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<br />Page No.......
<br />Policy Number
<br />By
<br />Item
<br />No.
<br />18. a.
<br />1°. a.
<br />20. la
<br />t
<br />21. a
<br />b
<br />22. a
<br />STATEMENT OF VALUES
<br />(FOR USE WITH INSTITUTIONAL PP.OGRAM)
<br />Issued
<br />Name of Company
<br />DESCRIPTION AND LOCATION
<br />OF PROPERTY
<br />Specify A-Building B-Personal Property
<br />Recreation Center (RC176)
<br />Dalrym le Park
<br />140 (R~ Globe Street
<br />Personal Property
<br />Concession Stand (R0176)
<br />Dalrymple Park'
<br />140-1/2 (R) Globe Street
<br />Personal Property
<br />Scorer's Stand (RC176)
<br />Dalrymple Park. Globe Street.
<br />Personal Property
<br />Utilit S1dc. Parr. Ave. Park
<br />807 Parr. Dr. (RC523)
<br />Personal Property
<br />~ath House - Hor UOn ~ ark
<br />2101-C7 ldashingtOD r_ti'enUe
<br />(RC 630)
<br />Personal Propert_
<br />(Ed. 549)
<br />VALUES
<br />This Space for Rating
<br />Actual Cash Value I Replacement Cost Organization Use
<br />When Applicable
<br />2,000.
<br />.2,675-
<br />KIi
<br />1,500.
<br />1dIl
<br />10,700.
<br />4,500.
<br />21,400..
<br />500.
<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 />,
<br />b. floor coverings fastened to floors or galls, fixed seats and desks, fixed ;abler, railings, altars, clocks. bells, pre curtain-
<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_s, fire extinguishing equipment, outdoor equipment.
<br />3. Include in personal property values, personal property including the legal liability of the insured for cimila.- prover;, belong-
<br />ing in }whole or in part to others and held by the insured, in each building which is not otherw ise a part of building values.
<br />4. The following are not cowered 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 />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, shrnb5, plants, growing crops
<br />g. motor boats, sail boats, aircraft, automobiles and self-propelled vehicles or machines except motorized equipment no;
<br />licensed for us on public thoroughfares and operated principally on the premises,
<br />In. animals and pet=s,
<br />L household furniture in apartments occupied by the insured, any officer, director, stockholder or partner of the- insured or any
<br />relative of the foregoing.
<br />5. Nothing contained in Ltrese instructions shall be construed as changing in any manner the conditions of the policy.
<br />Fcr.. h:LE-24 (£d. 5-E9) (OVER) Page 1 of
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