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Philip Morris

Comprehensive Liability Policy 1al13219rry 600101 - 630101

Date: 01 Jan 1960 (est.)
Length: 95 pages
2040025723-2040025817
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Author
Beers, K.S.
Ellison, E.W.
Knudsen, H.
Senger, L.F.
Type
CONT, CONTRACT, AGREEMENT RESOLUTION
CHAR, CHART, GRAPH, TABLE, MAPS
INVO, PAY REQUEST, INVOICE
Area
LUTTRELL,JERRY/INSURANCE POLICIES
Site
N530
Named Person
Yates, C.H.
Recipient (Organization)
PM, Philip Morris
Characteristic
ILLE, ILLEGIBLE
MARG, MARGINALIA
Author (Organization)
Aetna Casualty + Surety
PM, Philip Morris
Litigation
Ieyo/Produced
Date Loaded
19 May 1999
UCSF Legacy ID
dxc77e00

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Page 1: dxc77e00
M N n U1 N O O a O N
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THE .tETNA CASUALTY AND SURETY C:Otvfpr,N,v M.rtrorG 15. eonneccicvt tntmga a Icase oi Cprem•sr~b r.,ac:•icnt acreement. srreement .-euu,• tmmunpal vrdmance, sldctr.l.k agrcement nr eie.at.tr or esca ~amtcnance agreement. Ir i wucomobile. Eccept tulerc . cd ,.a ;~r,trzn, 'automoblle" means a!:md n:~~l••r arinrie•r :ra:ler as foilow• ~ 1, Owned Automoblle-an autom.•hiie --uned br the named lured : • I i Hlred 4utomobile-an automnhile under ca,rtract in b 'Ai, or loaued tn. the named Insured procvled >uch :lutonlobile i •,lcned by nr registered in the uame of ia t the named Insured o/ all esccutice officer thereof or , c t an employee or agent of the Comprehensive Liability Policy Comprehensive Liability Policy the policy with the * •PS'. stands for our Personal Service as an independent business firm -and for the coast to coast service of the entire sEtno Casualty organization. "AL' Form PLANNED FOR YOUR PROTECTION BY Help us to help you. Report all accidents or losses promptly. POLICY PROVISIONS - PART I FORM C-2251 The AEtna Casualty and Surety Company (A stodc insurance company, herein called the Company) Poge ' Agrees with the Insured, named in the declarations made a part hereof, in consideration of the payment of the premium and in reliancc upon the statements in the declarations and subject to the limits of liability, exclusions, conditions and other terms of this policy: INSURING L Coverage A-Bodily Injury Liability--Automobile • 1'u pay olt behalf •/f the Ineurcd all sunts which the Insured shall becunm Ic3allc o6ligated tu pac ,t- damages because of bodily injury, sick- nc•>.•r <li.ca.r. nlcludlnu dcatll at :tny ttme rc•wltinK therefrottt, tustained by anly penun. cauxd b., accident and an>ing out of the ownership, malttlellalice Vr use t.l alla' LutullWbile. Coverage B-Property Damage Liability-Automobile , To puy un behali uf the ln;urcd .tll >ums which the Itlsured shall 1•ctome Icgall.uhlieatud tu pa% ee Lunagc. txcause uf injury to or d¢strucuun ui prut/crty. iurluding the L-» ..f use thereof, caused by u,tdcnt and arhmg ,-ul -ji tlle .,ttncr>iup, nutntcuau~e ur use of any .tutuntubile. Coverage C-Bodily Injury Liability -Except Automobile •I•., p.ly on b.half ul thr In.ured all •wn, w'hlch the Insured shall l.,unle Ie-,alh Jjli¢ated tu pay as •lamattes Lxcaux uf bodily injitry, C :151 AGREEMENTS lickness or discue, including death at mtc time resulting therefrom .ustauted by any person and caused b, accident. Coverage D-Property Damage Liability-Except Automobile Tu pay on behalf of the Iluured all sunts which the Insured shall lKcume legally obligated to pay as Jantages hecause of injury to or destruction of property, including the luss of use thereof, caused by ' atcidcnt. _ , II. Defense, Settlement, Supplementary Payments ~ With respect to such insurance aa is afforded by this policy, the Com- panc sha11: t•u defend any suit against the Inaurcd alle:;ltlg such injury, siekness. .bscase or destruction and seeking d:lntat;c, r.n account thereof, eecn if such smt is groundless, false ur fraudulent: hut the Contpany m.y make such inrestigation. negutiari,w and rlticntent of any claim or .tot as it deems espcdicnt: ,C•-ut.nu:d pwt.• :l 2040025724
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Tt1e llrtna Casualty and Surety Cct-r" any • Hart`ard, COr,nectict:t Part 2 This Declarations page, with "Policy Provisions - Part S," compierc-s :^e te•e w COMPREHENSIVE LEA.SE•_d^Y PO:.lC %' DECLARATIONS = t. \amed Insured and Address Policy Form C-2251 Business oi the named Insured is C I G A R ET T E TA@ACCO MANUFACTURERS \amed Insured is: Individual ( ) Partnership ( Corporation (X ) Other: 2. Policy Period: Policy Na1 A L 13 2 19 R~ Y _~ I P ~^ORR I S 1 NCORPORATE ~ (O0 PARK AVE.,•MEw YORK, N.Y. _ ~/i,~ From 1•- 1-6 Q To 1- 1-~-~j'3 12:01 A. M., standard time at the address of the named Insured as stated `nerein. 3. The insurance afforded is only with res premium charge or charges. The limi subject to all the terms of this polic t to such and so many of the following coverages as are indicated by specific of the Company's liability against each such coverage shall be as stated herein, having reference thereto. Coverages Limits of Liability Advance Premiums ~ A. Bodily Injury Liability-Automo e 200 1 000 thousand dollars each person thousand dollars each aeeidentQea... $ 42, 802, B. Property Damage Liability-A omobile 3l Do thousand dollars each accident $ , . ~ C. Bodily Injury Liability-Excep Automobile 200 thousand dollars each person $ 1000 thousand dollars each a.eidentQt u.1 18s r 17-3,t sk~ ` 1 ()00 thousand dollars aggregate product s I t V D. Property Damage Liability Except Automobile 00 thousand dollars each accident $ 1()o thousand dollars aggregate operations L '` 100 thousand dollars aggregate protective Jp thousand dollars aggregate products / Q C thousand dollars aggregate contracnul Endorsements (Attache onreverseside) $ K I tJC DES KENTUCKY P1UN I C I PAL TAX OF t`L2Q.7O AUT KY. TAX. INCLUDED I N COMPSITE RATEJ SEE E.NDORSEMENT , Total Advance Prernium S , If the policy period is more than one year and the premium is payable in installments, $ is payable in advance, jT0 f9 E D ET.on the first anniversary, and $T0 B E 0 ET.on the second anniversary. 4. The declarations are completed on attached Automobile Liability and Genenl Liability Schedules. S. The Automobile Liability Schedule contains a complete list of (a) all automobiles and trailers owned by the named Insured at the effec- tive date of this policy and the purposes of use thereof, and (b) all persons within the definition of Class 1 persons at the effective date of this policy, unless otherwise stated herein: A record of changes for each division of said Schedule is to be submitted to the Company: ( ) Monthly ( ) Quarterly ( ) Semi-Annually ( X ) Annttally. 6. The General Liability Schedule discloses all hazards insured hereunder known to exist at the effective date of this policy, unless otherwise statcdherein: 'i0 EXCEPTI 0NS 7. During the past year no insurer has cancelled insurance, issued to the nar~o Insured, similar t?7tf}tt_Wrded her_eunder, untess othenvise stated herein : p; O tJ E "AL" Form (C•3I52) • 2040025725
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t ;,., . . . . , _. . . _ . . . ., - au • ... ... .,•r-.. . . u:•cU w a .m:n irrrnd- , ..t~ a.l .•~ , . . . .•:,I . r.,., uu •:. eut , . . .•[ .. ',::,C : ,y[:On •:~':ng , .. . U. •ytl t ••![ ., ;!:Ut!t u.it u , ,,tl rots •aerd t^'e !:!>urcd !n any ucit ,wt anu all d:trrc,t ,+,.rur.:g ,:ter entr•• •iI 'udqrncnt unttl the C.-pany' ha• natd tcndered r6t!- t•.•I in .,,nrt ;uch part ut .uLit +udgwc•nt .:> d.1e, uut aLd d,c ::tt!!t ul the Curnpt!n)'s Irahd:ty •herc••n. .~ p.r+ r.ncn>re !ncurred h) the In;ured for ,uch irnmediate r•it.al ant! :ur,!~al rritri to uthern a, ,Ball be mtpcrtrtce at the ••mt •.t thr aoaJcnt- ~ 4 r r-mtbur=e the 1 ~al i- all roa.•ntable c.u-ves• "ther :h•.,n i•.,, r,i carnmq.. .•.trrcd at the t:•tupan>'~ rcqucst. .urd tnc .rm•,unts au miurre•j, exe~;rt .~•::Icmenia ol ilauns aud auits, nrc n•n.t!de h) the Cuut(,an)m a&huun tu the alrpltrahle limit of itahtht) uf tht> pubc). III. Definition of Insured The unqualuicd word "Insured'• includes the uanted lu,ured and also includes t I t vuder l•.,cerages C and D. auy executive r,ri'icer, director or stuckhuldcr thereuf ,thtle acting wtthin the scope oi hts duties as such, and any orgauization or proprietor with respect to real estate management for the named Insured, and if the named Insured is a partnerslup, the unqu:ditied word "Insured'• also includes auy partner therein btrt unl>' with rrapect to his liability as such. aud (2) under Coverages A attd B. any person while using an owned automubile or a hired automobile and any penon or orgamzation legally responsible for the use thereof, provided the actual use of the automobile is by the named In,ured or with his permission, and any executive officer of the This policy does not apply: . . , ~ ~ ^e _ _ , , b r to an% prr,on or or;antzatton, or to any aecu •.r c r o„- ec ; uf. ur,erauug au automobtie sales agettq', repair shop. ser'-:.e :ra:, owrage garage ur public parking place. with re+pect ur an, a;c!.1r anatng out uf the operation thereoi, but :his prov!s!nu rl~~e~ not ,-t to a restdent of the sante household as the named In,urrr. to ner,b!p tn which such resident or the named Incured r, a par:^, or to any partner, agent or employee of such rerde•n ur rar:urn'r•• tc/ to arn emplu)ee with respect to m)ury' to or st~kncis. dtsea,r death uf another entployee of the same employer ntt::red :n the :r•ur of such entplucment in an accident aristng out of the maunenance t use of an automobile in the business of such rmployer: (d ) with respect to any hired automob!le, to the owner, ur a lesse thereof other than the named Insured, or to any acent or emplute of euch owner or lessee: (et ..ith respeet to any non-owned autontobile, to any executive r,mce if such automobile is owned by him or a ntember oi the sarne house hold- IV. Policy Period, Territory This policy applies only to accidents which occur durin¢ the polic; period n•tthin the United States of America, its terrttnrtes or pos;esstons or Canada. With respect to automobiles this policy also applies tt acctdents which occur during the policy period tchile the automobile