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commonwealth unless commenced within two years from the time the loss occurred.

IN WITNESS WHEREOF, the said ..INSURANCE COMPANY, has caused this Policy to be signed by its President and attested by its Secretary, at their office in....

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This policy shall not be valid until countersigned by the duly authorized Agent of the Company at..

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NOTICE. This policy is in a stock corporation and is issued under and in pursuance of Section 130, 131 and 132 of the Insurance Law of the State of New York.

PRESIDENT

RECEIPT FOR RETURN PREMIUM

In consideration of the sum of....

to________paid by..

19__ Dollars,

this Policy is hereby acknowledged cancelled and surrendered to the said Company.

This policy is not assignable for purposes of collateral security; but for such purpose, it is to be endorsed "loss, if any, payable," etc., such endorsement being on its face. In cases of actual sale and transfer of title, leave having been previously obtained, the form subjoined may be used, which must be executed at the time of said transfer.

hereby consents that the interest of.. in the within policy, subject to all the terms and conditions therein mentioned and referred to, be assigned to

1.

_and_

FOR VALUE RECEIVED,.

Agent

hereby transfer, assign and set assigns, all____ title and interest

over unto_:
in this policy, and all advantages to be derived therefrom.

WITNESS...

hand and seal this

Sealed and delivered in presence of

_day of... 1

(L. S.)

hereby consents that the interest of..

in the within policy, subject to all the terms and conditions therein mentioned and referred to, be assigned to.

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in this policy, and all advantages to be derived therefrom.

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Dollars

against all direct loss or damage by fire except as hereinafter provided

To an amount not exceeding

to the following described property while located and contained as described herein and not elsewhere, to wit:_

This Policy is made and accepted subject to the stipulations and conditions printed on back hereof, which are hereby specially referred to and made a part of this Policy, together with such other provisions, agreements, or conditions as may be endorsed hereon or added hereto; and no officer, agent, or other representative of this Company shall have power to waive any provision or condition of this Policy except such as by the terms of this Policy may be the subject of agreement indorsed hereon or added hereto; and as to such provisions and conditions no officer, agent, or representative shall have such power or be deemed or held to have waived such provisions or conditions unless such waiver, if any, shall be written upon or attached hereto, nor shall any privilege or permission affecting the insurance under this Policy exist or be claimed by the insured unless so written or attached.

"Provisions required by law to be stated in this policy."-This policy is in a stock corporation, and is issued under and in pursuance of Sections 130, 131 and 132 of the Insurance Law of the State of New York.

In Witness Whereof, this Company has executed and attested these presents; but this policy shall not be valid unless countersigned by the duly authorized Agent of the Company at.

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1

SECRETARY

PRESIDENT

AGENT

This Company shall not be liable beyond the actual cash value of the property at the time any loss or dam

2 age occurs, and the loss or damage shall be ascertained or estimated according to such actual cash value, with

3 proper deduction for depreciation however caused, and shall in no event exceed what it would then cost the in

4 sured to repair or replace the same with material of like kind and quality; said ascertainment or estimate shall be made

5 by the insured and this Company, or, if they differ, then by appraisers, as hereinafter provided; and, the

6 amount of loss or damage having been thus determined, the sum for which this Company is liable pursuant to

7 this Policy shall be payable sixty days after due notice, ascertainment, estimate, and satisfactory proof of the

8 loss have been received by this Company in accordance with the terms of this Policy. It shall be optional, how

9 ever, with this Company to take all, or any part, of the articles at such ascertained or appraised value, and also to

10 repair, rebuild, or replace the property lost or damaged with other of like kind and quality within a reasonable

11 time on giving notice, within thirty days after the receipt of the proof herein required, of its intention so to do;

12 but there can be no abandonment to this Company of the property described.

13

This entire Policy shall be void if the insured has concealed or misrepresented, in writing or otherwise, any material fact or cir

14 cumstance concerning this insurance or the subject thereof; or if the interest in the property be not truly stated herein;

15 or in case of any fraud or false swearing by the insured touching any matter relating to this insurance or the subject thereof, whether

16 before or after a loss.

