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<br />Page
<br />Po'icc Number
<br />By
<br />Company
<br />STATEMENT OF VALUES
<br />(FOP. USE WITH INSTITUTIONAL PROGRAM)
<br />To
<br />Fc.- LLB-:'
<br />Ed. 5-69)
<br />DESCRIPTION AND LOCATION
<br />V A L U E S
<br />This Space ]or Rating
<br />hem
<br />No.
<br />OF PROPERTY
<br />5 A-Buildin B-PereOnal Property
<br />pecify g
<br />Actual Cash Value
<br />Replacement
<br />nt 6Cost
<br />When Ap le
<br />Organization Use
<br />13,
<br />a. Broadway Library E ape
<br />Fear Rural Fire.Dist.)
<br />111 S. Main Street
<br />74,900•
<br />b. Personal Property
<br />10,000.
<br />14.
<br />a. Garage Maintenance (RC144)
<br />37,450.
<br />1305 Elm Street
<br />666."
<br />1^
<br />b. Personal Property
<br />,
<br />15.
<br />a. Landfill Maintenance (RS30)
<br />700.
<br />10
<br />Lemon Springs 2d/S 58-123E
<br />,
<br />b. Personal Property
<br />6,000.
<br />16.
<br />a. New Hope School (RS 135)
<br />~n
<br />7
<br />26
<br />1301 County Road
<br />,
<br />'
<br />Personal Property
<br />b
<br />NIL
<br />17.
<br />.
<br />a. Utility Bldg.-Temple Park
<br />1 504 Ilclnver St. (R049y)
<br />n cq0,
<br />f+
<br />~
<br />b. Personal Prop?rty
<br />NIL
<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.
<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 galls, fixed seats and desks, fixed tables, railings, altars. clocks, bells, fire cu::ain=_,
<br />and stained glass windows,
<br />e. 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 basement floor, or whe_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 />c. pilings, piers, pipes, flues. wiring and drains which are underground,
<br />d. those portions of walks, roadways and other pawed surfaces which are outside of buildings,
<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 self-propelled vehicles or machines except motori2ed 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. anv officer, director. stockholder or partner of the insured or any
<br />relative of the foregoing.
<br />5. Nothing contained in these instructions shall be construed as changing in any mariner the conditions of the policy.
<br />F°:m MLE-24 (Ed. 5-69) (OVER) Page 1 of 2
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