2022/10/31 Western A/V, Inc. (22)StateFam tl(Doo STATE FARII GENEFAL INSURAI{CE COIT|PANY
A STOCK COMPANY WIfH HOME OFFICES IN BLAOMNGTON, ILLINOIS
E?oEPi &?1i,, u, ror-a,s
Addl lnsured-Section ll Only
M-23-61F8-FB8A F Z
004636 3123
CITY OF HENIFEE
AND ITS OFFICERS, EI{PLOYEES,
AGEilTS & AUTHORIZED VOLUNTEERS
298{4 HAUI{ RI)
t{EN I FEE CA 925E6.6539
ll'11l,rglrg1;llr11;'lrlllll,lrllL;,lrrr11l11,lr11l1llll',l11ll
DECLARATIONS At\TENDED JAN s 2023
Policyllumber 92-GY-D812{
Pollcu Prriod Elleciive Date Eroiralion Dab
12 M'onths OCT 31 2022 ocT 31 2023
Ihe polipy period begins and ends at 12 01 am standard
tme at the Premlses Iocaton
Named lnsured
UESTERN A/V INC
E riahW
I
E
Home Product Sales Policy
Automatic Renewal -
forms in effectlor eac
lf the polisY
h succeedln gp
dod is shown as 12 monlhs , this po
olicy period. lf tris policy is termina
licy
ted , we will give you and $e Mortgagee/Lienholder written notice in
will be renewed automatically subjectto tre premiums, rules andPe
compliance witr the policy p rovlslons 0r as requlre d by law
Entlty: Corporation
Reason tor Declarations: YouI policy is amended JAN 5 2023
ADDITIONAL INSURED ADDED
PREMIUM ADJUSTMENT
FORM CMP.4786.1 ADDED
Endorsement Premium
lncrease $ 44.00
Discounts Applied:
Renewal Year
Years in Business
Enclosed Building
Protective Devices
Sprinkler
Claim Record
Prepared
FEB 06 2023
cMP-4000
037461 290 Al
N
O Copyrigh! State t!rm Mutu!l Automobile ln!urlnce Compuy,2000
lnclud€s cogyriohtsd mrtsrial of lnsurince SorvicBs ofticr, lnc., wi6 its psrmission
Conlinued on Reverse Sido ol Page Page 1ot 7
Home Product Sales Pollcv
Pollcy Numbe. 92-G
DECLAHATIONS (CONTINUEO)
for CITY OF MENIFEE
Y-D812{
SECTION I. PROP TY SCHEDULE
Location
Number LocaUon ol
Descrlbod
Premlses
Limlt ol lnsuranca'
Coveraoe A -
Buildi'ngs
Llmit ot lnsurance'
Coveraoe B -
Business Iersonal
Proporty
Seasonal
lncrease-
Buslness
Porsonal
Property
001
002
1592 N BATAVIA ST STE 2
oRANGE CA 92867-3554
1590 N BATAVIA ST STE 4
oRANGE CA 92867-3534
No Coverage $ 141,100
$ 140,900
25%
25%
.Aso ctive date of this po , the mt to lnsurance as s own includes any rncrease rn
SECTION I.
limit due to ation veragen
INFLATION COVEBAGEINOEX(ES}
Cov A - lnf lation Coveraoe lndex:
Cov B - Consumer Pricdlndex:
N/A
296.3
SECTION I - DEDUCTIBLES
$2,500
$2so Data Compromise
O Copyrioh! Stlt8 F6rm l\4utu 0l AutomobilB lnsurrnce Complny, ZmE
lnclud!r copyrightod mltori.l of lnsur!ncs Servicas Olfice, lnc.,with iBprrmislion
Continued on Next Page
Prepared
FEB 06 2023
cMP-4000
037461 Page 2ol 7
No Coverage
Baslc D,aduc.tible
Speclal Dsductlbles:
Money and Securities $1.000
StateFann !&
Home Product Sales Policv
Policy Number 92-G
DECLARATTONS (CONINUED)
for CITY OF MENIFEE
Y-D812-0
Equipment BreakdownEmployee Dishonesty $2so
Other deductibles may apply - refer to policy.
