL CHICO CA 95928-8419 AGENT NAME: JONI GINNO INS AGENCY INC COMPREHENSIVE $1000 DED.LOLL. AGENT PHONE: (530)891-5881 ENDORSEMENT NO: 6028BU POLICY EFFECTIVE JUL 13 2023 UNTIL TERMINATED POLICY MESSAGES: This policy shown above supersedes policy#4581212-55X. The policy includes a loss payable clause protecting the additional insured's interest in the described car to the extent of the insurance provided and subject to all policy provisions.The additional insured will be given 20 days notice if the policy is terminated. Until such notice is provided,it shall be presumed that the required renewal premiums have been paid. The additional insured must notify us within 10 days of any change of interest or ownership coming to their attention. Failure to do so will render this policy null and void. • • FRT V410«i12 Al III 0 1 M 1 C r Mnlv1- ® DATE OF NOTICE: SEP 19 2023 PO Box 2368 CODE: Bloomington IL 61702-2368 62A AT1 12 A 001167 Doss NOTE: PLEASE NOTIFY STATE FARM AT THE CITY OF CAMPBELL ISAOA ADDRESS LISTED AT THE TOP, LEFT CORNER 70 N 1ST ST OF THIS PAGE REGARDING ANY CHANGE OF CAMPBELL CA 95008-1459 ADDRESS INFORMATION. IIIII111111111111I'111.111I11hhil1111I1i1111111111111'Twin State Farm Mutual Automobile Insurance Company 1066-FA96-A • NAMED INSURED: POLICY NO: 583 1686-E30-55 COVERAGE: TAYLOR,AUDREY E YR/MAKE/MODEL: 2008 LINCOLN SPORT WG El AND PD LIABILITY E 2550 LAKEWEST DR STE 10 VIN/CAMPER: 2LMDU88C08BJ38537 CO MIL MPREHENSIVE CHICO CA 95928-8419 AGENT NAME: JONI GINNO INS AGENCY INC $100o DED.LOLL. AGENT PHONE: (530)891-5881 ENDORSEMENT NO: 6028BU POLICY EFFECTIVE AUG 31 2023 UNTIL TERMINATED POLICY MESSAGES: This policy shown above supersedes policy#4581212-55Z. The policy includes a loss payable clause protecting the additional insured's interest in the described car to the extent of the insurance o provided and subject to all policy provisions.The additional insured will be given 20 days notice if the policy is terminated. Until such notice is provided,it shall be presumed that the required renewal premiums have been paid. The additional insured must notify us within 10 days of any change of interest or ownership coming to their attention. Failure to do so will render this policy null and void. • • • • • FRT .cdLWrdim Si I A I b I-AllM"' ' O O ® DATE OF NOTICE: SEP 20 2023 PO Box 2368 CODE: Bloomington IL 61702-2368 58A AT1 • 12 A ooiias Doss 1STNOTE: PLEASE NOTIFY STATE FARM AT THE CITY OF CAMPBELL ISAOA ADDRESS LISTED AT THE TOP, LEFT CORNER 70 N CT OF THIS PAGE REGARDING ANY CHANGE OF CAMPBELL CA 95008-1459 ADDRESS INFORMATION. I1h1111111II111111111111II11111I'll111I111111111I1IiIi1111111iill 0 0 0 0 11 0 0 ' :/�DDITIOI�II L.IIVSUI �D'Sa.K3TI0E PitO REF AGE . :: :: ::.. ... .. :'.::•;: i : ::: • State Farm Mutual Automobile.Insurance Company • • •1066-FA96-A NAMED INSURED: POLICY NO:• 583 1686-E30-55 COVERAGE: TAYLOR,AUDREY E YR/MAKE/MODEL: 2008 LINCOLN SPORT WG BI AND PD LIABILITY N 2550 LAKEWEST DR STE 10 VIN/CAMPER: 2LMDU88C08BJ38537 C 1 MIL OMPREHENSIVE CHICO CA 95928-8419 AGENT NAME: JONI GINNO INS AGENCY INC $1000 DED.coLL. AGENT PHONE: (530)891 5881 o ENDORSEMENT NO: 6028BU POLICY EFFECTIVE AUG 31 2023 UNTIL TERMINATED ii POLICY MESSAGES: This policy shown above supersedes policy#4581212-55Z. 9 The policy includes a loss payable clause protecting the additional insured's interest in the described car to the extent of the insurance o provided and subject to all policy provisions.The additional insured will be given 20 days notice if the policy is terminated. Until such notice co is provided,it shall be presumed