17

This entire Policy, unless otherwise provided by agreement indorsed hereon or added hereto, shall be void if the insured now has

18 or shall hereafter make or procure any other contract of insurance, whether valid or not, on property covered in whole or in part by this

19 Policy; or if the subject of insurance be a manufacturing establishment and it be operated in whole or in part at night later than ten

20 o'clock, or if it cease to be operated for more than ten consecutive days; or if the hazard be increased by any means within the control

21 or knowledge of the insured; or if mechanics be employed in building, altering, or repairing the within described premises for more

22 than fifteen days at any one time; or if the interest of the insured be other than unconditional and sole ownership; or if the subject of

23 insurance be a building on ground not owned by insured in fee-simple; or if the subject of insurance be personal property and be or be

24 come incumbered by a chattel mortgage; or, if with the knowledge of the insured, foreclosure proceedings be commenced or notice given

25 of sale of any property covered by this Policy by virtue of any mortgage or trust deed; or if any change, other than by death of an

26 insured, take place in the interest, title, or possession of the subject of insurance (except change of occupants without increase of haz

27 ard) whether by legal process or judgment or by voluntary act of the insured, or otherwise; or if this Policy be assigned before a loss;

28 or if illuminating gas or vapor be generated in the described building (or adjacent hereto) for use therein; or if (any usage or custom

29 of trade or manufacture to the contrary notwithstanding) there be kept used, or allowed on the above described premises, benzine,

30 benzole, dynamite, . ether, fireworks, gasoline, Greek fire, gunpowder exceeding twenty-five pounds in quantity, naphtha, nitro-glycerine, 31 or other explosives, phosphorus or petroleum or any of its products of greater inflammability than kerosene oil of the United States

32 standard (which last may be used for lights and kept for sale according to law but in quantities not exceeding five barrels, provided it

33 be drawn and lamps filled by daylight or at a distance not less than ten feet from artificial light); or if a building herein described,

34 whether intended for occupancy by owner or tenant, be or become vacant or unoccupied and so remain for ten days.

35

This Company shall not be liable for loss caused directly or indirectly by invasion, insurrection, riot, civil war or commotion or

36 military or usurped power, or by order of any civil authority; or by theft; or by neglect of the insured to use all reasonable means to save

37 and preserve the property at and after a fire or when the property is endangered by fire in the neighboring premises; or (unless the fire 38 ensues, and, in that event, for the damages by fire only) by explosion of any kind, or lightning; but liability for direct damage by light

39 ning may be assumed by specific agreement thereon.

40

If a building or any part thereof fall, except as the result of fire, all insurance by this Policy on such building or its contents shall

41 immediately cease.

42 This Company shall not be liable for loss to accounts, bills, currency, deeds, evidences of debt, money, notes or securities; nor,

43 unless liability is specially assumed hereon, for loss of awnings, bullion, casts, curiosities, drawings, dies, implements, jewels, manu

44 scripts, medals, models, patterns, pictures, scientific apparatus, signs, store or office furniture or fixtures, sculpture, tools, or property

45 held on storage or for repairs; nor, beyond the actual value destroyed by fire, for loss occasioned by ordinance or law regulating

46 construction or repair of buildings, or by interruption of business, manufacturing processes, or otherwise; nor for any greater

47 proportion of the value of plate glass, frescoes, and decorations than that which this Policy shall bear to the whole insurance on

48 the building described.

49

If an application, survey, plan, or description of property be referred to in this Policy it shall be a part of this contract and a

50 warranty by the insured.

51

In any matter relating to this insurance no person, unless duly authorized in writing, shall be deemed the agent of this Company.

52 This Policy may by a renewal be continued under the original stipulations, in consideration of premium for the renewed term,

53 provided that any increase of hazard must be made known to this Company at the time of renewal or this Policy shall be void.

54

This Policy shall be cancelled at any time at the request of the insured; or by the Company by giving five days notice of such

55 cancellation. If this Policy shall be cancelled as hereinbefore provided, or become void or cease, the premium having been actually

56 paid, the unearned portion shall be returned on surrender of this Policy or last renewal, this Company retaining the customary short

57 rate; except that when this Policy is cancelled by this Company by giving notice it shall retain only the pro rata premium.