i- being transported between ports thereof. EXCLUSIONS (a) to liability assumed by the Insured under any cnntract or agree- ment except, under Coverages C and D. (I) a co!ttract as defined herein or (2) as respects the insurance which is afforded for the Prod- ucts (including completed operations) Hazard as detined, a warranty of goods or products; (b) to injury, stckness, disease, death or destructiun due to war, whether or not declared, civil war, insurrectton, rebellion or revolu- tion, or to any act or condttion incident to any of the furegoing, with respect to 11 ) liability assumed by the Insured uttder atty contract or agrcement or (2) espenses under Insuring Agreement 11 (b) (3) : (c) ander Cucrrage A. to bodily injury to or sicknees. disease or death of any entployee of the Insured arising out of and in the course of ( l) domestic employment by the Insured, if beneets therefor are in whole or in part either payable or required to be provided under an>• w•orknten's compensation latv, or (2) other cniplo)ment by the Insured: (d) under Cuverages A and C, to any obligation for which the Insured or any carrier as his insurer may be held liable under any workmen's compensation, unemployntent compensatiou or disability benetits law, or under any similar law; (e) under Coverage B, to injury to or destruction of property owned or trattiported by the Insured, or property rettted to or in charge of the Insured other than a residence or private garage injured or destroyed by a private passenger automobile covered b)• this policy; (f) under Coverage C. except with respect to liability assumed by the Insured under a contract as defined herein, to bodily injury to or stckness, disease or death of any employee of the Insured arising out of and in the course of his employment by the Insured: (g) under Coverages C and D, to any obligation for which the Insured may be held liable in an action on a contract or an agreement by a person not a party thereto; ' (h) uttder Coverages C and D, except with respect to operations performed by independent contractors and except with respect to liability assumed by the Ittsqred under a contract as defined herein, to the ownership, maintenance, operation, use, loading or unloading of (1) watercraft if the accident occurs away from premises owned by. rented to or controlled by the named Insured, except insofar as this part of this exclusion is stated in the•declarations to be tnappli- cable, (2) automobiles if the accident occurs away from such premises or the ways immediately adjoining, or (3) aircnft; (i) under Coverages C and D, to liability imposed upon the Insured or any indemnitee, as a person or organization engaged in the business of manufacturing, selling or distributing alcoholic beverages, or as an o+vner or lessor of,premises used for such purposes, by reason of sured. or work completed by or for the named Insured, out of whici the accident arises; (k) under Cuvcrage D, to any of the following insofar as any of therr occur on or front premises owned by or rented to the named Insurec antl injurc or destroy buildings or property therein: tl) the dis• charge. leakage or overflow of water or steaut from plumhing, heat• itig, refrigerating or air-conditiotting systems, standpipes for fire hose or ittdustrial or domestic appliances, or any subitance from automattc sprinkler systems. (2) the collapse or fall of tanks or the component parts or supports thereof which form a part of automatic sprinkler systems, or (3) rain or snow admitted directly to the butldtng interior through defective roofs, leaders or spnnnng, or open or defec- tive doors. wtndotvs, skylights. transoms or ventilators; provided, huw- ever, this exclusion does not apply to loss due to fire. to the use of elevators or escalators, to operations performed by independent con- tractors, or to the extent that this exclusion is stated in the declara- tions to be inapplicable; (1) under Coverage D, to injury to or destruction of any property arising out of ( I) blasting or explosion, other than the explosion of air or steam vessels, piping under pressure, prime movers, machinery or power transinitting eqinpment, or (2) the collapse of or structural injury to any building or structure due (a) to grading of land, exca- vation, borrowing, filltng, back-filling, tunneling, pile driving, coffer- dam work or caisson work, or (bT to moving, shortng, tinderpinntng, raising or demolition of any building or structure or removal or re- building of any structural support thereof; provided, however, this exclusion does not apply with respect to liability assumed by the In- -ured under any contract covered by this policy, to operations per- formed for the named Insured by independent contractors or to com- pleted or abandoned operations within the meaning of paragraph 2 of the Products (including completed operations) Hazard, and provided further that part ( I) or part (2) of this exclusion does not apply to . ~ ... ---- -- - shall be equivalent to mailing. If the named Insured cancels, earned premium shall be comp accordance with the customary short rate table and procedure. Company cancels. earned premium shall be computed pro rata. Pr adjustment may be made either at the time cancellation is e or as soon as practicable after cancellation becomes effective, but pay- ment or tender of unearned premium is not a condition of cancellattott. 17. Declarations- By acceptance of this policy the named Insured agrees that the statements in the declarations are his agreements and any statute or ordinance pertaining to the sale, gift, distribution o5--_ representations, that this policy is issued in reliance upon the truth of use of any alcoholic beverage; ' ..cttckrenr.vntatinns and that rhia mlirv rmhrtrlies all a¢reements extst- to injury to or destruction of ( ll oroaerty ( j) tinder Coverage D , owned or occupied by or rented to the Insured, or (2) except with re>pect to liability under sidetrack agreements covered by this policy, property used by the Insured, or (3) ccept with respect to liability under such stdetrack agreements or the use of elevators or escalators at premtses owned by, rented to or controlled by the named Insured- prr•pert-v in the care, custe}~•erS9ntrol of the Insured or property as to n•htch the Insured ior an purpose i; exercising physical •con- troL ur ti) anp goods. prodt r containers thereof manufactured. 3uld• !:2ndled or distributed tL emtses alienated by the named In- ~ '•+mg to operatiotts stated. iit the declarations or in the Company's manual. as not subject to such part of this exclusion ; (m) under Coverage D, to injury to or destruction of wires, conduits. pipes. mains, iewers or other stmdar property, or any apparatui m connection therewith, be(ow the surfacC~ of the ground, if such intur,v or destruction is caused by and ocr rs tluring the use ui ntecltan!cat equipment for the purpose of gr- of land, paving, excavating or (Continura Oo9e ~/ 2040025726
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1 CONDITIONS 1. Premtum-''•~ •„ 'lases and rates (or the hazards de- .•'.'1a"3 t"'1! :?ea. .. tcC'~•frea: .~•-GmtCm.bases and rates ior na7ar.is :x: » •t~ tcr:•~szd are rrese applLcable rn accordance with t:u m.rtuais n .i,e L tae '-_ .. .a,^• ascrage ; er.ec:age -tvucn.m is to he computed in accorcance the iuilusssug !a:,~e and app:rcd to t:u premiums for all ovv.n.ec :.....r.., Inles. PRE`•fl::.`.1 REO(.'CTIO\. TABLE __ \u b<r o, ' Tr- ar , Ins erd vwnea Auwmoiwet, E:numve , red Her :-er teomputed pro ra lu r rcuntare ~ , e rw.rcy xrrod) N r_ cvon 2 0^rc ,':est Is 10 c \est 30 ISr~ \axt :u ?0 ~ . I .\!I .,tar IW . 250 The adtance premium stated tn the dectarations is an estima[ed pre- mium only (.'pun termrnatton uf this policy, the earned premium shall be computed tn accurdance with the Company's rules, rates, rating plans, premiums and nunununt premiums applicable to this insurance. If the earned premtuut tltuw computed exceeds the estimated advance premium paid, the named Insured shall pay the excess to the Company; if less, the Company shall rcturn to the named Insured the unearned portion paid by such Insured. When used as a prenuunt basis: (1) the word "admrss[ons" means the total number of persons, other than employees of the named Insured, admitted to the event insured or to the events conducted on the premises whether on paid admission tickets, complintentary tickets or passes; (2) the word "cust" means the total cost to (a) the named Insured with respect to operauuns performed for the named Insured during the policy period by independent contractors, or (b) any indemnitee with respect to any contract covered by this policy, of all work let or sub-let in connection with each specific project, including the cost of all labor, materials and equtpment furntshed, used or delivered for use in the execution of such work, whether furnished by the owner, contractor or subcontractor, including all fees, allowances, bonuses or commissions made, paid or due ; (3) the word "receipts" means the gross amount of money charged by the named Insured for such operations by the named Insured or by others during the policy period as are rated on a receipts basis other than receipts from telecasttng, broadcasting or motion pictures, and includes taxes, other than taxes which the named Insured collects as a separate item and renttts directly to a governmental division; (4) the word "rentuneratton" means (a) the entire remuneration eanted during tlte policy period by all employees of the named Ittsured, otlter thau dnsers oi tums or autotnobiles and aircraft pilots and co- prlots, sub)ect to any overttme earnings or limitation of remutteratiun rule applicable in accurdattce with the ntanuals in use by the Company, and subject tvtth re:pect to raeh executive officer to a maxtmmrit and a mnttmunt of $100 and $30 per week, and (b) the remuneration of each proprietor at a tixed arnount of $3.600 per annum; (5) the tvord "sa(cs" means the ttross amount of monev charged by the named Insured or D~ others [rang under r~s name tor airgo s an< products sold or distributed during the policy period and charged during the policy period for