HomeMy Public PortalAbout177-2023 - Hoosier Sheds - new shed at treatment plant AGREE ME
'1141.1S AGR.EEMENT made and entered into this .2-1 day of N Ovem bil,C 2023, by and
between the City of Richmond, Indiana, a municipal corporation acting by and through its Board
of Sanitary Commissioners (referred to as the "City"), and Hoosier Sheds, EEC, 1206 Beckley
Osborne Road, Sebree, KY 42455 (hereinafter referred to as the "Contractor").
SECTION I. STATEMENT AND SUBJECT OF WORK
City hereby retains:Contractor to furnish and deliver a storage shed to the Wastewater Treatment
Plant for the City of Richmond Sanitary District.
A Request for Quotes has been made available for inspection by Contractor, is on file in the
office of the Department of Sanitation for the City of Richmond.
The response of Contractor to said Request for Quotes is attached hereto and incorporated by
reference herein as Exhibit"A".
Should any provisions, terms, or conditions contained in any of the documents attached hereto
and incorporated by reference herein as Exhibits, conflict with any of the provisions, terms, or
conditions of this Agreement,this Agreement shall be controlling.
The Contractor shall furnish all l.abor, material, equipment, and services necessary for the proper
completion of all work specified.
No performance of services shall commence until the following has been met:
1. The City is in receipt of any required certificates of insurance and/or warranties;
2. The City is in receipt of any required affidavit(s) signed by Contractor in accordance with
I.C. § 22-5-1.7-11(a)(2); and
3. A purchase order has been issued by the Purchasing Department.
SECTION II, STATUS OF CONTRACTOR
Contractor shall be deemed to be an independent contractor and is not an employee or agent of
the City of Richmond. The Contractor shall provide, at its own expense, competent supervision
of the work.
SECTION HE COMPENSATION
City shall pay the sum of Thirteen Thousand Eight Hundred Sixty-Nine Dollars and 00/00
($13,869.00) for the total project cost.
SECTION IV, TERM OF AGREEMENT
This Agreement shall become effective when signed by all of the parties hereto and shall remain
in effect until Contactor completes the Statement and Subject of Work described herein.
Notwithstanding .the term of this Agreement, City may terminate this Agreement in whole or in
part, for cause, at any time by giving at least thirty (30) clays written notice specifying the
effective date and the reasons for termination which shall include but are not he limited to the
following:
Contract No. 177-2023
P a e
a. failure, for any reason of the Contractor to fulfill in a timely manner
its obligations under this.Agreement;
b. submission of a report, other work product, or advice, whether oral or written, by the
Contractor to the City that is incorrect, incomplete, or does not meet reasonable
professional standards in any material respect;
c. ineffective or improper use of funds provided under this Agreement;
d. suspension or termination of the grant..funding to the City under which this Agreement
is made, or
e. unavailability of sufficient funds to make payment on this Agreement..
This Agreement. "may also be terminated by either the City or the Contractor, in whole or in part,
by mutual Agreement setting forth the reasons for such termination, the effective date, and in the
case of partial termination, the portion to be terminated.
This Agreement n ty also he terminated by either the City or the Contractor, without cause, by
giving at least thirty (30) days written notice to the other party.
In the event of termination of this Agreement, the City shall be required to make payment for all
work performed prior to the date this Agreement is terminated, but shall be relieved of any other
responsibility hereiii.
This Agreement may also be terminated by the City if a force-m.ajeure event occurs and the
results or aftereffects of said event causes the performance of this Agreement to become.
impossible or highly impracticable. Said event or results or aftereffects of said event would.
include events or effects which the parties to this Agreement.. could not have anticipated or
controlled. Exa.mples of a force-majeure event, or its results, would include, but would not be
limited to, events such as an Act of God, an Act of Nature, an Act of Law, or au Emergency Act
of Executive Enforcement of the Federal government, the State of Indiana, or local government.
SECTION V. INDEMNIFICATION A:ND INSURANCE
Contractor agrees to obtain insurance and to indemnify the City for any damage or injury to
person or property or any other claims which may arise from the Contractor's conduct or
performance of .this Agreement, either intentionally or negligently; provided, however, that
nothing contained in this Agreement shall be construed as rendering the Contractor liable for acts
of the City, its officers, agents, or employees. Contractor shall as a prerequisite to this
Agreement, purchase and .thereafter maintain such insurance as will protect it from the claims set
forth below which may arise out of or result from the Contractor's operations under this
Agreement, .wheth2r such operations by the Contractor or by any sub-contractors or by anyone
directly or indirectly employed by any of them, or by anyone for whose acts the Contractor may
be held responsible.
