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BOOK
<br />9
<br />STATEMENT
<br />OF
<br />VALUES Fc.-h'LL-a
<br />(FOR USE WITN INSTITUTI
<br />ONAL PROGRAM.)
<br />Page No
<br />,Lee County
<br />,IN
<br />.C
<br />.
<br />Lee County
<br />Police Number
<br />Issue
<br />d To
<br />si
<br />o
<br />Board o ners
<br />o
<br />i
<br />BI
<br />Date
<br />Name of Company
<br />DESCRIPTION AND LOCATION
<br />VALUES
<br />This Space (ur Rv[ng
<br />It.
<br />t No
<br />OF PROPERTY
<br />Replacement C.
<br />Organization Us
<br />.
<br />Speciiy A-Bulding B Pusorul Property
<br />Actual Cash Value When Applicable
<br />1.
<br />a. '(s;noM^Iv6"9Y~eet
<br />347)750•
<br />ba Personal ProperL
<br />57,366.
<br />2.
<br />a.•Library (RC567-1)
<br />114 N. Steele
<br />74,900•
<br />b. Personal Property
<br />1201000.
<br />3.
<br />a. Library (RC466)
<br />309 Vest Plain Street
<br />2100.
<br />3 ,
<br />b. Personal Property
<br />16,000.
<br />4
<br />a. Courthouse (old) (RC318)
<br />.
<br />1316 South Horner Blvd.
<br />OG.
<br />267,5
<br />b. Personal Property
<br />18,000.
<br />5.
<br />a. Co)„sthouse (ne;n)(RC318)
<br />1518 S. corner Elva
<br />'-17170U•
<br />b. persona= Property
<br />151000.
<br />6.
<br />a. r.sc7ricultural Eldg. Un-neY_)
<br />225 S. Steele Street(RC587)
<br />13°,100.
<br />b. personal Prope-ty
<br />15,000.
<br />INSTRUCTIONS:
<br />1. The values shown should reflect the basis of coverage (ACV or Replacement Cost) for each item and for either Coverage 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 seats and desks, fixed tables, railings. ahars. clocks, bells, nre curtains.
<br />and stained glass windows,
<br />e. al) permanent fixtures (including organ(s)) being a permanent 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, in each building Nohich 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. ioundations of machinery or boilers and engines which are below the surface of the ground,
<br />c. pilings, piers, pipes, flues, wiring and drains which are underground,
<br />d. those portions of [calks, roadways and other paved surfaces which are outside of buildings,
<br />e. land values. cost of excavations, grading or filing,
<br />f. lawns, trees, shrubs, pianic, growing crops,
<br />g. motor boats, sail boats, aircraft, automobiles and self-propelled vehicles or machin=_s except motorized eoctpmer,t not
<br />licensed for us on public thoroughfares and operated principally on the premises,
<br />h. animals and pets,
<br />i. household furniture in apartments occupied by the insured, anc officer, director, stockholder or partner of the insured o.- am
<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 />Fore.. be1,33-24 (Ed. $-69) (OVER) Page 1 of 2
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