installation, servicmg or repair, and includes taxes, other than taxes which the named Insured and such others collect as a separate item and remit directly to a governmental division; (6) the [vords "eu,t of hire" mean the amount incurred for hired automobiles, mdudrnq the entire remuneration of each employee of the named Insured engaged in the operation of such automobiles subject to an average weekh• tnaximutn remuneration of $100, provided that such amount shall not tnclude any amouut incurred for the hire of any such automobiles whrch are subject to compulsory insurance require- ments of any federal'ur public authority; (71 the words '•C!a,s I persons" mean the following persotts, provided their usual duties in the business of the named Insured include the use of non-owned autontobdes: (a) 211 employees, including of6cers, of the named Insured cuntpensated for the use of such automobiles by salary, commusunt. terms of employment, or specifie operating allow- ance of any sort: rb) all direct agents and representatives of the na[ned Insured: (8) the s.ords "llass 2 etuployees" mean all employees, including otficers, of the n.rncd Insured, not included in Class 1 persons. The named Iu.urvd shall ntaintain for each hazard records of the information ttece>sar. f„r premtum computation on the basis stated in the declarations, and shall send copies of such records to the Cotttpany at the end of the I*+licy period and at such times during the policy period as the Company ntay direct• 2. Inspection and Audit-Tlte Contpatty shall be pertttitted to inspect the :nsured prerutSes, operretions• automobiles attd elevators and to exannne .tnd .rud:t the In,ured's books and records at any time during the puth.% ponnd in,i an>' e.tension thereof and svithrn three years after the un,a tcrmmauun of this policy, a's far as they relate to 'ne . . _- ~as., , •. , . .. • . .. .. .. 1. ur: .c.-.`-s ..-~ona.a., .. ' .._... : . __ ... . .. ... . . .... ' . - i.C r -. iuwmopue-ai; aut,~mnhtie ..nnc•d l~y the . n:ed I:, sured . 12) Hired Autoutubile-in automobile •_sed under ;-t-ac: r"e^, a,! -A or loaned t". the named !n-ured protrded euch ••a!•imwhile . •n : ,~ ned hy nr registered in the :ume c•f i a t the :tamed in<Ur e•i ~ rh an exccutrve officer thereof or 'i ) an emplo)ee nr age:•t r,i tF.e ^'tr•e^. Insured who is granted an operatur,g allotsance ~4 an) s•!rt isr :re ttse of such automobile: t3t Xon-Owned Autnmobile-any other automobile. The following described equipment shall be deemed an automobile while towed by or carried on an autontobile not so descrtbed, hut not otherwrse: if of the crawler-type. anv tractor, po[ver crane or ~h,nel• ditch or trench digger: any farm-type tractor: any concrete mixer .,:her than of the mix-m-transn type: ane Frader, scraper. roller or iarm implement: and, if not subject to motor vehicle regrstratron, am„ther equtpment not specified !xlow, which is designed for use princrpaliv •trT public roads. The following described equipntent shall be deemed an autmnohile while towed by or carried on att automobile as above detitted solclc for purposes of transportation or tchile being operated solely for Iocumo. tion, but not otherwise: if of the non-crawler type, any putt•er crane or shovel, ditch or trench digger; and any air-compressing, building or vacuum cleaning, spraying or welding equipment or well drilling machinery. (c) Semitrailer. The word "trailer" includes semitrailer, (d) Privatt Pusenaer Automobile. The term "prit•ate passenster auto- mobile" nteans a private passenger, station wagon or jeep type auto- mobile, and also includes at[y automobile the purposes of use of which are stated itt the declarations as "pleasure and business". (e) Two or More Automobiles. The terms of this policy apply sepa- rately to each automobile insured hereunder, but a motor t•chtcle and a trailer or trailers attached thereto shall be held to be one automobile as respects limits of liability. (f) Purpos.a of Use. The term "pleasure and business" is derined as personal, pleasure, family and business use. The term "commercial" is defined as use principally in the business occupation of the named lusured as stated in item I of the declarations, including occasional use for personal, pleasure, family and other business purposes. Use of au automobile includes the loading and unloading thereof. (g) Preducts (including completed operations) Hazard. The ternt "Products (including completed operatrons) Hazard" means ( 1) goods or products manufactured, sold, handled or distrthuted hy the named Insured or by others trading under his name, if the accr dettt occurs after possession of such goods or products has been re- linquished to others by the nauted lnsured or by others trading under his uame and if such accident occurs away from premises owned, rentetl or controlled by the named Insured or on premises for whtch the classification stated in divisron (A) of the declarations excludes any part of the foregoing; prot•itled, such goods or products shall he deemed to include an}' container thereof. other than a vehicle• but shall not include any cending machine or an-v property, other than such container, rented to or located for use of others but not sold: (2) operations, if the accident occurs after such operations have been completed or abandoned atd occurs away from premises owned. rented or controlled by the nanmd Insured; provided• operations shall not be deemed incomplete because improperly or defectrt•ely performed or because further operattons nay be required pursuant to an agree- ment; provided further, the following shall not Ix tleemed to be "operationi" within the meaning of this paragraph: (a) pick-up or delivery, except from or onto a railroad car. (b/ the maintenance of vehicles owned or used by or in behalf of the Insured. (c) the exist- ence of tools, uninstalled equipment and abattdoned or unused materials and (d) operations for which the classification stated in division (A) of the declarations specifically includes completed operations. (h) Assault and Eattery. Asuult and battery shall be deemed an accident unless committed by or at the directiott of the Insttred. . 4. Limits of Liability-(a) coverases A assd C. The lihtit of bodily injury liability stated in the declaratiorts as applicahle to "each person" is the limit of the Company's liabilty fur all dtu»ages, including damages for care and loss of servtces, arising out ui bodily injury, sickness or disease, including death at any time re,ulting therefront, sustatned by one person as the result of any one accrdeut: tlte limit of such liabilnv 'stated in the declarations as applicahle tu "each accident" is, subject to the above provismn respecting each per.nn, the tut:rl Iimit of the Cnut- pauy's habi!ity for all damages. mchrdute danuqec 6-r care and lu,; „f servrces. arising out of bodily injun, >1tknes, ur including death lCOnrirured ws pa,lt li 2040025727
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, ,Co,enge,•S nd D, 7 . "it i prcpe-:) a rr.l. _ . ]. . . ..... lC.•.1C^.~,5...,C .,.:. ... • .r t .:vr. a ;'r ^r: •t :•e ~r a•,r-- y• _.^.s ,. ,- . tnt i_•n,t u>e,:llcrt•:he (•-uit DIan y nne a._.lta:: , ~ Produees rmcludrng oemplet.d op<raponsj--+.mr::ca ~ _.._ _. n, ire .::ur. ••t :abriny .~'rth respec: to cac.. ...<: 1, i ^ - hmn, •,t r:-dtlp liability and property damage hahrhts the ~1r~:ar.ruun, a> "...grc•gate products" are respecttvely the tota: lnurts oi the tr::pany'• Lahdny for all damages arising out :d :he Nr••I::ets r rncra _mpi,:c I~., pcrau,ris I Hazard. All such damaces an>:n¢ •mt "rt rnre .:,t -t x-l. :r pn•ducts prepared or acquired by the s:amcd ln,ured or Ly am•:her traJmg under his name shall be cunardcred as er:;:nc ••ut vi •me atc;dent r c r AggretacrCovernge D. Sub7ect to the limit of liabilit,v uulr ro<trc•ct to "each acctder:t". d:c• ::mrt ui ^r.aperty damage liabihty stax•v nt t::e dectaraucns as '•aGgreqate operau•mi- is the total /ir..rt of the Com- pam''s liability for all damages arising out of injury to or destruction of property, including the luss of use thereoE, caused by the ownenhip• maintenance or use of premises ur operations rated on a rentunerauon premmm basis or by cotttractors' equipment rated on a receipts pre- mium basis. Subiect to the limit ui liability with respect to "each accident'• the limit ue property dantage liabilrtc stated in the declarations as "aggre- gate protectne•' is the total limit of the Company's liability for all darnages arising out oi injury to or destruction of property including the loss of use thereof• caused by operations performed for the named Iltsuretl by tndependent contractors or general supervision thereof by the tnrtted Insured• except ( a ) maintenance and repairs at premises owned by or rented to the named Insured and (b) structural alterations at such premises which do not involve changing the size of or moving buildtngs or other structures. Sulrlect to the limit of liabilrty with respect to "each accident". the limit .-f property damage liability stated in the declarations as "aggre- gate cuntractual" is the total limit of the Compauy s liability for all dantages arising out of injury to or destruction of property including the loss of use thereof• wtth respect to liability assumed by the Inaured under contracts covered by this poltcy in connection with operatinns fur which there is an "aggregate operations" litnit of property damage liability stated in the declarations. The limtts of property damage liability stated in the declarations as 'aggregate operations"•. "aggregate protective` and "aggrcgate con- tractual" apply separately to each prolect with respect to operations being performed away from premises owned by or rented to the named Insured. 5. Severability of Interests-The term "the Insured" is used sever- ally and not collecttvefy, but the inclusion herein of more than one Insured shall not operate to increase the limits of the Company's lia- btlity. 