Coverage Limits
A. Worker's Compensation& Statutory
Disability Requirements
B. Employer's Liability 5 I 00,000
2 P e
C. Comprehensive General Liability
Section L Bodily Injury $1.,000,000 each occurrence
S2,000,000 aggregate
Section 2. Property Damage $1.,000,000 each occurrence
D. Comprehensive Auto Liability
Section 1. Bodily Injury $1,000,000 each person
$1,000,000 each occurrence
Section 2. Property Damage $1.,000,000 each occurrence
F. Comprehensive Umbrella Liability $1,000,000 each occurrence
$1,000,000 aggregate
F. Malpractice/Errors&Omissions Insurance $1,000,000 each occurrence
S2,000,000 aggregate
SECTION VI. COMPLIANCE WITH WORK.ER'S COMPENSATION LAW
Contractor shall comply with all provisions of the Indiana Worker's Compensation law, and shall,
before commencing work under this Agreement, provide the City a certificate of insurance, or a
certificate from the industrial board showing that the Contractor has complied with Indiana Code
Sections 22-3-2-5, 22-3-5-1 and 22-3-5-2. If Contractor is an out of state employer and therefore
subject to another state's worker's compensation law, Contractor may choose to comply with all
provisions of its 'home state's worker's compensation law and provide the City proof of such
compliance in lieu of complying with the provisions of the Indiana Worker's Compensation Law.
SECTION VII. IRAN INVESTMENT ACTIVITIES
Pursuant to Indiana Code (IC) 5-22-16.5, Contractor certifies that Contractor is not
engaged in investment activities in Iran. In the event Board determines during the course
of this Agreement that this certification is no longer valid, Board shall notify Contractor
in writing of said. determination and shall give, contractor ninety (90) days within which
to respond to the written notice. In the event Contractor fails to demonstrate to the .Board.
that the Contractor has ceased investment activities in Iran within ninety (90) days after
the written notice is given to the Contractor, the Board may proceed with any remedies it
may have pursuant to IC 5-22-16.5. In the event the Board determines during the course
of this Agreement that this certification is no longer valid and said determination is not
refuted by Contractor in the manner set .forth in IC 5-22-16.5, the Board reserves the right
to consider the Contractor to be in breach of this Agreement and terminate the agreement
upon the expiration of the ninety (90) day period set forth above.
SECTION VIII. PROHIBITION AGAINST DISCRIMINATION
A. Pursuant to Indiana Code 22-9-1.-10, Contractor, any sub-contractor, or any person acting
on behalf of Contractor or any sub-contractor shall not discriminate against any employee
or applicant for employment to be employed in the performance of this Agreement, with.
respect to hire, tenure, terms, conditions or privileges of employment or any matter
:3 e
directly or indirectly related to employment, because of race, religion, color, sex,
disability,national origin, or ancestry,
B. Pursuant to Indiana Code 5-16-6-1, the Contractor agrees:
That in the hiring of employees for the performance of work under this
Agreement of any subcontract hereunder, Contractor, any subcontractor, or any
person acting on behalf of Contractor or any sub-contractor, shall not
discriminate by reason of race, religion, color, sex, national origin or ancestry
against any citizen of the State of Indiana who is qualified and available to
perform the work to which the employment relates;
2. That Contractor, any sub-contractor, or any person action on behalf of Contractor
or any sub-contractor shall in no manner discriminate against or intimidate any
employee hired for the performance of work under this Agreement on account of
race, religion, color, sex, national origin or ancestry;
3, That there may he deducted from the amount. payable to Contractor by the City
under tins Agreement, a penalty of five dollars (S5,00) for each person for each.
calendar day during which such person was discriminated against or intimidated
in violation of the provisions of the Agreement; and
4. That this Agreement may be canceled or terminated by the City and all money
due or to become due hereunder may be f.brfeited, for a second or any subsequent
violation of the terms or conditions of this section of the Agreement.