that the required renewal premiums have been paid. The additional insured must notify us within 10 days of g any change of interest or ownership coming to their attention. Failure to do so will render this policy null and void. CI FRT `.... •... ,7 I/1 I L. I f'1f71111 O® DATE OF NOTICE: OCT 06 2023 PO Box 2368 CODE: Bloomington IL 61702-2368 50A AT1 12 A ooloal ooss CITY OF CAMPBELL ISAOA NOTE: PLEASE NOTIFY STATE FARM AT THE 70 N 1ST ST ADDRESS LISTED AT THE TOP, LEFT CORNER CAMPBELL CA 95008-1459 OF THIS PAGE REGARDING ANY CHANGE OF �'� ADDRESS INFORMATION. �1z�. • IIII'I'Ii.IIIiiIililiiIuI 111gdlin I'II'II"'I'IIIIIIIIIIIIIII 0 0 0 9 IL 00 . ADDITIONAAL INSURED S NOTICE OF COVERAGE ' .: State Farm Mutual Automobile Insurance Company toss FA96 A. NAMED INSURED: POLICY NO: 583 1686-E30-55A - COVERAGE: • . • TAYLOR,AUDREY E YR/MAKE/MODEL: 2008 LINCOLN SPORT WG BI AND PD LIABILITY ✓ 2550 LAKEWEST DR STE 10 VIN/CAMPER: 2LMDU88C08BJ38537 $1 MIL N COMPREHENSIVE to CHICO CA 95928-8419 AGENT NAME: JONI GINNO INS AGENCY INC $1000 DED.COLL. 4 AGENT PHONE: (530)891-5881 o ENDORSEMENT NO: 6028BU POLICY EFFECTIVE ..- SEP 06 2023 UNTIL TERMINATED gi POLICY MESSAGES: This policy shown above supersedes policy#5831686-55. , The policy includes a loss payable clause protecting the additional insured's interest in the described car to the extent of the insurance o provided and subject to all policy provisions.The additional insured will be given 20 days notice if the policy is terminated. Until such notice oR is provided,it shall be presumed that the required renewal premiums have been paid. The additional insured must notify us within 10 days of p any change of interest or ownership coming to their attention. Failure to do so will render this policy null and void. N .- • • FRT vava�il Wig" a7 1 M 1 C rmnow— CYQ® DATE OF NOTICE: OCT 18 2023 PO Box 2368 CODE: Bloomington IL 61702-2368 60A AT1 12 A 001313 0093 0 N 1STNOTE: PLEASE NOTIFY STATE FARM AT THE CITY7 CT OF CAMPBELL ISAOA ADDRESS LISTED AT THE TOP, LEFT CORNER CAMPBELL CA 95008-1459 ��. OF THIS PAGE REGARDING ANY CHANGE OF ADDRESS INFORMATION. '�I�II'�IIIIIIII.III"IIIIIIII"'IIIIIIIIIII'I'II'IIIIIII'IIII'II 0 0 0 9 iL s ADDIi'IONt,:::::: SUREQ.S:::NOTI::7.:: State Farm Mutual Automobile Insurance Company 1066-FA96-A NAMED INSURED: POLICY NO: 583 1686-E30-55B COVERAGE: TAYLOR,AUDREY E YR/MAKE/MODEL: 2008 LINCOLN SPORT WG BI AND PD LIABILITY 2550 LAKEWEST DR STE 10 VIN/CAMPER: 2LMDU88C08BJ38537 $1 MIL CHICO CA 95928-8419 AGENT NAME: JONI GINNO INS AGENCY INC COMPREHENSIVE 4 $100o DED.COLL. AGENT PHONE: (530)891-5881 8 ENDORSEMENT NO: 6028BU POLICY EFFECTIVE OCT 02 2023 UNTIL TERMINATED E POLICY MESSAGES: This policy shown above supersedes policy#5831686-55A. A The policy includes a loss payable clause protecting the additional insured's interest in the described car to the extent of the insurance o provided and subject to all policy provisions.The additional insured will be given 20 days notice if the policy is terminated. Until such notice is provided,it shall be presumed that the required renewal premiums have been paid. The additional insured must notify us within 10 days of o any change of interest or ownership coming to their attention. Failure to do so will render this policy null and void. - - - - N FRT U1.1.LAX'INV/V—/ ATTACHING INLAND MARINE SCHEDULE PAGE ATTACHING INLAND MARINE ENDORSEMENT LIMIT OF DEDUCTIBLE ANNUAL NUMBER COVERAGE INSURANCE AMOUNT • PREMIUM FE-8745 Inland Marine Computer Prop 36,0 0 0 $ 5 0 0 $ 152 . 