$2,500
H*
SECTION I. EXTE ONS OF COVEBAGE . LIMIT OF INSU RANCE - EACH DESCRIBED PREMg
a8 The coveraqes and corrsspondlng limits shown below apply separately to oach described premisss shown in these
Declaration:, unless indicated byr'See Schedule." lf a cbverag6 does hot hav€ a corresponding limit shown below,
but has "lncluded" indlcated, please reler to that pollcy provision tor an explanatlon ol that coverage.
COVERAGE
Accounts Beceivable
On Premises
Orf 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
lncreased 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
LIMIT OF
INSUBANCE
See Schedule
See Schedule
ss,000
SBe Schedule
lncluded
Coverage B Limit
2570 ol covared loss
lncluded
92,s00
$5,000
$10,000
lncluded
10%
See Schedule
See Schedule
$1,000
Prepared
FEB 06 2023
cMP-4000
O Copyright, Slcls Farm lvltitu al Automobile ln.ur!ncs Company, 2$8
lnrludBs copyn0hted mrtsrisl ot lns0r!nce Services 0llic8, Inc , with its permission
Continued on Reverse Side ol Page037462 290
N
Page 3 of 7
Home Producl Sales Pollcv
Policy Numb€r g2-G
DECLARATIONS (CONTINUEO)
Ior CITY OF MENIFEE
Y-D812-O
Newly Acquired Business Personal Property (applios only il this policy provides
Coverage B - Business Personal Property)
Newly Acquired Or Constructed Buildings (applies only if this policy provides
Coverage A - BuiHings)
Ordinance Or Law - Equipment Coverage
Outdoor Proporty
Personal Errocts (appli6s only to those premises provided Coverage B - Business
Personal Property)
Personal Proporty Off Premises
Pollutant Clean Up And Removal
Preservation Of Prop€rty
Properly.Of Others (applies only to those premises provided Coverage B - Business
Personal Property)
Signs
Valuable Papers Ard Records
On Premises
Oll Premises
$100,000
$2s0,000
lncluded
See Schedule
$2,s00
$25,000
$10,000
30 Days
See Schedule
See Schedule
See Schedule
See Schedule
LOCANON
0001
0002
COVERAGE
Signs
Back-Up Of Sewer Or Drain
Money And Securities (On Premises)
Money And Securities (Off Premises)
Property.Of Others (applies only to those premises provided Coverage B - Business
Personal Property)
Accounts Receivable (On Premises)
Accounts Receivable (Of f Premises)
Outdoor Prop€rty
Valuablo Papers and Records (On premises)
Valuable Papers and Records lOlf premises)
Accounts Receivable (On Premises)
@ Copyri0h! 3t0t8 F m Mutual AutomobilB lnsur.nc€ Comp!ny, Zom
lncludss copvrighted mrtsrirlof lnsur!ncs Seryicos offics, lnc., with its D0.mission
Continued on Next page
LIMIT OF
INSURANCE
$s,000
$15.000
$10,000
$s,000
$2,s00
$10,000
$5,000
$5,ooo
$10,000
$5,000
$10,000
Prepared
FEB 06 2023
cMP-4000
037462 Page 4 ol 7
SECTION I . EXTENSIONS OF COVEBAGE. LIMIT OF INSURANCE - SCHEDULE
The coveragos and cone3pondlng limits shown below apply only to the described premisos as shown,
StateFarm E(-)oo
Home Product Sales Pollcv
Policy Number g2-G
DECLARATIONS (CONTINUED)
Ior CITY OF MENIFEE
Y-0E12.{)
EE*Ir+i!
5
a3
Accounts Receivable (Of f Premises)
Back-Up Of S€wer Or Drain
Money And Socurilies (Ofl Premises)
Money And Securities (On Premises)
Outdoor Property
Property Ol Ohdrs (applies only to those premises provided Coverage B - Business
Personal Properly)
Signs
Valuable Papers and
Valuable Papers and
$5,000
$1s,000
$5,ooo
$10,000
$s,ooo
$2,500
$s,000
$10,000
$s,000
Records
Records
On Premises)
Off Premises)
SECTION I -ONS OF COVERAGE . LIMIT OF INSURANCE . PER LICY
The covetages and corrospondlng limits shown below aro the most we will pay r€gardless of the number ol
described premisos shown ln theto Declarations.