Violation of the terms or conditions of this Agreement relating to discrimination or
intimidatiol shall be considered a material breach of this Agreement.
SECTION IX, RELEASE OF LIABILITY
Contractor hereby agrees to release and hold harmless the City and all officers, employees, or
agents of the same from all liability which may arise in the course of Contractor's performance of
its obligations pursuant to this Agreement,
SECTION X. MISCELLANEOUS
This Agreement is personal to the parties hereto and neither party may assign or delegate any of
its rights or obligations hereunder without the prior written consent of the other party. Any such
delegation or assipment, without the prior written consent of the other party, shall be mill and
void. This Agreement shall be controlled by and interpreted according to Indiana law and shall.
be binding upon the parties, their successors and assigns. This document constitutes the entire
Agreement betweel the parties, although it may be altered or amended in whole or in part at any
time by filing with the Agreement a written instrument setting forth such changes signed by both
parties. By executing this Agreement the parties agree that this document supersedes any
previous discussion, negotiation, or conversation relating to the subject matter contained herein.
This Agreement may be simultaneously executed in several counterparts, each of which shall be
an original and all of which shall constitute but one and the same instrument.
The parties hereto submit to jurisdiction of the courts of Wayne County, Indiana, and any suit
arising out of this Contract must he filed in said courts. The parties specifically agree that no
arbitration or mediation shall be required prior to the commencement of legal proceedings in said
4 P a
Courts. By executing this Agreement, Contractor is estopped from bringing suit or any other
action in any alternative forum, venue, or in front of any other tribunal, court, or administrative
body other than the Circuit or Superior Courts of Wayne County, Indiana, regardless of any right
Contractor may have to bring such suit in front of other tribunals or in other venues.
Any person executing this Contract in a representative capacity hereby warrants that he/she has
been duly authorized by his or her principal to execute this Contract.
In the event of any breach of this Agreement by Contractor, and in addition to any other damages
or remedies, Contractor shall be liable for all costs incurred by City in its efforts to enforce this
Agreement, including but not limited to, City's reasonable attorney's fees.
In the event that an ambiguity, question of intent, or a need for interpretation of this Agreement
arises, this Agreement shall be construed as if drafted jointly by the parties, and no presumption
or burden of proof shall arise favoring or disfavoring any party by virtue of the authorship of any
of the provisions of this Agreement.
IN WITNESS WHEREOF, the parties have executed this Agreement at Richmond, Indiana, as of
the day and year first written above, although signatures may be affixed on different dates.
[THE REMAINDER OF THIS PAGE INTENTIONALLY LEFT BLANK—SIGNATURES TO
FOLLOW]
5 I Paqe
"CITY" -CONTRACTOR"
The City of Richmond, Indiana, by and Hoosier Sheds, LLC
through its Board of Sanitary
Commissioners
By:
-5ue iller, President 4.;
Dated: 101 Lf -2, 3 (Printed): Pfloor-ti Et Pcf5e
Title: 561 te AILA
AiTraTillikshi, Vice President
Dated: /0/2v/202,3 Dated: I I121 2-0 2 3
Gre ins, ember
ted: 10 /
APPROVED:
-Snow, fayor
Dated: 76) 5.-/cs
6
Hoosier Sheds, LLC Delivery Questions? Call: 270-213--1 549
1206 Beckley Osborne Rd Sebree KY 42455
Fax Order to: 270-639-6298 Date of Sale IC". 0 2-- 2-0 23
Sold to: Name C J 4.1 C) '"`-61.0k0v.J Cell phone
Address Home phone
E-mail address
office use only
Delivery Address ( )To Be Built
(If different)
( ) Off Lot
( ) Repo
?-(� .- bli0 - /Cc
Metal, Paint, Urethane, or Vinyl
t Building Id Number t Shingle Roof Metal Roof Wall Trim Color
Siding Building Style Size Color Color Color • Vinyl:Shutter Color
W. 1 le-xGb
Sldln4 Materials; Shingle Roof Metal* Urethane Stain Paint Colors; ([ Vinyl Colors;
Metal Colors: Colors; Colors; Almond Clay
Painted Black Black Chestnut Brown Black Flint
Treated Wood Dark Brown Burnished Slate Driftwood Brown Tan
Urethaned WeatherwDod Charcoal Ebony Clay White
Vinyl Green Honey Gold Green (Dark) Shutter Colors:
Red Red Mahogany Dark Gray Black
Light Gray Brown
*See the Metal Color Chart for more choices. Additional charges apply for select colors. Red (Barn Red) Charcoal
Delivery Questions? Call: 270-213-1549 Tau e fGtreen
ed
Attach an additional page with directions to delivery address and a map If necessary. White White
CASH SALE RTO SALE Options: .