00 Loss of Income and Extra Expense $ 2 5, 0 0 0 Included • • • OTHER LIMITS AND EXCLUSIONS MAY APPLY-REFER TO YOUR POLICY • Prepared OCT 09 2023 C)Copyright,State Farm Mutual Automobile Insurance Company,2008 • FD-6007 Includes copyrighted material of Insurance Services Office,Inc.,with its permission. • 007939 530-5115 a.2 05-31-2011 10113233c aiacerarm STATE FARM GENERAL INSURANCE COMPANY • LJ Q A STOCK COMPANY WITH HOME OFFICES IN BLOOMINGTON,ILLINOIS INLAND MARINE ATTACHING DECLARATIONS OOo P BoX ngton 2915 IL 61702-2915 Policy Number 90-E3-K870-7 B�oomr Named Insured Policy Period Effective Date Expiration Date M-12-1066-FA96 F N 12 Months OCT 15 2023 OCT 15 2024 The policy period begins and ends at 12:01 am standard CHABIN CONCEPTS INC time atthe premises location. • 0 ATTACHING INLAND MARINE 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 by law. Annual Policy Premium $ 152.00 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-8739 Inland Marine Conditions FE-6271 Amendatory Endorsement FE-8745 Inland Marine Computer Prop • See Reverse for Schedule Page with Limits Prepared OCT 09 2023 ©Copyright,State Farm Mutual Automobile Insurance Company,2008 FD-6007 Includes copyrighted material of Insurance Services Office,Inc.,with its permission. • 007939 - DECLARATIONS(CONTINUED) . •Office Policy for CITY OF CAMPBELL • . Policy Number 90-E3-K870-7 • CMP-4713.1 Excl Testing Consulting E&O CMP-4787 Waiver of Trans Rgt of Recov CMP-4875 Loss Payable CMP-4860.1 Al Design Person Org . • 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. ?crAiA)11-liaeWtig- • • • , Secretary President . IMPORTANT NOTICE: . • California law requires us 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 di this document.Another option is to reach out by mail or phone directly to: State Farm®Executive Customer Service PO Box 2320 Bloomington IL 61702 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 Services Division • . ' 300 South Spring Street Los Angeles,CA 90013 Phone#1-800-927-HELP(4357)or visit www.insurance.ca.gov/01-consumers . . • Prepared OCT 09 2023 ®Copyright,State Farm Mutual Automobile Insurance Company,2008 • CMP-4000 Includes copyrighted material of Insurance Services Office,Inc.,with its.permission. • 007938 290 Page 6 of 6 • ratei-arm u 0 O'Om DECLARATIONS(CONTINUED) Office Policy for CITY OF CAMPBELL Policy Number 90-E3-K870-7 F SECTION II- LIABILITY LIMIT OF 4 COVERAGE INSURANCE co. Coverage L- Business Liability $2,000,000 Coverage M - Medical Expenses (Any One Person) - • $5,000 Damage To Premises Rented To You $300,000 • • LIMIT OF AGGREGATE LIMITS INSURANCE Products/Cornpleted Operations Aggregate $4,000,000 • General Aggregate $4,000,000 • 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-4786.1 *Addl Insd Owners Lessee Sched • CMP-4819.1 Unauthorized Business Card Use FE-6999.3 Terrorism Insurance Coy Notice. • CMP-4260.1 Amendatory Endorsement-CA CMP-4261 Amendatory Endorsement CMP-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 Incm CMP-4788.1 Addl lnsd Mgrs Lessor of Prem Prepared OCT 09 2023 ©Copyright,State Farm Mutual Automobile Insurance Company,2008 • CMP-4000 Includes copyrighted material of Insurance Services Office,Inc.,with its permission. 007938 290 Continued on Reverse Side of Page Page 5 of 6 Al DECLARATIONS.