COVERAGE
Data Comoromise
Legal And Forensic lnformation Technology Review
Per Occurrence
Dependent Property - Loss Ol lncome
Employee Dishonesty
ldentity Restoration
Other Expenses
Case Management Servicos
Per Occurrence
Lost Wages And Supervision Expenses
Utility lnterruption - Loss Ot lncome
Loss Of lncome And Extra Expense
LIMIT OF
INSUBANCE
$5,000
$50,000
$5,000
$10,000
$1,000
1 2 months
$35,000
$s,000
$10,000
Actual Loss Sustained - 12 lvlonths
Prepared
FEB 06 2023
cMP-4000
037463 290
N
Page 5 of 7
O Cofyri0ht 5r!16 Frrm Mutu!l Automobils lnsur!0c! Comprfly,2m
lncludes copyrightod mrtsri!l of lnsurancs Strvices officr, |n6., wi$ its psrmi6sion
Continued on Reverse Sido ol Page
Home Product Sales Policv
Policy Number 92-G
OECLARATIONS (CONTINUED)
to. CITY OF MENIFEE
Y-D812-0
SECTION II. LIABI ITY
COVERAGE
Coverage L - Businoss Liability
Coverage M - Medical Expenses (Any One Person)
Damage To Premises Rented To You
AGGREGATE LIIIIITS
Products/Completed Operations Agg regate
General Aggregate
LIMIT OF
INSURANCE
$2,000,000
$5,000
$500,000
LIMIT OF
INSURANCE
$4,000,000
$4,000,000
Each pakl claim for Liability Covorage reduces the amount of insurance we provids during the applicable
annual period. Please refer to Section ll - Liabilily in the Coverage Form and any attached endoiiaments
,v-9yr ngligf colssls of these.D-€clarations, the BUSINESSOWNEBS COVERAGE FORM shown betow, and any otherforms and endorsements that apply, including those shown below as well as those issued subsequent to theissuance ol this policy.
FORMS AN ENDORSEMENTS
cMP-4101
cMP-4786.1
cMP-4787
cMP-4260.1
cMP-4261
cMP-4705.2
cMP-4710
cMP-4709
cMP-4698
cMP-4704.1
cMP-4703.1
cMP-4610
cMP-4746.1
Businessowners Coverage FormtAddl Insd Owners Lessoe Sched.Waiver of Trans Bgt of Recov
Amendatory Endorsement-CA
Am€ndatory Endorsement
Loss of lncome & Extra Expense
Employee Dishonesly
Money and Securilies
Back-Up ol Sewer or Drain
Dependent Prop Loss of lncome
Utility lnterruption Loss lncm
General Agg Limil Per Proj
Hired Auto Liability
Prepared
FEB 06 2023
cMP-4000
037463
O Copyrilh! Stats t6rm Mltu!l Auromobil0 lnrur.nco Compuy,2m
lnclud!! co[yri0htod mlterial of lnsurrnce Servic0s Office, lnc.. wilh iti pstmi!rion,
Continued on Next Page Page 6 of 7
StateFarm&
E*rfi
Ets5f;
Home Product Sales Policv
Policy Number 92-G
DECLABATIONS (CONTINUED)
lor CITY OF MENIFEE
Y-D812-0
cMP-4990.1
cMP-4994
cMP-4875
FE-6999.3
cMP-4793.1
cMP-4788.1
FD-6007
ldentity Resloration Coverage
Data Compromise
Loss Payable
Terrorism lnsurance Cov Notice
Al State Political Perm Prem
Addl lnsd Mgrs Lessor of Prem
lnland Marine Attach Dec
NOTICE: INFORMATION CONCERNING
CHANGES IN YOUR POLICY
LANGUAGE IS INCLUDED. PLEASE
CALL YOUR AGENT IF YOU HAVE
ANY OUESTIONS.
' New Form Attached
E
This polioy is issued by the State Farm General lnsurance Company
Parlicipating PolicY
You are entitled to participate in a distributlon of the earnings of thecompany as determined by our Board of Diroctors in
accordance wilh th6 Company's Articles of lncorporation, as amended
ln Witness Wher€of, he State Farm General lnsurance Company has caused this polioy to be slgned by its Prosident and
Secretarv at Bloominqton. lllinois.-f*,.-:nW*" -il*tu M4
Secreta"ry Presid€nt
IMPORTANT NOTICE:
Colllomlo hw tequltes us to plovlde you whh lnlomatlon tor tlllng colnplslms whh the grate lnsumnce D,epanmed reoardlng tlE
coverage and ervico provired und€r thie policy'
your 8g€7|l'! nEme and co .ct l] ormatlon sle providod on the frotd ot lhl! documer , Another optlon ls to reach out by
m8il or phom directly to:
Stste FanP ExscullYo Cudomer Ssrvlcr
PO Box 2320
Bloominglon lL 61702
Phone t l €OO.STATEFAR (l-8fi1782.6332)
DeDortment of lnsursnce comphint! should be llled onlY alter you lnd stst€ FaIm ol youl sgent ol olher comparry
rgdrcsntttfue hqvs lilled to rgqch o s6tislaqlory agreement on. problem.