Sales Price 13, t4'41 Sales Price / ,. td~ 4"4,4rnev
Options Cost Security Deposit 4c6
Subtotal 1st Monthly Payment '`7 47'
le le RAJ-if
ri:__
Sales tax ( %) ,Sales tax ( %) S W t L
Total Total
(C--
Total Received ' Total Received ���
q 2 - -s't i
1/4
Balance Due /3- re 4•
Attach an additional page with a
Sales Lot:
411 00,4,,k drawing If necessary.
Hoosier Sheds, LLC is not responsible for ruts In the yard or any other property damage. The customer must provide
concrete block for leveling if the building site Is more than 8" unlevel. Delivery path must be free of obstructions
(tree branches fences, etc.) If the driver,is-unable to finish delivery because of obstructions or Inadequate concrete
blocks, the d mpaay will:charg )' 15.Q-,. 0 to return at a later date to finish the setup and leveling.
�rYi P� ' ibS-r ter.-
X itD(OM - --_:.____.7-----°E i
Customer Signature
Customer is responsible to supply concrete leveling blocks. Sheds are measured eave to eave.
i XHi6-1-T_._Q- PAOi 1 Qf` 1 1
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•
ACE? 8 CERTIFICATE OF LIABILITY INSURANCE DATE IMWODEYYYYT
11/7/2023
THIS CERTIFICATEIS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS
' CERTIFICA E DOES NOT AFFIRMATIVELY' OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES
BELOW. T IS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED
REPRESEN ATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER.
IMPORTAN : If the certificate holder is an ADDITIONAL INSURED,the policy(les)must have ADDITIONAL INSURED provisions or be i endorsed.
If SUBROG TION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement A statement on
this certlfic e does not confer rights to the certificate holder in lieu of such endorsementisj.
, . . . . •
PRODUCER tonsocr eggy Roey
We tern Kentucky Insurance,Agency,Inc. NFE PRONE (270)247-2582 (270)247-5449
30 South Sixth Street
PO
ri5114.9-! :- -
: ox 388 „Apr 0051. peggvt?'.,eSternkentuckyinsurance,net
Ma field,KY 42066
INSURES).AFFORDIG COVERAGE , NAIL W.
INSURED Hoier Sheds LLC ,
INSURER A: Ohio Security
' 24082
,
INSURER 8
Ohio Casualty 24074
:120 Beckley Osborne Road
VVSC
Sets ee, KY 42455
! •
'INSURER C: WestIn Surety Co
INSURER 0
INSURER E I
INSURER F:
COVERAGES CERTIFICATE NUMBER: REVISION NUMBER:
THIS IS TO C'','TIEY THAT THE POLICIES OF INSURANCE,LISTED BELOvV HAVE UEEN ISSUED'TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD
INDICATED, NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS
CERTIFICATE AY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT' TO ALI., THE TERMS,
EXCLUSIONS AND CONDITIONS OF SUCIf POLICIES LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS, .
. ,.
INSR i ADOCSUMie"'
'II POLICY UP POLICY EV.' I
,,rp; TYPE OF INSURANCE , I , , POUCY NUMBER ,IMM/BINYYYY)i trasivcoryrys LIMITS
1
A COMME IAL GENERAL LIABIUTY I BLS59183878 109/21/2023 n/21/2024 i (iAcH occ t,)RRENcE
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, PERSONAL 8 ADV INJUR Y ,$ 1,000000
. !9,EN.AGGRE ALE LIMIT APPLIES PER : i GE NE.RAL,AGGREGATE $ 2000,000
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I COMBINED SiNGLE Lair $
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B ,UMBREL LIAB
Nir OCCUR 1 ! US059183878 I09/21/2023 I 09/21/2024
EACH OCCURRENCE $ 1,000,000'
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EXCESS L B , 1._.....1 CLAWS.MADE,i ' ' A,C.1GR EGAT E ,3 1,000„000
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A WORKERS COP6 ENSATVON VVS62918437 103/23/2023 103/23/2024 I v175FI'frru,,..-; , ',(,?4,'"'-' T,
AND EMPLOYER 'LLABILITY
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OF ME3E, E AC LIOED? L_____J ' ,
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!Limit $5000:
GeneraI Cont actor Co of Delaware , , 111/30/2023 I11/30/2024 1 ,
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, .