(CONTINUED) Office Policy for CITY OF CAMPBELL • Policy Number 90-E3-K870-7 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 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 $2,500 Personal Property) • Signs • $2,500 Unauthorized Business Card Use $5;000 • • Valuable Papers And Records On Premises $50,000 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. • • • LIMIT OF COVERAGE INSURANCE Dependent Property- Loss Of Income $5,000 Employee Dishonesty $10,000 Utility Interruption - Loss Of Income $10,000 Loss Of Income And Extra Expense Actual Loss Sustained- 12 Months Prepared OCT 09 2023 ©Copyright,State Farm Mutual Automobile Insurance Company,2008 CMP-4000 Includes copyrighted material of Insurance Services Office,Inc„with its permission. 007937 Continued on Next Page Page 4 of 6 Jrarerarrn O 0 0,, DECLARATIONS(CONTINUED) Office Policy for CITY OF CAMPBELL • Policy Number 90-E3-K870-7 • Ii SECTION I- EXTENSIONS OF COVERAGE-LIMIT OF INSURANCE- EACH DESCRIBED PREMISES g 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, cod 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 $15,000 Arson Reward $5,000 Back-Up Of Sewer Or Drain $1,5,000 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 $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 10% 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 OCT 09 2023 ©Copyright,State Farm Mutual Automobile Insurance Company,2008 CMP-4000 Includes copyrighted material of Insurance Services Office,Inc.,with its permission. • 007937 290 Continued on Reverse Side of Page Page 3 of 6 DECLARATIONS(CONTINUED) . • Office Policy for CITY OF CAMPBELL Policy Number . 90-E3-K870-7 • • 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 2550 LAKEWEST DR STE 10 No Coverage $ 62,100 25% CHICO CA 95928-8419 • *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) • Coy A - Inflation Coverage Index: N/A Coy B - Consumer Price Index: 304.1 • SECTION I - DEDUCTIBLES Basic Deductible $500 • Special Deductibles: • Money and Securities $250 Employee Dishonesty $250 Equipment Breakdown $500 Other deductibles may apply- refer to policy. • • Prepared OCT 09 2023 ©Copyright,State Farm Mutual Automobile Insurance Company,2DD8 CMP-4000 Includes copyrighted material of Insurance Services Office,Inc.,with its permission. 007936 , Continued on Next Page Page 2 of 6 mare term STATE FARM GENERAL INSURANCE COMPANY LJ O A STOCK COMPANY WITH HOME OFFICES IN BLOOMINGTON, ILLINOIS DECLARATIONS AMENDED SEP 6 2023 O'O® Po Box2_915 Policy Number 90-E3-K870-7 Bloomington IL 6 1 702-29 1 5 Addl Insured-Section H Only Policy Period Effective Date Expiration Date M-12-1066-FA96 F N 12 Months OCT 15 2023 OCT 15 2024 001058 3123 The poli y period begins and ends at 12:01 am standard CITY OF CAMPBELL time atthe premisesTocation. AGENTS OFFICERS ATTORNEYS EMPLOYEES OFFICIALS & • c VOLUNTEERS Named Insured 70 N 1ST ST CHABIN CONCEPTS INC . CAMPBELL CA 95008-1458 • 'I11I19[IIlllll"lll'l'lllll'I'I'llll'I I'Ill'll'llhIll'II"'llIl • • 0 0 0 cos Office Policy • Automatic Renewal-lithe policy period is shown as 12 months,this policy will be renewed automatically subject to 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 by law. Entity: Corporation - Reason for Declarations: Your policy is amended SEP 6 2023 ADDITIONAL INSURED ADDED . PREMIUM ADJUSTMENT = • FORM CMP-4786.1 ADDED Other items shown are effective with the policy's 2023 renewal • Endorsement Premium None Discounts Applied: Renewal Year Years in Business Sprinkler • Prepared OCT 09 2023 ©Copyright,State Farm Mutual Automobile Insurance Company,2008 CMP-4000 Includes copyrighted material of Insurance Services Office,Inc.,with its permission. 007936 290 Al Continued on Reverse Side of Page Page 1 of 6 ataeerarm STATE FARM GENERAL INSURANCE COMPANY U Q A STOCK COMPANY WITH HOME OFFICES IN BLOOMINGTON, ILLINOIS, DECLARATIONS AMENDED OCT 15 2023 O'O® P?o ng o15 Policy Number. 