6. Financial Responsibility Lasvs-Coverase A and E. When this policy is certrtied as proof of financial responsibility for the future under the provisions uf the motor vehicle financial responsibility law of alty state or province, such insurance as is afforded by this policy fur bodily injury liability or for property damage liability shall comply wtth the provisions of such law which shall be applicable with respect to any such liability arising out of the ownership, rnaintenance or use during the policy period of any automobile insured hereunder• to the extent of the coverage and limits of liability required by such law, but in no etent in excess of the limits of liability stated in this policy. The Insured agrees to reintburse the Company for any payment made by the Company tvhich it would not have been obligated to make under the terms of this policy except for the agreement contained in this paragraph. 7. Notice of Accident-When an accident occurs written notice shall be given by or on behalf of the Insured to the Company or any of its authorized agents as soon as practicable. Such notice shall cun- tam particulars suffscient to identify the Insured and also reasonably obtainable information respecting the time• place and circumstances of the accident, the names and addresses of the injured and of available w•ttnesses. 8. Notice of Claim or Suit-If claim is made or suit is brought against the Insured• the Insured shall immediately forward to the Company every demand. notice, summons or other process received by him or his representative. 9. Assistance and Cooperation of the Insured- The Insured shall cooperate with the Company and• upon the Company's request, shall attend hearings and trials and shall assist in effecting settlements. securing and giving evidence• obtaining the attendance of witnesses and iu the conduct of >uits. The Insured shall not, except at his own cost• voluntarily make any payment, assume any obligation or incur . .-. . .. . ., ., • ..~.. s. ...,~., : . a. ~.c . . :a . !a. Ac[ton •; F.-.rnst Comt.any-,,. -- . .. . ., ,. e . . ., pre.c•:r:n • _ . . _'. .., ::. :. L... ...p .......; . ..,• _ . .. ., .r_ _ r .. -- ..., , ... . : - :..~ ._. „ ., . :,i. -r,ati ~se ~eer a,',. .... ... •. ~ . .. ' _ ._.... __a.. , tr•c lnaurr.i ai:cr , tuar :::ai r _ . .... Ime:r,ei. ere clam:aut and cr.e C~n:r:an. .\nl pcrs•m ur nr¢amzab~n ••r the !ecal renresc::ra:ae has secured ;u.h ;udgment -r %vnrtcn -,gretment >!;aC ;hc^:_i:creanded to recocer under ehu pr+irce to the extent 7 ^e • atiurded by this poircy \~n:htn¢ cntuamed in th:c pnir.. :z;i c• per,on or organaanun an1 rrght to lotn the Companc as a+-:ctxvi +rt any' action agarnar the Irsurc•d to determtne the lnsured~> Bankruptcy or msolvency nf :he Insured or oi the Icsured + e.t . shall not relieve the Compa^c of any of its obligatrons nereunder 11. Other Insuranee-If the Insured has other msurance agarr a loss covered by this poltcy the Company shall not be liable under a. policy for a greater proportion of such loss than the appbca:,le ;;n of liability atated in the declarations bears to the total applrcable {im of Labithty ot all valid and collectible insurance against such lost provided. however, the insurance under this policy with respect to lo- arising out of the maintenance or use of any hired automobile insure on a cost of hire basis or the use of any non-owned automohtie >ha be excess insurance over any other valid and collectible insurance. 12. Subrogation- In the event of any payment ttnder this polic• the Company shall be subrogated to the Insured's rights of recover therefor against any person or organization and the Insured cha execute and deliver instruments and papers and do whatever else i necessary to secure such rights. The Insured shall do nothing after los to prejudice such rights. 13. Three Year Poliey-.-\ policy period of three years is cntn prised of three consecutive annual periods. Rates for hazards describe in divisions 1• 2 and 3 of the Description of Hazards are subject t autendrnent for the second and third annual periods in accordance ,vtu the Company's rules attd rating plans. Amended rates shall be stater by endorsement issued to form a part of the policy. Computation am adlustntent of earned premium shall he made at the end of each annua period. Aggregate limits of liabilty as stated in this policy shall appl separately to each annual period. 14. Changes-b;otice to any agent or knowledge possessed bv an; agent or by any other person shall not effect a waiver or a change ir any part of this policy or estop the Company from asserting any righ under the terms of this policy; nor shall the terms of this policy b< waived or changed, except by endorsement issued to form a part o this policy, signed by the President., a. Vice-Prestdent• Secretary ot Assistant Secretary of the Company. 15. Assignment-pssignment of interest under this policy shall no• bind the Company until its consent is endorsed hereon; if however• the nanted Insured shall die, this policy shall cover (1) the named Insured's legal representative as the ttamed Insured and (2) under Cneerages ?A and B• subject otherwise to the provisions of Insuring Agreement III, any person having proper temporary custody of any owned auto- mobile or hired automobile, as an Ittsured until the appoitttment and qualification of such legal representative; provided that notice of cancellation addressed to the Insured named in the declarations attd mailed to the address shown in this policy shall be sutTicient notice to effect cancellation of this policy. 16. Caneellation-This policy may be cancelled by the named In- sttred by mailing to the Company written notice stating when there- after the cancellation shall be effective. This policy may be cancelled by the Company by mailing to the named Insured at the address shown in this policy written notice stating when not less than ten days there- after such cancellation shall be effective. The mailing of notice as afore- said shall be sutl•icient proof of notice. The effective date of cancellattort stated in the notice shall become the end of the policy Pertod. Delivery of such written notice either by the named Insured or by the Company shall be equivalent to mailing. If the named Insured cancels, earned premium shall be computed in accordance with the customary short rate table and procedure. If the Company cancels• earned premium shall be computed pro rata. Premium adjustment tnay be made either at the time cancellation is ettected or as soon as practicable after cancellation becomes effective• but pay- ment or tender of unearned premium is not a condition of cancellation. 17. Deelarations-By acceptance of this policy the named Inaurcd agrees that the statements in the declarations are his agreements atrd representations, that this policy is issued in reliance upon the truth of such representations and that this policy embodies all agreements "nt- ing between himself and the Company or any of its agents relatttrq to this insurance. IN WITNESS WHEREOF, The tEtna Casualty and Surety Company has caused this policy to be signed by its President and - a Secretary at Hartford, Connecticut. and countersigned on the declarations page by a duly authorized agent of the Company. 204002572g
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r-' =I-,_' V~4,TvF`' i;".DO=S=MEtlT - -_-e t c, "remium Condition) It is agreed that the definition of "remuneratiosi" in the Premium Condition is amended to read as follows : The word "remuneration" means the entire remuneration earned during the policy period by proprietors and by all em- ployees of the named Insured, other than drivers of teams or automobiles and aircraft pilots and co-pilots, subject to any overtime earr.ings or l.mitation of remuneration rule applicable in accordance with the manual. in use by the company. Forming part of the policy to which attached.from its date of issue. Tho IEtna Casualty and Surety Company Hartford, Connecticut Vice Prrtiden0 AL-LC-PS tC-rnr] 2040025729
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lb.e'l YaRK AUTOMOBILE UABIUTY ENDORSEMENT I ..=ti~rE-;Ek;T OF `L.NC_! LATfON CONDITION It is agreed t.`•at :n mc c. --._ Condition, the word "ten" is replaced by "twenty" and the following a added thereto. ' "provided in the event of non-payment of premium, such notice shall state when not less than tm days thernfter such cancellation shall be effective." This endorsemeat forms a part of the policy to wbidt amc3ted, effacrive from its date of issue The JEtna Casuatty and Surety Company Hartford, Connecticut Aeridrnr• 2040025730
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r E=-Pv !lAH(LITY EXCLUSION ENDORSEMENT It is at te-• ,..e -- . - . , - 1 _-__• a. .-. _ or destruction ta) ut:'r, rt>pect to wn:cn an ir;ur•6 t::e policy is also an Insured under a nuclear energy liability policy issued by \uciear Energy Liability Insurance Association. Mutual Atomic Energy Liability Underwriters or Vuclear Insurance Association cf Canada. or would be an Insured under any such policy but for its termination upon exhaustion of its limit of liability: or (b) resulting rrom the hazardous properties of nuclear material and with respect to which (1) any person or organtzatton is required to maintain financial protection pursuant to the Atomic Energy Act of 1954. or any law amendatory thereof. or (_) the Insured is. or had this policy not been issued would be, entttled to indemnity from the United States of Amertca• or an~ agency thereof, under any agreement entered into by the United States of America, or any agency thereof, with any person or organization. 