I DESCRIPTION OF OPE MRS/LOCATIONS/VEHICLE,S(ACORD 101,A0clitlonel Remertus Schedule,may he attached IF mere spec*Is ressulredI
CERTIFICATE HOLDER
CANCELLATION
City of Richmond _
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED,BEFORE
2380 Llberty Ave THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
Richmond,IN 47374 ACCORDANCE WITH THE POLICY PROVISIONS,
AUTWORIZED REPRESENTATIVE
CF .
.1";1988-2015 ACORD CORPORATION. All rights reserved.
ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD
1
State Farm Insurance
PO Box 2368
�nvni�mn IL01r0zzono
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State Farm Mutual Automobile Insurance Company
HDOS|ER SHEU8LLC
1308 BECKLEYOSBORNE RO
SE8REEKY 43455'0169
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Policy number: 38,0086-E2517
-
October 8O'2O23
We're contacting you about the above State FnnnOpolicy.
We're enclosing your Declarations for the above policy due to a recent change. We are enclosing a copy
nf your new endorsements, ifany.
This is not a bill.The policy premium is being added to your billing account. If you'd Uhw to pay
now, you can pay adsbatefann.comor contact your agent.
THANK YOU FOR CHOOSING STATE FARM.VVE APPRECIATE YOUR BUSINESS.
Ifyouhave anyquestions,callyour State FennAgentKowh Chandler at270-029-91O4. Ifyooum deaf,Aan/u/hearing,o/Uunot
muynorvoice tom/mmwnkmte,youmeynontactux via 711n/other relay services.
cc: Kevin Chandler
17'1454
DISCLAIMER: This message is provided for informational purposes only and does not grant any insurance
coverage. The terms and conditions Vf coverage are set forth i7 your State Farm Car Policy booklet, the
most recently issued Declarations, and any applicable endorsements.
Page 1m1
,
State Farm Mutual Automobile Insurance Company
State Farm Insurance
PO Box 2368
Bloomington, IL 61702-2368
Your State Farm Agent
Kevin Chandler
Chandler Ins and Fin Svcs Inc
22 US HWY 41 A South
Dixon KY 42409
Bus: 270-639-9104
Email:kevirtchandler.wthf@statefarm.com
* cfrr0
11.11 MWMPIM
Policy number: 3840686-E25-17
Named Insured: HOOSIER SHEDS LLC
Policy period: November 25,2023 to May 25,2024
The policy period begins and ends at 12:C.1 am standard time.
BUSINESS CAR POLICY
Policy address:
1206 BECKLEY OSBORNE RD Years in business: 21
SEBREE KY 42455-9169 Business description: Not Otherwise Classified -Manufacturing.
AU TOM RENEWAL
This State Farm® policy will be renewed automatically subject to the rates in effect, the coverages carried, the applicable limits,
deductibles, and other elements that affect the premium that apply at the time of renewal.
ENTITY
Corporation
POLICY PREMIUM
This is not a bill If an amount is due,then a separate statement wit/be sent prior to the due date. The premiums shown in the table(s)below are the 6-month
premiums for the characteristics of the poky as described in this Declarations.
TrtyA ju,/' %`' '%(%;;;;IMPW11107YMKM,VAVVVV,V,Y) , VIA1,,,AWZIMpli'090//,M01%;:%4*,:,;,4;;7%,t/40;90Wel 424 92:
wtr".:FT.L.""wm, '"),%,*;<0*,/,9 00‘ep 4,v4;t1. ,
Kentucky Surcharge $38.25
TOTAL SAVINGS1(included in Total P-emium above) $0.00
'Savings from Discounts Applied shown below.
