own, or held by him in trust or on commission, or on joint account with others, or sold, but not delivered, in all or any of the brick or stone warehouses, and while in transitu, in or on any of the streets, yards or wharves, in the cities of New York, Brooklyn, Jersey City and Hoboken, and unless under the protection of a marine policy in any ship or vessel in the ports of said cities-subject to the following conditions of average. It is hereby declared and agreed that in case the property aforesaid in all the buildings, places, or limits, included in this insurance, shall, at the breaking out of any fire or fires, be collectively of greater value than the sum insured, then this company shall pay and make good such a portion only of the loss or damage as the sum insured shall bear to the whole value of the property aforesaid, at the time when such fire or fires shall first happen. But it is at the same time declared and agreed, that if any specific parcel of goods included in the terms of this policy, or such goods in any specified building or buildings, place or places, within the limits of this insurance, shall at the time of any fire be insured in this or any other office, this policy shall not extend to cover the same, excepting only as far as relates to any excess of value beyond the amount of such specific insurance or insurances, and shall not be liable for any loss unless the amount of such loss shall exceed the amount of such specific insurance or insurances, which said excess only is declared to be under the protection of this policy and subject to average as aforesaid. It being the true intent and meaning of this agreement, that this company shall not be liable for any loss, unless the amount of such loss shall exceed the amount of the specific insurance or insurances, and then only for such excess, which said excess shall be subject to average as above. This policy does not cover in Hudson River Railroad stores, in any tobacco inspection or other tobacco warehouse, or in any grain elevator or elevator store in New York City, Brooklyn, Jersey City or Hoboken. B (Another form of description): On merchandise, hazardous, not hazardous, and extra hazardous, his own, or held by him in trust or on commission, or on joint account with others, or sold but not delivered, in all or any of the brick or stone warehouses, and while in transitu, in or on any of the streets, yards or wharves, in the cities of New York, Brooklyn, Jersey City and Hoboken, and unless under the protection of a marine policy in any ship or vessel in the ports of said cities-subject to the following conditions of average. It is hereby declared and agreed that in case the property aforesaid in all the buildings, places, or limits, included in this insurance, shall, at the breaking out of any fire or fires, be collectively of greater value than the sum insured, then this company shall pay and make good such a portion only of the loss or damage as the sum insured shall bear to the whole 'value of the property aforesaid, at the time when such fire or fires shall first happen. It is further declared and agreed, that goods in stores, warehouses, and other places, in which the assured has specific insurance or insurances, are not covered in whole or in part by this policy; and that the same is not intended to attach to such goods in whole or in part. This policy does not cover in Hudson River Railroad Stores, in any tobacco inspection or other tobacco warehouse, or in any grain elevator or elevator store in New York City, Brooklyn, Jersey City or Hoboken. It is understood and agreed, that in case the above-named building or any part thereof being occupied shall be rendered untenantable by fire, so as to cause to the assured an actual loss of rents, this company shall be liable for such loss of rent ensuing therefrom, not exceeding the sum insured. The assured hereby agrees to rebuild or repair the premises in as short a time as the nature of the case will admit; but if for any reason this shall not be done, the limit of time required for the purpose to be determined, if necessary, by estimates of competent builders obtained by the company and by the assured. Loss to be computed from the date of the occurrence of said fire, not being limited by day of expiration named in policy, as to fire occurring before such expiration, and cease on said building being rendered tenantable. And the sum insured will be taken as the yearly rent of the premises, and this company shall be liable only for such proportion of any loss as the sum hereby insured bears to the actual annual rent of the building. It is understood that the rental value of that portion of the above described premises occupied by the assured or employees is covered by this policy. IX. Form of Clause for Insurance of Use and Occupancy. ...... On the use and occupancy of his mill buildings, situate at It is a condition of this contract of insurance that, if the said buildings or machinery therein, or either of them, or any part thereof, shall be destroyed, or so damaged by fire occurring during the continuance of this policy that the mill is entirely prevented from producing goods, this company shall be liable at the rate of ........ dollars per day for each working day of such prevention, and in case the buildings, or machinery, or any part thereof, are so damaged as to prevent the making of a fuli daily average production of goods, this company is to be liable per day for that proportion of ........ dollars which the product so prevented from being made bears to the average daily yield previous to the fire, which, for the purpose of this insurance is agreed to be the average daily production of goods based upon the time said mill was running for one year previous to the fire, not exceeding in either case the amount insured. Loss to be computed from the day of the occurrence of any fire to the time when the mill could with ordinary diligence and dispatch be repaired or rebuilt, and machinery be replaced therein, and not to be limited by the day of expiration named in the policy. STATE OF COUNTY OF X. Form of Proofs of Loss. SS. me, ........9 BE IT KNOWN, That on this ...... day of.... 189.., before a Notary Public duly commissioned and sworn, and residing in the County and State aforesaid, personally appeared ..............., who, being duly sworn, says that the following statement and the papers therein referred to and signed with his own hand contain a particular, just and true account of his loss in the words and figures following, to wit: ........ I. That on the day of ........, 189.., the ........ Insurance Company by their Policy of Insurance, numbered ........, did insure the party herein and therein named against loss or damage by fire to the amount of .............. dollars on (description of property insured from the policy) for the term of ........ from the ........ day of the........ day of ........, 189.., at noon. ...... ...... , 189.., to II. That in addition to the amount covered by said policy of said company, there was other insurance made thereon to the amount of ........ dollars, as specified in the following schedule, besides which there was no other insurance thereon. (List of policies covering any of the property, showing as to each policy its date, term, and amount, the name of the company, and a copy of the description and schedule of property insured contained in such policy.) (statement of III. That the property insured belonged to interest of insured and of all others in the property and of all incumbrances thereon and changes of title, etc., since the issuing of the policy). IV. That the building insured or containing the property destroyed or damaged, was occupied at the time of fire in its several parts by the parties hereinafter named, and for the following purposes, to wit: (List of tenants.) V. That the actual cash value of the property so insured amounted to the sum of........ dollars at the time immediately preceding the fire, as set forth in the following schedule: That on the ........ day of ...... 189.., a fire occurred by which the property insured was injured or destroyed to the amount of dollars, as set forth in the following schedule which the deponent declares to be a just, true and faithful account of his loss as far as he has been able to ascertain the same: (Schedule of property damaged or destroyed, showing the cash value of each item thereof and the amount of loss thereon.) And the insured claims of the ........ Insurance Company the sum of ........ dollars. (If there are subdivisions in policy, also a statement of the amount claimed under each subdivision.) VI. That the fire originated (statement of knowledge and belief of the insured as to the time and origin of the fire), and the said deponent further declares that the said fire did not originate by any act, design or procurement on his part, or in consequence of any fraud or evil practice done or suffered by him, and that nothing has been done by or with his privity or consent to violate the conditions of insurance or render void the Policy aforesaid. (insured.) Sworn to before me this day of...... 188... Notary Public. } XI. Form of Application for Life Insurance. I hereby apply for an assurance of $ .. ........ ..... on the ...... plan, on ...... 18. for ....... years resident of intemperate in the use of stimulants or narcotics. I agree that the answers given herewith to the questions of the Agent and Examiner, which I declare and warrant to be true, shall be the basis of my contract with the company, and that such contract shall at all times and places be held and construed to have been made in the City of......... I also agree that if within two years from this date, the Insured shall, without the written consent of the company, reside or travel elsewhere than in or to the United States, Canada, or Europe; or shall within such period and without such consent, be personally engaged in blasting, mining, submarine operations, or in the making of explosives, or in service on any railway train, or on a steam or sailing vessel, or in naval or army service in times of war; the policy hereby applied for shall thereupon cease and determine. Questions to be asked by the Agent, and answered by the person to be insured: 1. A What is your full name? B Are you married? 2. What is your occupation? (Give kind of business and position held.) 3. Are you in good health? 4. A For whose benefit is the proposed insurance? в How related to you? 5. What is the total insurance now on your life? 6. In what companies and for what amounts? 7. Have you any application for insurance now pending? In what companies? 8. A Have you ever applied to any agent or sought insurance in any company which either postponed or refused to issue a Policy? B State companies and cause. 9. Are you engaged in or connected with the manufacture or sale of Malt or Spirituous Liquors? The answers to the following questions must be written by one of the Company's Examiners: 10. Have you now any disease or disorder? If so, what? 11. A For what have you sought medical advice during the past seven years? B Dates? c Duration? D Physicians consulted? 12. A Have you had any personal injury or accident? B What? c When? D Result? 13. A Have you had Rheumatism? B Number of attacks? D Duration? E Severity? c Dates? 14. ▲ Are you or have you been subject to Dyspepsia? в Dates? c Duration? D Severity? 15. Have you ever had any of the following? |