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Page No.... .._2..........
<br />STATEMENT OF VALUES
<br />(FOR USE WITH INSTITUTIONAL PROGRAM)
<br />Policy -Number Issued
<br />By
<br />Name of Compan.
<br />Form MLB-24
<br />(Ed. 5-69
<br />It
<br />m
<br />DESCRIPTION AND LOCATION
<br />V A L U E S
<br />ace for Ratin
<br />This S
<br />e
<br />No.
<br />OF PROPERTY
<br />Specify A-Building B-Persoml Property
<br />Actual Cash Value
<br />Replacement Cost
<br />When Applicable
<br />g
<br />p
<br />Organization llse
<br />7.
<br />a. Health Center RC4?2'
<br />406 rlakepeace Street
<br />9-0,300.
<br />b. Personal Property
<br />30,000.
<br />8.
<br />a. Jail (RC-480)
<br />206 McIntosh Street
<br />197,950.
<br />b. Personal.Property
<br />101000.
<br />9.
<br />a. Dept. of Soc. Ser.(RC417)
<br />906 Martin Streets
<br />140,800.
<br />b. Personal Property
<br />19,414,
<br />10.
<br />a. Audio-Visual Center(RC148)
<br />10,?00.
<br />405 Evergreen Lane
<br />b. Personal Property
<br />NIL
<br />11.
<br />a. Nental-Health (RC26)
<br />321,000.
<br />130 Carbonton Road
<br />_
<br />D. Personal Property
<br />50,000.
<br />12.
<br />a. San`crd Redevelopment Comm.
<br />407 Evergreen Lane (RC148)
<br />16,050.
<br />b. Personal Property
<br />NIL
<br />I
<br />I
<br />INSTRUCTIONS:
<br />1. The values shown should reflect the basis of coverage (AC\r 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, altars, clocks, belle, fire curtains,
<br />and stained glass windows,
<br />c. all 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 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 basemen; 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 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 walks, roadways and other paved surfaces which are outside of buildings,
<br />e. land values, cost of excavation=s, grading or filing,
<br />f. lawns, trees, shlbs_, plants, growing crops.
<br />g. motor boats, sail boats, aircraft, automobiles and self-propelled vehicles or machines except motorized equipment not
<br />licensed for us on public thoroughfares and operated principally on the premises,
<br />h. animals and pets,
<br />L household furniture in apartments occupied by- the insured, any officer, director, stockholder or partner of the'insured er any
<br />relative or the foregoing.
<br />5. Nothing contained in these instructions shall be construed as changing in any manner the conditions of the policy.
<br />Form MLB-24 (Ed. 5-69) (OVER) Page I of 2
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