11, Under any Medical Payments Coverage, or under any Supplementary Payments provision relating to immediate medical or surgi- cal relief, to expenses incurred with respect to bodily injury, sickness, disease or death resulting from the hazardous properties of nuclear material and arising out of the operation of a nuclear facility by any person or organization. III. Under any Liability Coverage, to injury, sickness, disease, death or destruction resulting from the hazardous properties of nuclear material, if (a) the nuclear material (1) is at any nuclear facility owned by, or operated by or on behalf of, an Insured or (2) has been dis- charged or dispersed therefrom; (b) the nuclear material is contained in spent fu:: or waste at any time possessed, handled, used, processed, stored, transported or disposed of by or on behalf of an Insured; or (c) the injury, sickness, disease, death or destruction arises out of the furnishing.by an Insured of services, materials. parts or equipment in connection with the planning, construction, maintenance, operation or use of any nuclear facility, but if such facility is located within the United States of America, its territories or possessions or Canada. this exclusion (c) applies only to injury to or destruction of property at such nuclear facility. IV. As used in this endorsement: "hazardous properties" include radioactive, toxic or explosive properties; "nuclear material" means source material, special nuclear material or byproduct material; "source material" , "special nuclear material", and "byproduct material" have the meanings given them in the Atomic Energy Act of 1954 or in any law amendatory thereof; "spent fuef" means any fuel element or fuel component, solid or liquid, which has been used or exposed to radiation in a nuclear reacttrr: "wute" means any waste material (1) containing byproduct material and (2) resulting from the operation by any person or orgaru- zation of any nuclear facility included within the definition of nuclear facility under paragraph (a) or (b) thereof; "nuclear facility" means (a) any nuclear reactor, (b) any equipment or device designed or used for (I) separating the isotopes of uranium or plutonium, (2) processing or utilizing spent fuel, or (3) handling, processing or packaging waste. (c) any equipment or device used for the processing, fabricating or alloying of special nuclear material if at any time the total amount of such material in the custody of the Insured at the premises where such equipment or device is located consists of or contains more than 25 grams of plutonium or uranium 233 or any combination thereof, or more than 250 grams of uranium 235. (d) any struuure, basin, excavation, premises or place prepared or used for the storage or disposal of waste. and includes the site on which any of the foregoing is located, all operations conducted on such site and all premises used for such operations; "nuclear reaUor" means any apparatus designed or used to sustain nuclear fission in a self-supporting chain reaction or to contain a critical mass of fissionable material; With respect to injury to or destruction of propeny, the word'9nJttry" or °detdntetton" includes all forms of radioactive contam- ination of property. This endorsement forms a part of the policy to which attached, effective from its date of issue. Tha IZtna Casualty and Surety Company Hartford, Connecticut For attachment to the following policy forms: (CA, 1C, J5. AL. S). MP. 1P, CJ, SK. GS, PS, LC, DR. DP. DG, DB. DH, DO) (13110-A) President. 2040025731
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N; YCaK A'JTCh+~iSl; Ll.., jTY ENDORSEMENTS - NE'•,V 'r-DP.K kUTOMOcfiE ACCIDENT INDEMNIFICATION ENDORSEMENT . _...-., - - - "'_emm5cation Corporation, here:nai:er ca:ied •'\f'~ a.IC.' agrees ~..:;;t :.,- o.,, __ ..n oi :;:e~;r^_:atum ior this endorsement and sub7ect to ati terms vt :nu enoOrsem2.^.: INSURING AGREEMENTS I. , Damages for Bodily Injury Caused by Uninsured Automobiles. MVAIC will pa•v all sums which the Insured or his legal representat:ve shall be legally entitled to recover as damages from the owner or operator oi an uninsured automobile ' because oi bodily mjury, sickness or disease, includin¢ death resulting therefrom, hereinafter ulled "bodily mlury"• sustained by the Insured• caused by accident and arising out of the ownership, maintenance or use oi such uninsured automobila; provtded, for the purposes of this endorsement, determination as to whether the Insured or such representative is legaily entitled to recover such damages, and if so the amount thereof, shall be made by agreement between the Insured or such representative and MVAIC or, if they fail to agree, by arbitration. IL Definitions. (a) In.arnd. The unqualified word "Insured" muns: . (1) the named Insuced and, while residents of the same household, his spouse and the relatives of either ; (2) any other person while oeettpying {i) an automobile owned by the named Insured or, if the named Insured is an individual, such spouse and used by or with the permission of either, or (ii) any other automobile while being operated by the named Insured or such spouse, except a person occupying an automobile not registered in the State of New York, while used as a public or livery conveyance; and (3) any person, with respect to damages he is legally entitled to recover for care'or loss of services because of bodily , injury to which this endorsement applies. (b) Uninrured Automobile. The term "uninsured automobile" meatu: ' (1) an automobile with respect to the ownership, maintenance or use of which there is, in the amounts specified in the New York Motor Vehicle Financial Security Act, neither (i) cash ar securities on deposit with the New York Commissioner of Motor Vehicles nor (ii) a bodily injury liability bond or insurance policy, applirable to the accident with respect to any person or organization legally responsible for the use of such automobile; or (2) a hit-and-run automobile as defined; but the term "uninsured automobile" shall not include : (i) an automobile owned by the named Insured or spouse; (ii) an automobile which is owned or operated by a self-insurer within the meaning of any motor vehicle financial responsibility law, motor carrier law or any similar law; (iii) an automobile which is owned by the United States of America, Canada, a state, a political subdivision of any such government or an agency of any of the foregoing; (iv) a tand motor vehicle or trailer, if operated on rails or crawle:-treads or while located for use as a residence or premises and not as a vehicle; or (v) a farm type tractor or equipment designed for use principally off public roads, except while actually upon public roads. (c) Hit-and-Rvo Automob;le. The term "hit-and-run automobile" means an automobile which causes bodily injury to an Insured arising out of physical contact of such automobile with the Insured or with an automobile which the insured is occupying at the time of the accident, provided: ( I) there cannot be ascertained the identity of either the operator or , the owner of such "hit-and-run automobile"; (2) the Ittsured or someone on his behalf shall have reported the accident within 24 hours or as soon as reasonably possible to a police, peace or judicial officer or to the Commissioner of Motor Vehicles, and shall have filed with MVAIC within 90 days thereafter a statement undei oath that the Insured or his legal representative has a cause or causes of action arising out of such accident for damages against a person or persons whose identity is unascertainable, and setting forth the facts in support thereof; and (3) at the request of MVAIC, the Insured or his legal representative makes available for inspection the automobile which the Insured was occupying at the time of the accident (d) Occapyis. The word "occupying" means in or upon or entering into or alighting from. (e) Srate. The word "state" includes the District of Columbia, a territory or possession of the United States, and a province of Canada. IIL Territory. This endorsement applies only to accidents which occur within the State of New York. EXCLUSIONS This endorsement does not apply: (a) to bodily injury to an Insured while operating an automobile in violation of an order of suspension or revocation; or to care or loss of services recoverable by an Insured because of such bodily injury so sustained; (b) to bodily injury to an Insured, or care or loss of services recoverable by an Insured, with respect to which such Insured, his legal representatives or any person entitled to payment under this endorsement shall, without written consent of MVAIC, make any settlement with or prosecute to judgment any action against any person or organization who may be legally liable therefor; (c) so as to inure directly or indirectly to thebenetit of any workmen's compensation or disability benefits carrier or any person or organization qualifying as a self-insurer under any workmen s compenation or disability benetits law or any similar law. CONDITIONS 1. Policy Provisions. None of the Insuring Agreements. Exclusions or Conditions of the policy shall apply to the insurance afforded by this ettdorsement except the Conditions "Notice" or "Notice of Accident" and "Declarations". 2. Premi.a,. If during the policy period the number of automobiles owned by the named Insured or spouse and registered in New York or the number of New York dealer's liceuse plates or transporter plates issued to the named Insured changes, the rtamed Insured shall notify the Company during the policy period of any change and the premium shall be adjusted as of the date of such change in accordance with the manuals in use by the Company. If the earned premium thus computed exceeds the advance premium paid, the named Insured shall pay the excess to the Company; if less, the Company shall return to the named Insured the unearned portion paid by such Insured. s, Notice and Pr.of of Claim; Medical Reports. Within 90 days or as soon as practicable, the Insured or other person making claim shall gtce to MVAIC written notice of claim under this endorsement. lt71d61 2040025732
