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Page No_._.......r~....
<br />Poliev Dumber
<br />By
<br />Name of Company
<br />F n. W. LB-a
<br />(Ed. 5-ts?
<br />hem
<br />DESCRIPTION AND LOCATION
<br />OF PROPERTY
<br />V A L U E S .
<br />No.
<br />Specify A-Building B-Pvsoml P
<br />g roperty
<br />I
<br />_
<br />Actual Cash Value
<br />Replteencm Cos:
<br />When Applicable
<br />This Space in. Raring
<br />Organisarion Use
<br />23.
<br />a. Raw Shelter Bldg. Horton
<br />I
<br />Park, Washington Ave. (RC630
<br />)
<br />3,210.
<br />b. Personal Property
<br />I
<br />IFIZ
<br />24.-
<br />a. Utility Bldg. Third St. Park
<br />409.S. Third St. (RC60c.)
<br />2,6 5.
<br />b. Personal Property
<br />- 1,500.
<br />25.
<br />a. Senior Citizens Center
<br />(Old Seaboard Depot)
<br />126 S: ;Moore St. (R'C506)
<br />6=,200.
<br />26.
<br />a. Bat:lhouse-O.T. Sloan Park
<br />80G(R) St. (Fci )
<br />96,0'0.
<br />b. Personal Property
<br />10,000.
<br />27.
<br />a. Pro Shop-O.T. Sloan Park
<br />0,00 (R) Bragg St. (RC15)
<br />23,540.
<br />b. Personal Proy^erty
<br />2,000.
<br />25.
<br />a. 1972 Oat-B=ook Mobile Home
<br />Ser. No. 5221
<br />1-yons Bottom
<br />1,500.
<br />b. Personal Property
<br />I'iIL
<br />11 INSTRUCTIONS:
<br />1. The values shown should reflect the basis of coverage (ACV or Replacement Cos;) for each item and for either Cove, aye 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 scats and desks, fixed tableE, railings, altars, clocks, bells, fire curtains,
<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 appliance fire extinguishing equipment, outdoor equipment.
<br />3. Include in personal property values, personal property, including the legal liability of the insured for similar proaertc 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 value;.
<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 />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 or filing.
<br />f. lawns, trees, shrubs, plants, growing crops,
<br />g. motor boats, sail boats, zireraft, 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 />h. animals and pets,
<br />i. household furniture in apartments occupied by the insured, any officer, director, stockholder or partner of the insured or an,
<br />relative of the foregoing. -
<br />5. Nothing contained in these instructions shall be construed as hanging in any manner the conditions of the policy.
<br />Fcan MLB-24 (Ed. s-es) - (OVER) Page 1 of 2
<br />BOOK 9 1"At-f~02
<br />STATEMENT OF VALUES
<br />(FOR USE WITH INSTITUTIONAL PROGRAM)
<br />Date
<br />
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