90-E3-K870-7 6loomrngton IL 61702 2915 • Add! Insured-Section II Only • Policy Period Effective Date Expiration Date M-12-1066-FA96 F N 12 Months OCT 15 2023 OCT 15 2024 000912 3123 The polipy period begins and ends at 12:01 am standard CITY OF CAMPBELL time attlie premises location. AGENTS OFFICERS ATTORNEYS 1... 1 EMPLOYEES OFFICIALS & tit Named Insured. ...1, VOLUNTEERS CHABIN CONCEPTS INC -. 70 N 1ST ST CAMPBELL CA 95008-1458 . Ifl''III.IiIIl1lllllldlliilliurulilill"II'Il'I'1III'lll1ltll0'll 0 0 S .. . 1)s Office Policy •-- - - Automatic Renewal-If the policy period is shown as 12 months,this policy will be renewed automatically subject to 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 by law. . Entity: Corporation . • Reason for Declarations: Your policy is amended OCT 15 2023 PREMIUM ADJUSTMENT • Endorsement Premium None • Discounts Applied: Renewal Year ' Years in Business Sprinkler • • Prepared OCT 12 2023 - ©Copyright,State Farm Mutual Automobile Insurance Company,2008 CMP-4000 Includes copyrighted material of Insurance Services Office;Inc.,with its permission. 006395 290 Al Continued on Reverse Side of Page Page 1 of 6 Al • ' DECLARATIONS(CONTINUED) Office Policy for CITY OF CAMPBEL'L ' Policy Number 90-E3-K870-7 . 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• 2550 LAKEWEST DR STE 10 - No Coverage • $• 62,100 25% CHICO CA 95928-8419 • *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) • Coy A - Inflation Coverage Index: N/A Coy B - Consumer Price Index: 304.1 • SECTION I - DEDUCTIBLES Basic Deductible $500 Special Deductibles: . Money and Securities $250 . Employee Dishonesty $250 Equipment Breakdown $500 . Other deductibles may apply- refer to policy. • Prepared OCT 12 2023 ©Copyright,State Farm Mutual Automobile Insurance Company,2008 CMP-4000 Includes copyrighted material of Insurance Services Office,Inc.,with its permission. 006395 Continued on Next Page Page 2 of 6 Jcaterai u O O'O� DECLARATIONS(CONTINUED) Office Policy for CITY OF.CAMPBELL • . . Policy Number 90-E3-K870- • 7 • x k tiT • SECTION I- EXTENSIONS OF COVERAGE- LIMIT OF INSURANCE- EACH DESCRIBED PREMISES g The coverages and corresponding limits shown below apply separately to each described premises shown in these Declarations, unless indicated by"See Schedule." If a coverage does not have a corresponding limit shown below, �$ but has"Included" indicated, please refer to that policy provision for an explanation.of that coverage. . . • LIMIT OF - COVERAGE INSURANCE Accounts Receivable On Premises • $50,000 Off Premises $15,000, 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 Limit Debris Removal 25% of covered loss Equipment Breakdown . :' . Included • Fire Department Service 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 . . 10% 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 OCT 12 2023 ©Copyright,State Farm Mutual Automobile Insurance Company,2008 CMP-4000 Includes copyrighted material of Insurance Services Office,Inc.,with its permission. 006396 290 'Contin'ued on Reverse Side of Page Page 3 of" 6 NI DECLARATIONS(CONTINUED) , Office Policy for CITY OF CAMPBELL Policy Number 90-E3-K870-7 • • ' 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 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 K Business $2,500 Personal Property) Signs $2,500 Unauthorized Business Card Use ' $5,000 Valuable Papers And Records On Premises $50,000 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. LIMIT OF • COVERAGE INSURANCE Dependent Property- Loss Of Income '$5,000 Employee Dishonesty $10,000, Utility Interruption - Loss Of Income $10,000 Loss Of Income And Extra Expense Actual Loss Sustained - 12 Months Prepared OCT 12 2023 Copyright,State Farm Mutual Automobile Insurance Company,2008 CMP-4000 Includes copyrighted material of Insurance Services Office,Inc with its permission. 