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EfiLSZ00bOZ As <oon a~ practtnble after written request by MVAIC, the Insured or other person making claim shall give to LiVAIC written proof oi claim, under oath if required, tncluding full particular> of the nature and extent of the injuries, treatment, and other detaJs entering into the determination oi the amount payable hereunder. The lrtsnred and every other person making claim hereunder shall as may reasonably be requtred subntit to examinations under oath by any person named by MVAIC and subscribe the same. Proof of claim shall be made upon forms furnished by MVAIC rmless MVAIC shalh have failed to furnish such form• aithm 1; da., after receiving notice of claim. The injured person shall submit to physical examinations by physicians selected by MVAIC when and as MVAIC may reasonably require and he, or in the event of his incapacity his legal representative, or in the event of his death his legal representative or the person or persons entitled to sue therefor, shall upon each request from MVAIC execute authorization to. enable MVAIC to obtain medical reports and copies of records. 4. Notice of Legal Action. If. before MVAIC makes payment of loss hereunder, the Insured or his legal representative shall instttute any legal action for bodily injury against any person or organization legally responsible for the use of an automobile involved in the accident, a copy of the summons and complaint or other process served in connection with such legal action shall be forwarded immediately to MVAIC by the Insured or his legal representative. S. Limits of Liability. (a) The limit of liability of MVAIC for all damages, including damages for care or loss of services. because of bodily injury sustained by one person as the result of atrv one accident is $10,000 and, subject to the above provision, the total limit of liability of MVAIC for all damages, including dirnages for care or loss of services, because of bodily injury sustained by tuo or more persons, whether Insureds or qualified persons under the New Y-ork Motor Vehicle Accident Indemni• ficattott Corporation law, as the result of any one accident is $20,0f10. The applicsuon of more than one New York Automobile Accident Indemnification enuorsement to any accident shall not operate to increase the limit of liability of MVAIC with respect to any and all persons sustaining bodily injury as a result of such accident. (b) Any amount payable under the terms of this endorsement, including amounts payable for care or loss of services, because of bodily injury sustained by one person, shall be reduced by (1) all sums paid to one or more Insureds on account of such bodily in)ury by or on behalf of (a) the owner or operator of the uninsured automobile and (b) any other person or persons jointly or severally liable together with such owner or operator for such bodily injury, (2) all sums paid to one or more Insureds on account of such bodily injury under any insurance similar to that provided by this endorsement and (3) the amount paid and the present value of all amounts payable on account of such bodily injury under any workmen's compensation law, exclusive of non-0ccupational disability benefits. i, Arbitration. If any person making claim hereunder and Is1VAIC do not agree that such person is legally entitled to recover damages from the owner or operator of an uninsured automobile because of bodily injury to the Insured, or do not agree as to the amount of ~pa,vmcnt which may be owing under this endorsement, then, upon written demand of either, the matter or matters upon which such person and MVAIC do not agree shall be settled by arbitration in accordance with the rules of the American Arbitration Association, and judgment upon the award rendered by the arbitrators may be entered in any court having jurisdiction thereof. Such person and MVAIC each agree to consider itself bound and to be bound by any award made by the arbitrators pursuant to this endorsement. 7. Trnvt Asreement. In the event of payment to any person under this endorsement : (a) MVAIC shall be entitled to the extent of such payment to the proceeds of any settlement or judgment that may result from the exercise of any rights of recovery of such person against any person or organization legally responsible for the bodily injury because of which such payment is made; - (b) such person shall hold in trust for the benefit of MVAIC all rights of recovery which he shall have against such other persott or organization because of such bodily injury ; (c) such person shall do whatever is proper to secure and shall do nothing after loss to prejudice such rights; (dt if requested in writing by MVAIC, such person shall take, through any representative designated by MVAIC, such action as may be necessary or appropriate to recover such payment as damages from such other person or organization, such action to be taken in the name of such person; in the event of a recovery, MVAIC shall be reimbursed out of such recovery for expenses, costs and attorneys' fees incurred by it in connection therewith; (a) such person shall execute and deliver to MVAIC such instruments and papers as may be appropriate to secure the rights and obligations of such person'aad MVAIC established by this provision and, upon request of MVAIC, shall attend hearings and trials and assist in securing and giving evidence, obtaining the attendance of witnesses and in the conduct of any legal proceedings. t. Payment of Lou by MVAIC. Any amount due hereunder is payable (a) to the Insured, or (b) if the Insured be a minor to his parent or guardian, or (c) if the Insured be deceased to his surviving spouse, otherwise (d) to a person authorized by law to receive such payment or to a person legally entitled to recover the damages which the payment represents; provided, MVAIC may at its option pay any amount due hereunder in accordance with division (d) hereof. f. Action Aaainst MVAIC. No action shall lie against MVAIC unless, as a condition precedent thereto, the Insured or his legal representative has fully complied with all the terms of this endorsement. 10. Chanan. This endorsement embodies all agreements existing between the Insured and MVAIC relating to this insurance. :~otice to or knowledge possessed by the Company, any agent or any other person shall not effect a waiver or a change tn this endorsement or estop MVAIC from asserting any right under the terms of this endorsement. It. A.sianmenc. Assignment of interest under this endorsement shall not bind \1VAIC until its consent is endorsed hereon; if, however. the named Insured or his spouse if a resident of the same household, shall die. this endorsement shall cover (I) the survivor as named Insured, (2) his legal representative as named Insured but only while acting within the scope of his duties as such, and (3 t any relative who was an Insured at the tinte of such death. ),T• Policy Period-Terminstioa. This endorsement applies only to accidents which occur on and after the effective date hereof and during the pohcy period and shall terminate upon ( I) termination of the policy of which it forms a part or (2) termination of ::e.t York regtstratton on all automobiles owned by the named Insured or spouse. LIMITATION OF FAMILY PROTECTION COVERAGE It is agreed tna: such insurance as is afforded by the policy or by any endorsement used therewith, other than the New York Automoot:e Acctdcnt Indemr.t5canon Endorsement, with respect to damages which the Insured sna,l become leyally entitled to recct•e: fr, om :i- owner or operator of an uninsured automobiie• does not apply to any accident occurring within the State of New Fork. form a par, of the poluy to which attached, e^ecuve from tts date ^. ...__ • The JEtna Casualty and Surety Company A Mart'rord. Conneaticut
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•.._, . _ _r_- _ - - Yo:3C-\C _ \,_ ~-~ : . ._.. _. ..---' =:ac ~-n /-:ncc..iag I AL 132, ?:i RY ( ...:.'d': .. ".StS oa•,^,ec. :ented. or rontroiied by the na:ned 1asu:ed. _. inte:esr o: sc,h pres,.,a - On~aet. ;ene:a• :•essr. r ' ce-= _.c r :nsured. - - ~ - -:c ::: s r.e:^_rnc ezrept as spec:naily prov~aodl Coae ~ Premium Rams Acvance :n rr: ~s c.secr:c:e ~s poe,-.' aC not ar;rv anYci =e other provissons ofl ticmbers Baseat BI PD _ BI p~ .. _.__,.... r. __... =-' `=' = s I ((1) Area•sq, ft. (1) Per 100 sq. ft. ( B ) Elevators (C) Independent Concracrors-Let or Sublet Work (D) Products (Including Complered Operations ) ( E ) Conrractual If Locanon same as address in Item 1 of the dedarations chec)c ( ANYWHERE IN THE U911TED STATES ALL OPERATIONS INCIDENTAL TO THE CONDOCT OF THE BUSINESS KENTUCKY MUNCIPAL TAX INCLUDED IN nA° ABOVE INCLUDED IN aA" ABOVE 1 Cost per $100 1(1) Sales (1) Per$1000 (2) Recei a (2) PerS1000 I(2) Fronnge ~(2) Perlinearft. (3) Remuneraaon (3) Per $100 ~ Number Per elevamr ' - Number i Per PRtMA Y LIMITS ~1 25,D00/2~,000/100,000 Po 25,P00/la0,o0o ~ E. ExcES OF 81 25/~25/i0p TO b0/100/100 PD 25 100 T{0o~100 1 EE - RAT S EXCESS F BI 0/10}~j100 i I 1 9987 CIGAR OR CIGARETTE MANUF'ACTURIt9 . I NCLUDED I I! "AR ABOVE INCREASED LIM{TS BAQIC CHARQE SPECIAL COVERAGE PREMIUMS 2~,677,8do P.013 .00q. E.00 .000, E.0 _~ 208. i 1826. 2122. 987' 1 9~ .--- 229.70 contract 9987 20,000,0 0 1 E.o0o4 E.0045 9981 E 7368. ~~ 3570• ~~ a pF 35• 15• P 6.57 2.9o E .76 .48 EE 1.31 • Dessgnates location to which hndlord's Liability Endorsement applies. t Described premium basis, if othet than ( I), (2) or ( 3). 2040025734
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r ENDO RS EFtENTS AUTOMOBILE 13000 131 1319 13194 12722F 13149 FORM No. 25 C21~4 1~ ~1'~7 J,;21 33D GENERAL LIABILITY C2351 C2237e ADDtL.INT. C2154 INCIDENTAL MALPRACTICE SUPPL.R ETRO.RATING-PLAH D c15491 A, 30, 4D, INSURING AGR:M{T N0. 4 AMEND. CIG57 , 3D C 17470. Cig041-s,2A INSURING AGRM'T III AMEND. SPECIAL END'T. POL. COND. No.11 AMEND. ADD'L. INSUREDS ENDtT-COMP. & LIAS. 1NS. (5PG8) 41MF2037A C2277 13113A 1W.OPER. EXCLUDED This endorsement forms a part of the policy to which attached, effective from its date of issue unless otherwise stated herein. (Tha in/orreation below it reqrired only when thit rndorternent is uti<ed rvbttq.ent to prrparation of the policy.) Endorsement Effetxi9e Policy No. Endorsement No. ~ Named Insured PREMIUM: Additional $ Return $ The IEtna Casualty and Surety Company Hartford, Connecticut Countersigned _._ Pretident. Jr. Kiod T torr Code (Sute & Countr or City) Policr Year Term Eap.rr Form Clan Premium Account, Esperience (90455) Ed. 2/59 2040025735