Csltomis DepEnment o, lnsunnce
Consumol Esrvlc€s DlYlebn
300 South 89rlrU $leet
L6 Anoclss. CA 90013
Phone i r.s0o427-HELP (4357) or vbit rt4rli0lsEtEE!,sElgLssB4lrs.
Prepared
FEB 06 2023
cMP-4000
037464 290
N
Page 7 ot 7
!
@ Copyriohl St[te Frrm Mutuil Automobils lnsurancs Comp.ny,20m
lnrludEs coWri0htqd matBtial of lnsuranca Servic€s offic€, lnc , with its pErmission
92-GY-D812{
037464
StateFarm STATE FAB GENERAL II{gUNA CE COTIIPA}IY
A STOCK COMPANY WI|H HO$E OFFICES IN BLOOMINGTON, ILLINOIS
E?#ff ,61i,fr ,, u, ror-re,s
Named lnsured
M-23-61F8-FB8A F Z
t{EsTERri A/V Il{C
ATTACHING INLAND MABINE
tl
INLAND MARINE ATTACHING DECLARATIONS
Policyr{umb6r 92-GY-D812-O
Pollcv Period Ethctlve Dcle Exoiralion Dab
12 Mbnths OCT 31 2022 OCT 31 2023
The policy oeriod begins qnd ends at l2:01 am standard
tme at the irremrses Tocaoon.
&,
B,ri'dE
EflE
I3
*A
Aubmatic Ronewal - lf t|e policy pcrlod is shown as 12 months , this policy will be renewed automatically subject to the premiums, rules and
forms in etf ect for each sucieediinb policy period. lt tris policy is terminated, we will give you and 6e Mortgagee/Lienholder written notjce in
compliance wi$ the policy provisions or as req uired by law
Your policv consists of ftese Declarations, $e INLAND MARINE C 0NDlTl0NS shown below, and any other forms and endorsements that
applv, inclirding $ose shown below as well as $ose issued subsequent to the issuance of tltis policy
Foms, 0ptiors, and Endorsemenb
FE-8739
fa-oz I I
FE-8745
See Reverse lor Schedule Page wi$ Limits
Prepared
FEB 08 2023
FD-6007
037465
@ CDpyrioht St6te Frrm lvlutu 0i Automobile lnsurince Comp!ny,2009
lncludes cogyrilhtsd m.teri!l ol lnsur.ncs Seryico! offic!, 1n0., wi6 its permission
530 tl6s 2 0! 31 20ll lo1t3?3?cl
Annual Policy Premium lncludod
The above Premium Amount is included in $e Policy Premium shown on $e Declarations.
lnland Marine Conditions
Amendatory Endorsement
lnland Marino Computer Prop
92-GY-D812-0
ATTACHING If, I.AI{D MARII{E
ATTACHING INI-AND MABINE SCHEDULE PAGE
ENDORSEMENT
NUMBER
FE-87 45
C OVERAGE
lnland Marine Computer Prop
Loss of lncome and Extra Expense
LIMIT OF
INSURANCE
DEDUCTIBLE
AMOUNT
$ 500
ANNUAL
P RE IvI IU IVI
I
I
25 , O00
25,000
Included
Included
Prepared
FEB 06 2023
FD-6007
037465
oTHER LtMtTS AND EXCLUST0NS MAy AppLy . REFER T0 yOUR p0LtCy_
O Copyri0hl Stlts Flrm luuflr al Automobil0 lnsur!nc0 Complny,2m
ln6ludBs copyriohtsd mlt8riilof Insur!nce ServicBs Offi6e,lnc.,with iB p8rmistiDn.
510 6!6d ? 05 3l ?0ll lolfl2l3.t