006396 Continued on Next Page Page 4 of 6 .5rarerarm u O OQ, • DECLARATIONS(CONTINUED) Office Policy for CITY OF CAMPBELL - Policy Number 90-E3-K870-7 t,,...a, . SECTION II- LIABILITY 0 LIMIT OF COVERAGE INSURANCE wo Coverage L- Business Liability $2,000,000; 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 $4,000,000 ' General Aggregate - . $4,000,000 • 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-4819.1 Unauthorized Business Card Use FE-6999.3 Terrorism Insurance Coy Notice CMP-4260.1 Amendatory Endorsement-CA CMP-4261 Amendatory Endorsement CMP-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 Incm CMP-4786.1 Addl Insd Owners Lessee.Sched , CMP-4788.1 Addl lnsd Mgrs Lessor of Prem Prepared OCT 12 2023 ©Copyright,State Farm Mutual Automobile Insurance Company,2008 CMP-4000 Includes copyrighted material of Insurance Services 0ffice,Inc.,with its permission. 006397 290 Continued on Reverse Side of Page Page 5 of 6 DECLARATIONS(CONTINUED) Office Policy for CITY OF CAMPBELL Policy Number 90-E3-K870-7 CMP-4713.1 Excl Testing Consulting E&O CMP-4787 Waiver of Trans Rgt of Recov CMP-4875 Loss Payable CMP-4860.1 Al Design Person Org FD-6007 Inland Marine Attach Dec • 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. ?;-n4.%)311.• ' • 4:4400441. / Secretary President IMPORTANT NOTICE: California law requires us 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 this document.Another option is to reach out by mail or phone directly to: Slate Farm®Executive Customer Service P0 Box 2320 • Bloomington IL 61702 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 Services Division 300 South Spring Street Los Angeles,CA 90013 • Phone#1-800-927-HELP(4357)or visit www.insurance.ca.ctovj0l-consumers - _ • • • • Prepared OCT 12 2023 ©Copyright,State Farm Mutual Automobile Insurance Company,2008 • . CMP-4000 Includes copyrighted material of Insurance Services Office,Inc.,with its permission. 006397 290 Page 6 of 6 N ,uneraner STATE FARM GENERAL INSURANCE COMPANY C. A STOCK COMPANY WITH HOME OFFICES IN BLOOMINGTON, ILLINOIS INLAND MARINE ATTACHING DECLARATIONS • Po Box 2915 Policy Number 90-E3-K870-7 Bloomington IL 6 1 702-29 15 Named Insured Policy Period Effective Date Expiration Date M-12-1066-FA96 F N 12 Months gqOCT 15 2023 OCT 15 2024 CHABIN CONCEPTS INC The policy period ends at12:01 am standard ...w..,z,,—. . . ATTACHING INLAND MARINE Automatic Renewal-If the 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. Annual Policy Premium $ 152.00 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-8739 Inland Marine Conditions FE-6271 Amendatory Endorsement FE-8745 Inland Marine Computer Prop • See Reverse for Schedule Page with Limits Prepared . OCT 12 2023 ©Copyright,State Farm Mutual Automobile Insurance Company,2008 FD-6007 Includes copyrighted material of Insurance Services Office,Inc.,with its permission. 006398 Fan.snn n 7 ns-a1-will 1o1f3232c1 w-c.I rav r 1.1-I 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 36 , 000 S 500 S 152. 0C Loss of Income and Extra Expense S 2 ,0 0 0 Included OTHER LIMITS AND EXCLUSIONS MAY APPLY-REFER TO YOUR POLICY Prepared OCT 12 2023 ®Copyright,State Farm Mutual Automobile Insurance Company,2008 FD-6007 Includes copyrighted material of Insurance Services Office,Inc.,with its permission. 006398 530-666 n.2 05-31-2011(n113233c1