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OCCURRENCE BASIS (Bodily Injury) It is agreed that such inauranu as i3 aSorded'cy tbe policy for Bodily Injury Liability applies subject to the following provisioru: 1. The words "taused by accideat" crt delered and elsewhere the word "accident^ is amended to read "occurrence". 2. "0:_rrmu" meana aa even4 oc a cectmuoua or repeated ezpo.ure to condition., which unezpecredly causes injury dunng the policy penod. All such ezposure to eubsraaca.'.ir the same gene:al cooditions shall be dtemed one occurrence. Thu endorsement forms a part of the policy to which attached e&ect3.e from its date of itsve unless otfiecwise srated herein. (The inform.non below is requind on17, wben this endorsement is ittued svbsequent to presottion of the polie7.) Fsdonetneac eftecrive Policy No. Fadonemeat No. 2 Named Insured Additional Premium I N C L. 1 N R A T ES Jr. fC•21d4 EI. 4.57 Biod Policy Year The fEtna Casualty and Surety Company Hartford, Conrsecticu FOR CO]SPANY USE ONLY Ters. I Fspir7 Pnsim State Vice Prtrident Premiem Cancelled 2040025736
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AL-LC CONTRACTUAL LIABILITY COVERAGE ENDORSEMENT (Blanket Coverage) Tiu Company acrecs the narned Insured, in consideration of the Payment of the premium and in reliance upon the statemen,ts :n the deciarauons and in the <,hedule beiow and subject to the limits of ltabdtty, exclustons,.con4'itpns and other,terms of thu endorsement:, INSURING AGREEMENTS L Coverages. To vay on behalf of the Insured all sums which the Insured by reason of the liability assumed by htm under any %%ntten contract shall become legally obligated to pay as damages because of 6odily tnjury Liab,l,ry. bodily injury, sickness oc disease including death at any time resulting therefrom, sustained by any per- so» and caused by accident; or Property Damage Liability. injury to or destruction of property including the loss of use thereof, caused by accident: _ provided this cndorsenent shall not apply with respect to any "contract" as defined in the policy. II. Defense, Settlement, Supplementary Payments. The prociaions of Insuring Agreement II of the pnlicy, other than paraeranh ) tbt (J) therenr are applicable to the insurance afforded under this endorsement. With respect to such injury, sickness. disease or de- ~trttetintt, as is covered by the terms of this ettdorsement, the Company also shall defend an arbitration proceeding wherein an mdem- ~ nitee under a uritten contract to which this endorsement applies seeks damages against the Insured on account thereof and u•heretn ' the Company is entitled to exercise the Insured's rights in the choice of- arbitrators and in the conduct'of such arbitration proceed= iugs. 111. Definition of Insured. The provisions of Insuring Agreement III of the policy are applicable to the insurance afforded under this endorsement. • t IV. Endorsement Period, Territory. _ This endorsement applies only to accidents which occur on and after the effective date here- 'of, during the policy period and within the United States of America, its territories or possessions, or Canada. • EXCLUSIONS 1. Thia endersemenr doee nor apply: (a) to liability for any warranty of goods or products; (b) to damages awarded in arbitration other than an arbitration proceeding as described in Insuring Agreement II of this endorsement; (c) to any obligation for which the Insured may be held liable in an action on a contract by a person not a party thereto; (d) to any accfdent for which the Insured has assumed liability under any contract or agreement, if such accident took place prior to the execurion of snch contract or agreement ; -- --- • (e) to injury, sickness, disease, death or destruction due to war, whether or not declared, civil war, insurrection, rebellion or revolution, or to any act or condition incident to any of the foregoing: (f) to liabi)ity imposed upon any indemnitee, as a person or organization engaged in the business of manufacturing, selling or distributing alcoholic beverages, or as an owner or lessor of premises used for such purposes, by reason of any statute or ordinance pertaining to the sale, gift, distribution or use of any alcoholic beverage; (g) under the Bodily Injury Liability Coverage, to any obligation for which the Insured or any carrier as his insurer may be held liable under any workmen's compensatton, unemployntent compenution or disability benefits law; or under any similar law: (h) under the Property Damage Liability Covenge, to mjury to or destruction of (1) property owned or occupied by or rented to the In- sured, or (2) property used by or in the care, custody or control of the Insured or property as to which the Insured for any purpose is exercising physical control; (i) under the Property Damage Liability Coverage, to injury to or destruction of any goods, products or containers thereof manufactured, sold, handled or distributed or premises alienated by the named Insured, or work completed by or for the tumed Insured, out of which the accident artses; (j) under the Property Damage Liability Coverage, to any of the follotving insofar as any of them occur on or from premises owned by or rented to the named Insured and injure or destroy buildings or property therein and are not due to fire: (I ) the discharge, leak- age or overflow of water or steam from plumbittg, heating, refrigerating or air-conditioning systems, standpipes for fire hose, or industrial or domestic appliances, or any substance from automatic sprinkler systems, (2) the collapse or fall of tanks or the com- ponent parts or supports thereof which form a part of automatic sprinkler systems, or (3) rain or snow admitted directly to the building interior through defective roofs. leaders or soouting, or ooen or defective doors. .windows, skylis:hts, trausorns or ventilatocs- z. Unless stated in the schedule below as not appticable the following exclusions also apply to liability assumed by the Insured under any written contract classified in the Comtuny i Manual as a "construction agreement". T6ie mdor.evreat doee aa apply: (a) if the Insured or indemnitee is an architeet, engineer or surveyor, to injury, sickness, disease, death or destruction, arising out of • defects in maps, plans, designs or specifications prepared, acquired or used by the Insured or mdemnttee; (b) to liability assumed by the Insured with respect to operations on board any vessel; (c) to the Products (including completed operations) Hazard; ' (d) to liability assumed by the Insured with respect to any contract under which the Insured undertakes to perform operations affecting any railroad bridge or trestle, tracks, roadbeds, tunnel, underpass, or crossing within fifty feet of any such railroad property; (e) to injury to or destruction of any property arising out of (i) blasting or explosion other than the explosion of air or steam vessels, piping under pressure, prime movers, machinery or power transmitting equipment, or (ii) the collapse of or structunl injury to any building or structure due (a) to grading of land, excatztion, borrowing, filling, back-filling, tunneling, pile driving, coffer-dam work or caisson work, or (b) to moving, shoring, underpinning, raising or demolition of any building or structure or removal or rebuilding of any structural support thereof, provided however this exclusion does not apply to operations: (A) performed for the named In- sured by independent contractors, or (B) stated in the Company's Mattual as not subject to this exclusion or (C) completed or abandoned within the nteaning of paragraph 2 of the Products (mcluding completed operations) Hazard as defined in the policy if insurance is afforded therein for the Products (including completed operations) Hazard; (f) to injury.to or destruction of wires, conduits, pipes, mains, sewers or other similar property or any apparatus in connection therewith below the surface of the ground if such injury or destruction is caused by and occurs during the use of mechanical equipment for the purpose of grading of land, paving, excavating or drilling, or injury to or destruction of property at any time resulting therefrom. provided this exclusion docs not apply to operations (A) performed for the named Insured by independent contractors, or (B) stated in the Company's Manual as not subject to this exclusion or (C/ completed or abandoned within the meaning of paragraph 2 of the Products (including completed operations) Hazard as defined in the policy if insurance is afforded therein for the Prodncts (including completed operations ) Hazard. (OVER) (t•2277•i) 2040025737
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8£LSZOOirOZ AL-LC CONDITIONS y Conditions. All of the Conditions of the policy shall apply to the insurance under this endorsement except those respecting "Uefinitioni', "Limits of Liability" and "Assistance and Cooperation of the Insured". s of Liability, (s) badily IniucT Liability Cov.rsis. The limit of contractual bodily injury liability stated in the schedule ,pplmable to "each person" is the limit of the Company s liability for all damages, including damages for care and loss of services. ~ oi bodily inlury. s+ckness or disease. including death at any time resulting therefrom, sustained by one person as the result of :cident. the limit of such liability stated in the schedule below as applicable to "each accident" is, subject to the above provision each lierson, the total limit of the Company's liability for all danuges, including damages for care and loss of services. arising ily injury, sickness or disease, including death at any time resulting therefrom, sustained by two or more persons as the result e aeetdeut. roparty Dama&s Liability Covaras.. The limit of contractual property damage liability stated in the schedule below as applicable cndent" is the total limit of the Company's liability for all damages arising out of injury to or destruction of all property of one ersons or organizations, including the loss of use thereof, as the result of any one acctdent; the limit of such liability stated in k below as "aggregate" is. subject to the above provision respecting "each accident", the total limit of the Company's liability tapes. Said aggregate limit applies separately to each pioject with respect to operations being performed away from premises or rented to the named Insured. ' he inclusiott herein of more than one Insured shall not operate to increase the limits of the Company's liability. • :ance and Cooperation of the