|
Page No
<br />
<br />Police N umber
<br />STATEMENT OF VALUES
<br />(FOP. USE WITH INSTITUTIONAL PROGRAM:)
<br />To
<br />Form MLB--_
<br />(Ed. s.ss
<br />By Date
<br />Name of Company
<br />I
<br />DESCRIPTION AND LOCATION
<br />V A L U E S
<br />Thi
<br />S
<br />f
<br />R
<br />i
<br />tun
<br />No.
<br />OF PROPERTY
<br />Specify A-Building H-Pvsmul Property
<br />-
<br />Actual Cash Value
<br />Replacement Cost
<br />When Applicable
<br />s
<br />pace
<br />or
<br />at
<br />ng
<br />Organization Use
<br />Comfort Station San Lee
<br />Park ld/S SR-1510
<br />3-1/2'
<br />,
<br />mile east of Sanford
<br />8,000.
<br />b. Personal Property
<br />till
<br />35,
<br />a. Pavillion - Bldg.
<br />San Lee Recreation ParK,
<br />,Ar/S S^-1510 3-112 file
<br />East of Sanford
<br />16,000.
<br />b. Personal Property
<br />?\7IL
<br />36.
<br />a. r1ulti-P pose Bldg. (Old
<br />Pampirs Suation)San Lee ;ar
<br />k
<br />'r:/j SR-1510 3-1/2 F . East
<br />of Sanford
<br />150,000.
<br />37.
<br />a. 152-58 S. Steele Street
<br />Sanford
<br />500,0..v.
<br />I
<br />b. Personal Property
<br />1255000.
<br />'
<br />INSTRUCTIONS:
<br />1. The values shown should reflect the basis of coverage (ACV or Replacement Cost) for each item and for either Cove. age' A
<br />- Buildings, Coverage B - Personal Property or both.
<br />2. Include in building values
<br />a. building service and maintenance equipment owned by the insured,
<br />b. floor coverings fastened to floors or walls, fixed scats. and desks, fixed tables. railings, altars, clocks, bells, fire cu::ai^s,
<br />and stained glass windows,
<br />e. all permanent fixtures (including organ(s)) being a permanent part or the building,
<br />d. mirrors, air conditioners, domestic appliances, fire extinguishing equipment, outdoor equipment.
<br />3. Include in personal property values, personal property, including the legal liability of the insured ion simiiar grope. tv belong-
<br />ing in whole or in part to others and held by the insured, in each building which is not otherwise a part of building values.
<br />4. The following are not covered and their value should not be included in values shown:
<br />a. brick, stone or concrete foundations which are below the undersurface of the lowest basement floor, or where there is no
<br />basement, which are below the surface of the ground inside the foundation walls of the building,
<br />b. foundations of machines- or boilers and engines which are below the surface of the ground,
<br />e. pilings, piers, pipes, flues, wiring and drains which are underground,
<br />d. those portions of walks, roadways and other paved surfaces which are outside of building-,
<br />e. land values, cost of excavations, grading or filing,
<br />f. lawns, trees, shrubs, plants, growing crops,
<br />g. motor boats, sail boats, aircraft, automobiles and selr-propelled vehicles on machines except motorized rqn o;::rn; no:
<br />licensed for us on public thoroughfares and operated principally on the premises,
<br />h. animals and pets,
<br />i. household furniture in apa. tments occupied by the insured, en.- officer, director, stockholder or partner of the insured or aa;.
<br />relative of the foregoing.
<br />5. Nothing contained in these instructions shall be construed as changing in any manner the conditions of the policy.
<br />For= MLB-24 (Ed. 5-E9) (OVER) Page I or 2
<br />
|