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Page No..........
<br />Police Number
<br />By
<br />Boor
<br />9
<br />':rAG05
<br />STATEMENT
<br />OF
<br />VALUES
<br />(FOR USE WITH INSTITUTIONAL PROGRAM)
<br />INatne of Company
<br />Fs. MLB~2<
<br />(Ed. S-59.
<br />Item
<br />DESCRIPTION AND LOCATION 1
<br />F
<br />P
<br />V A L U E S
<br />Thi
<br />S
<br />f
<br />R
<br />i
<br />No.
<br />PRO
<br />O
<br />ERTY
<br />- 5PecifY A-Building B-Pvaa
<br />ml Property
<br />Actual Cash Value
<br />I Repiacement Co.:
<br />When Applicable
<br />pace
<br />s
<br />or
<br />at
<br />ng
<br />Organization Usc
<br />38.
<br />2. 1310 'Elm St. Sanford, P.C.
<br />Dwelling-2 Story Frame
<br />App. Roof, Ter_. Occupied
<br />12,500.
<br />i
<br />3,581,648.
<br />TOT._L BUILDIIIGS I
<br />3,047,?00-
<br />rc r_- Psor;cs. LRCP_RTY
<br />533„i`--'s.
<br />Dotes:
<br />;teals 33
<br />34, 35, 36 Fot R l
<br />ed as Const
<br />ruction has
<br />just
<br />,
<br />been completed
<br />i
<br />Teen ~j7 Lee CO., :-.C. Lee
<br />Ollity Board
<br />of Co ssn
<br />oners
<br />ohm 55/100's Of Lee Co. 0£fl
<br />Bldg.
<br />e
<br />52-5c S. St
<br />eele Wit.
<br />Sanford) Fire insurarce LiIIl
<br />.
<br />it or T:-is L
<br />ocation. Refl
<br />ect=
<br />CnlT Their Ov.•nership %
<br />I
<br />I I
<br />I 1
<br />~
<br />INSTRUCTIONS:
<br />1. The values shown should reflect the basis of coverage (AC\' or Replacement Cost) for each item and for either Coverage A
<br />- Buildings, Coverage B - Personal Property or both. j
<br />2. Include in building values I
<br />a. building service and maintenance equipment owned by the insured.
<br />b. floor coverings fastened to floors or walls, fixed seats and desks, fixed tables, railings, altars, clocks, bells, fire curtains,
<br />and stained glass windows,
<br />e. all permanent fixtures organ(s)) bein a permanent
<br />(including g part of 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 for similar property belong-
<br />ing in whole or in part to others and held by the insured, Iin 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 v:he:e there is no
<br />basement, which are below the surface of the ground inside the foundation walls of the building.
<br />b. foundations of machinery 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 buildings,
<br />e, land values, cost of excavations, grading m filing,
<br />f. lawns, trees, shrubs, plants, growing crops,
<br />g. motor boats, sail boats, aircraft, automobiles and self-propelled vehicles or machines except mo:orized equipment not
<br />licensed for us on public thoroughfares and operated principally on the premises,
<br />It. animals and pets,
<br />i. household furniture in apartments occupied by the insured, any officer, director, stockholder or partner of the insured o: any
<br />l
<br />relative of the foregoing.
<br />5. Nothing contained in these instructions shall be construed as changing ir. any manner the conditions of the policy.
<br />I
<br />Fo..n MLB-24 (Ed. 5-69) (OVER) Page 1 of 2
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