, ,'";;;AVA'41,)11;e,6N/kanAi4;iiiWz4,,lc, „ ‘440010;440,0S46007Aa";,Neek
,,,f A,40:00,00`106$4,4440"44*14040,,V;A•il,WWi00041r,,,,,,, ATW://Ag'
Vehicle '1'"L1'''Al4fNeffMC4F*.rAVgfriti40044,11W,,,,,,lieff 'fffifffVff,fat .,ff';1"
001 Premium $418.76 $28.94 $6.25 $30.26
002 Premium $432.77 $30.26 $5.95 $28,75
Policy number 3840686-E25-17 Page 1 of 3
C1008599KY-CV 1008599 2010 151510 210 09-11.2021
StateFarm.
Vehicle 0l,V: :;:l,;:gag,j';',0151(girgagrAgagggpOttgabiatpaakptgAggV:lelgg.,l': Total premium by car
001 Premium $223.54, $344.91 $1,052.66
Deductible $2,000, $2,000
002 Premium $176.86 $397,67 $1,072.26
Deductible $2,000 $2,000
Discounts Applied"'
'Savings amount displayed in Total Premium section above. These Discounts do not apply to all coverages.
For complete program details,please cortact your State Farm agent.
Vehicle Antl.TheftPellce
Discount
002
Surcharges Applied
Vehicle Kentucky Surchrqe ,
001 ,/
002
VEHICLE SCHEDULE
VEHICLE 001
Vehicle year:2024 Gross vehicle weight(lbs):14000 Garaged address:
Make:CHEVROLET Total MSRP:$74,238 1206 BECKLEY OSBORNE RD
Model:3500HD Radius of operation(mL):200 mi. SEBREE KY 42455-9169
VIN:1GB4YTEY7RF239764 Annual mileage(mi.): Territory:023
Vehicle use description:Delivery to Business-Other-On Demand
VEHICLE 002
Vehicle year:2022 Gross vehicle weight(lbs):11550 Garaged address:
Make:GMC Total MSRP:$66,290 1206 BECKLEY OSBORNE RD
Model:SIERRA 2500HD Radius of operation(mi.):75 mi, SEBREE KY 42455-9169
VIN:1GT49NEY6NF309799 Annual mileage(mi.):20000 mi. Territory:023
Vehicle use description:Delivery to Business-Other On Demand
COVERAGES AND 1,„1,','D'S
This policy provides the following coverages to the vehicles for which the appropriate "Coverage Symbol"and a corresponding premium
are shown in the"POLICY PREMIUM"schedules above.
Coverage
Symbol Coverage
A Liability Coverage Each Accident
$1,000,000
D Comprehensive Coverage
Collision Coverage
P10 No-Fault Coverage See Policy Schedule for Limits
U Uninsured Motor Vehicle Coverage Bodily Injury Limit
Each Person, Each Accident
$50,000 $100,000
W Underinsured Motor Vehcle Coverage Bodily Injury Limit
Each Person, Each Accident
$50,000 $100,000
Poky number 3840686-E251 7 Page 2 of 3
FORMS AND
This policy consists of this Declarations, the policy booklet- Form 9617C, and any endorsements that apply, including those listed
below an well as those issued subsequent tV the issuance pf this policy. '
Endon;nment(s)that apply tn the POLICY aoawhole
.
4917: mNENDATORYENDOR! BWBNT
|MP0RTANTNESSAGES
The change in premium anoreou@nf this policy transaction for November 25.2O23tu May 25.2O24. in+$97.53
mUTUALCQN0T|ONS
Membership. While this policy is in force, the first insured shown on the Declarations is entitled to vote at all meetings ofmembers
and to receive dividends the Board of Directors in its discretion may declare in accordance with reasonable classifications and
groupings Qfpolicyholders established hy such Board.
No contingent liability.This policy ionon'asoesneb|e.
Annual meeting. The annual meeting of the members of the company shall be held at its home office in Bloomington, Illinois,on the
second Monday cf June at the hour 0f1O:OOa.m, unless the Board of Directors shall elect bochange the time and place nfsuch
meeting, in which case, but not otherwise, due notice shall be mailed each member at the address disclosed in this policy at least 10
days prior ho thereto.
In Witness Whereof, the State Farm Mutual Automobile Insurance Company has caused this policy to be signed by its President and
Secretary at Bloomington, Illinois.
--- k'.'�m
� ��.
President Secretary
— -
Policy number.3840686-E25-17 Page 3 of 3