58 If, with the consent of this Company, an interest under this Policy shall exist in favor of a mortgagee or of any person or cor

59 poration having an interest in the subject of insurance other than the interest of the insured as described herein, the conditions herein

60 before contained shall apply in the manner expressed in such provisions and conditions of insurance relating to such interest as shall

61 be written upon, attached, or appended hereto.

62 If property covered by this Policy is so endangered by fire as to require removal to a place of safety, and is so removed, that

63 part of this policy in excess of its proportion of any loss and of the value of property remaining in the original location, shall, for the

64 ensuing five days only, cover the property so removed in the new location; if removed to more than one location, such excess of

65 this Policy shall cover therein for such five days in the proportion that the value in any one such location bears to the value in all

66 such new locations; but this Company shall not, in case of removal, whether to one or more locations, be liable beyond the propor

67 tion that the amount hereby insured shall bear to the total insurance on the whole property at the time of fire, whether the same cover 68 in new location or not.

69

If fire occur the insured shall give immediate notice of any loss thereby in writing to this Company, protect the property from 70 further damage, forthwith separate the damaged and undamaged personal property, put it in the best possible order, make a complete

71 inventory of the same, stating the quantity and cost of each article and the amount claimed, thereon, and, within sixty days after the 72 fire, unless such time is extended in writing by this Company, shall render a statement to this Company, signed and sworn to by said

73 insured, stating the knowledge and belief of the insured as to the time and origin of the fire; the interest of the insured and of all others

74 in the property; the cash value of each item thereof and the amount of loss thereon; all incumbrances thereon; all other insurance,

75 whether valid or not, covering any of said property; and a copy of all the descriptions and schedules in all policies; any changes in the

76 title, use, occupation, location, possession, or exposure of said property since the issuing of this Policy; by whom and for what purpose

77 any building herein described and the several parts thereof were occupied at the time of fire; and shall furnish, if required, verified

78 plans and specifications of any building, fixtures, or machinery destroyed or damaged; and shall also, if required, furnish a certificate

79 of the magistrate or notary public (not interested in the claim as a creditor or otherwise, nor related to the insured) living nearest the

80 place of fire, stating that he has examined the circumstances and believes the insured has honestly sustained loss to the amount that

81 such magistrate or notary public shall certify.

82 The insured, as often as required, shall exhibit to any person designated by this Company all that remains of any property

83 herein described, and submit to examinations under oath by any person named by this Company, and subscribe the same; and, as

84 often as required, shall produce for examination all books of accounts, bills, invoices, and other vouchers, or certified copies thereof if

85 originals be lost, at such reasonable place as may be designated by this Company or its representative, and shall permit extracts and

86 copies thereof to be made.

87

In the event of disagreement as to the amount of loss the same shall, as above provided, be ascertained by two competent and

88 disinterested appraisers, the insured and this Company each selecting one, and the two so chosen shall first select a competent and

89 disinterested umpire; the appraisers together shall then estimate and appraise the loss, stating separately sound value and damage, and—

90 failing to agree, shall submit their differences to the umpire; and the award in writing of any two shall determine the amount of such

91 loss; the parties thereto shall pay the appraisers respectively selected by them, and shall bear equally the expenses of the appraisal and

92 umpire.

93 This Company shall not be held to have waived any provision or condition of this Policy or any forfeiture thereof by any

94 requirement, act, or proceeding on its part relating to the appraisal or to any examination herein provided for; and the loss shall not

95 become payable until sixty days after the notice, ascertainment, estimate, and satisfactory proof of the loss herein required have been

96 received by this Company, including an award by appraisers when appraisal has been required.

97 This Company shall not be liable under this Policy for a greater proportion of any loss on the described property, or for loss by

98 and expense of removal from premises endangered by fire, than the amount hereby insured shall bear to the whole insurance,

99 whether valid or not, or by solvent or insolvent insurers, covering such property, and the extent of the application of the insurance

100 under this Policy or of the contribution to be made by this Company in case of loss, may be provided for by agreement or condition

101 written hereon or attached or appended hereto. Liability for re-insurance shall be as specifically agreed hereon.

102

If this Company shall claim that the fire was caused by the act or neglect of any person or corporation private, or municipal,

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