Insured. The Insured shall cooperate with the Company and, upon the Company's re- attend hearings and trials and shall assist in effecting settlements, securing and giving evidence, obtaining the attendance of nd in the conduct of suits and arbitration proceedings covered hereunder. The Insured shall not, except at his own cost, volun- r atty payment, assmtte any obligation or incur any expense. iura. The advance premium stated in the General Liability Schedule or in the schedule below is the estimated premium on such written contracts as are on file with or known to the Company. The named Insured shall notify the Company of all other :tracts entered into during the policy period which are covered by this insurance. On termination of this endorseaxat, the earn- 1 shall be computed in accordance with the Company's rules, rates, rating plans, premiums and minimum premiums applicable trance. If the earned premium thus computed exceeds the estimated advance premium paid, the gtaraed Insured shall pay the ie Company, if less the Company shall return to the named Insured the unearned portion paid by such Insured. used as a premium basis the word "cost" means the total cost to any indemnitee of all work let or sub-let in connection with c project• including the cost of all labor, materials and equipment furnished, used or delivered for use in the execution of such her furnished by the owner, contractor or subcontractor, including all fees, allowances, tfonuses or commissions made, paid or due. SCHEDULE surauce afforded under this endorsement is only with respect to such of the following coverages as are indicated by specific tbiltty applicable thereto, and such limits shall apply in lieu of the limits set forth in the declarations of the policy. Contractual Coverages Litaita of Liability iry Ltabtltty '~2 8 Thousand Dollars each person ,amage Liability 100 Thousand Dollars each accident ThousandDollarseachaceident 100 Thousand Dollars aggregate tgraph 2 of the exclusions, the following exclusions do not apply to liability under any "construction agreement": to be used only when this endorsement is issued subsequent to the preparation of the policy. Rates Advance Premium Designation of Contracts Premium on file with or known to the Company Code Bases B.I. P.D. B.I. P.D. ritten contrgcts, other than (a) Number (a) perContract ny easement agreelr.ent, xcept (b) Cost (b) per$tooof nnection with a railroa grade Cost ing, or (2) any agreeme t red by municipal ordina ces, INCLUDED rI CofPOSt E RATE t in connection with th work .^.e Ir.uni c ipality TOT.4L 4$ IS vem iorms a part of the policy to which attached effective from its date of issue unless otherwise stated herein. :non betou is rcqurrrd mrly te•hcn t6u cndorsement ts issrted subseqtmnt to preparation of fht policl•.] eCccnvr Policy 1o. Endorsement No, 3 The Mtna Casualty and Surety Company Hartford, Connecticut . ! `..•••.............. Authorized Agent / -- FOR COMPANY CSE ONL1' - Term . E:ovy .Secrrtary. Premwm Suee 7Prem,um Canceded .I
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REDACTED REDACTED
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r I roC l D Et1TAL NfALP RACT I C E L I AB I L I TY 6. THE DEFENSE; SETTLEMENT; SUPPLEMENTARY PAYMENTS INSURING AGREEMENT AND ASSISTANCE AND COOPERATION CONDITION OF THE POLICY SHALL NOT APPLY TO THIS INSURAIQCE INSOFAR AS THEY REFER TO EXPENSES INCURRED BY THE INSURED FOR IMMEDIATE MEDICAL AND SURGICAL RELIEF TO OTHERS iHPERATIYE AT THE TIME OF ACCIDENT. 7. THE PREMIUM FOR THE INSURANCE PROVIDED BY THIS ENDORSEMENT Is INCLUDEI IN THE COMPOBiTE RATES SHOWN IN THE GENERAL LlABSLtTY SCHEDULE OF THE POLICY. This endorsement forms a part of the policy to which attached, effective from its date of issue unless otherwise stated herein. (The i.(or.nation below is required only whea this ertdorrnrtent is is.tucd subsequent to preparation of the policy.) Endorsement Effective' Policy No. Endorsement No4 Named Insured PREMIUM: Additiortal; Return $ The Xtna Casualty and Surety Company Hartford, Connecticut Countersi n d g e ~ . ~..ty.. ~..w.f~ ,.__._...~ .. Authorized Agent Pretident. )r. Ktod T rnro Code (State & Cor~ unty or City) Policy Ycar Term E-Ptry Form Cl.n Premmm Account. Emtrnrnc 1 2 / rGn.cci FA +•cc 204002S740
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. 1.\ f)PStltlt'IION 01' 1IA7.ANWS- I •O+.n.d Ad•dr. i - ' - --- -- - • , For all .utomohiles mortga~ed when covered for Comprehensive, Fire, Theft or Gdlision, shnw all information called for an revrrse Irrren(. 1 r 1• uli+l Nu. ~ ol AlrHl IJ'urr ; _1 Yr. N rc I ltnr++rv 1111 ha+r;I htn. ~Il:oin{; CI.i..iGr;d(on '1'r.;dr \.um• 'I'auk f:,dhnia{;r, "Ifu. tii•.uin • (:•r ,.u ity ~ I 'i'rurk Svr RoKIy'Lypr ~ Idrntificatiun No. ;md Atud~•I I I.i.l I'nrr ~ Cod to D,rurrd 1'own and State whrrr prinripnily - t;amg~rl .tnd'I'rrr. CrHlr i' ~mit of Linhility ~ i. ~mit (-omp., Fire and Theft PRf•:\tll/\/5-11'IihT111th1 BASIS- 1'l•:II AUTOA1O1111.F.1 A5 rr+pnte each autnmobde dmeribed hrrein, the inairanrr afforded applics only with resprct to surli aml +n many of U,c folluwing cnverages a% ue indicalnl by sPr'r'ific pn•mium charge or chnr{tes. Rodily Injury Automobile Property Damage - RATE -- Compre- Fire Theft ~ UrJ. Liability A1rd. Pay. l.iability •nmp-Fire henaive C:nlli+inn eft ~N CtiNSIU ERA TI0 N •F )sL A [2LT1IlN R [iE IuM •F -j75Q~r3 ~~ IT IS THE ADV NCE r Ergl 1M ~ FtIR THE - -_. CRIfO I I 6 - T• - _ I I6'1 IS AS FOLLOt,7. S- . 5/~l~ ?-'l.'j8- COVE AGE A I'-.OD(LY INJ RY COVE A.GE A SPEC.Ci V. - --- j'.03.: CiVE AGE A DOC •54. C-•NDT 39q BI ?_0 25~5~~CtaVE AGE B PR*('ERTY D MAGE 3. . CtaVE AGE B SFEC.COV. rj.40- COVE AGE B DOC 3.I4- CNDT 399 PD • . ~ . 8~ FP T TAL $75 ~-8.86 r - F EET D C ~ -- ~- - - - - ~ - - - - - - -- - )• - ) - - ~ -. FL.LsF.T RATE (IF APPLICABLE) Total Div. I. llnless ' othcrwise stated in cach rnlry tlro Limit of Liability " Total Div. 2. (ur ComprrhrHUive, hirc, and Theft Coverages is Actual Ca.h Valuc. " , t ' Total Div. 3. - -- I urposes for which lhe above described automobiles are to hu u.al arc "Pleasurr and Iiuriness" for private passenger - ---- - - - -- and "Commrrrixl" for cununrrcial or trnck type. I ' SI'tsC. COV. =~- ~~ - - < ~ - . ~~\ - fhis rudorscmrnt lunns a part of the policy In which tt h •II i l R f d t l d f i nn d -- - -- a ac IY VC rom ;ts n rs n rerw sr n , C c o ssue un 9 .1 rr uirer) on6 whrn en- f NDORSEAtENTS -- - - ~--•- - ~ - - -- - -- du..Y "~~jn~p2iuurd suhsrquen( to preparation oJ po/icg.) h --- - --- -- -~- F.mL 1{i~ L'al. No. I aL 13 ? I() f~R ' nd. No. Nanu•tl Insured • R PHILIP M R IS NC. GRAND TOTAL The {Efna Casualty and Surety Company HaPtford, Connecticut (rnrr e) Countersignal . . . P.nedrN. 2040025741
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The automobiles described on the reverse hereof under Entry Numbers corresponding to those indicated below are mortgaged u follows and Loss, if any, under Comprehensive. Fire, Theft or Collision shall be payable, as their interest may appear, to the named Insured and mortgagee named below Entrv i Down Due Date of No. Pay'rttent i Final Payment i Name of Mortgagee Entry Down No. Pavment Due Date of Final Payment I- Name of Mortgagee 1 4 ~ i I ~ I= (The following parts of the schedule are for use with Comprehensive and Schedule policies only). 2 Hired Automobiles Premiuia Basis • Cost of Hire LIABILITY I Rata per $100 Advsnce Pruniums Locauons .here automobilea wdl l+e pcinnpally uaed (If other than in declaration 1) Type FLrsd Purpmn 1 of Usa• Ettimated Coat of Htre , Hodily Injury Liability Propeny Damage Liabibty - Bodily Injury ~- Ltabdiry Propvty Damag. Liabibry 'Stace "a" for "Pleasure and Business", "b" for "C.ommerdal" 3 Non-Owned Automobiles K - Premium Basis - Qass I Persons and Qass ZrEtnplovees - " I Advance Prcmiums Ctl.a I Paaoas •~ Locatim of H..dquattm of _ ~ Bodily Ptopetty : Name of Each - Penom Named Hardn ' " Inlur7 Damare _ ( If other than in decl.iation I) K - Liabiliry Liabiliry • - .. ~ .. f .. . y -t . ~ . . . .. - . . , . . . ' . . . . . . ~ . _ ' . ''. . J . . . ? . ~ - ! ( R ates per Emol ' I o~ee .- - Cla.v 2 Emprovees Location of Hodquartm of Bodily Property i' Bodily~ Propvty _ Estmated Avet.ge !~:umber . . Ciass 2 Emplovees Iniury Damage Inlury Damage ( If other than in declaration 1) Liability Lubilrcy I Liability Liabibry _ I ~ i 2040025742 ~ - ~
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1 rl•St.lt_II' I IUN UP 11A'LAItI Lti: I• Ownrd_d AJ,Jea 1•:nln Yr Nr.c ---- -- Ilaliny; Clas,ifirnlinn Lisl Nu, ~ of ~ or •1•radr Namr Tank Gallnn:rl;c; 1'rirr Ahnl llsrd Ihn Seating (:apar~ily For all automobiles mortgaged when covered for C.omprehensive, Fire. Theft or Collision, show, all Information c.lled for on reverse hereof. ~Ihvchnsrvl i ------{.~11I- 111--- nrk S ' ~o .~vr Ihhlv'1 yp • andMo~hd drulifiralinu Nn. 'ocl 1o Imrncd Town and Stale where principally ~ garaged and'i err. Cndr • !,mril of Liabilily - Cump.. Fire aml Theft I'IlEM1U\IS-(1'flEM1UM BASIS-1'lilt A(/TOMOHILI•:1 As resprets each automobtle described herern, the insurance afforded applies anly with respn•t to sucF and so many of dre following coverages as are indicated by specific premium chargc or charges. _ AA_TE '- ~- - - - - - Bolily Inlury Aulwnnbil@ PrnnertY Damagc ~~ 'Firc ('ornprc- Fire Thrfl Drvl. Liabilily Mni• Pay. Liabllity ~~ hrnsive Colli.inu i UNDErt 01 iSI.N I•F - - HE - EaCP.IPTI.N • ---- -- F HAZAP g7 T• HE MAINT fIANCE •~ U E f nLL •t'1NE AUT.f1.Dl EE A610 UNDE UI I11.N ?•F T HE f)ERC IPTI~II •F f~AZAR Sr T• THE 'JSE F AL .D AUT.M.DI EE AND I1NDF ~l ISI.IJ ~•F T HE nESC IPTI.N f/F HAZAR S T• HE 11 SE • • ALL I N.N-.WNE AUTgM.RILE LL VEHIC E3 R RA E PER EHICLE/ Aov NCE REM - - - EFINED A - - - •VE VEH - --- --- CLE - ---- (~ 1 PD ~ PO 6 ~ P 60. 82 ~ I .' %~ P 3t. R03. 16 - 207 - 5. _ E 2.75 • . . 1- 1 5n. ,0• E I, t'70. 12 - _ A L~ ST_ATEJ WITH THE E XCEPTI.N F THE STATE T E' AB.VE ATES ARE N• •F h1AE3. FLEf:T IlA•1•E (IF APPLICABLE) _ Total Div. t. . ~ o, - 20 25.55 - FP ' Ilnlrss otherwise stated in each entry the Limit of Liabilily lur Comprrhtatsive, firr, autl 'I'hcft Coverages is ' Achrel l:aqh Valirc.'• / I' l l f h h h l Total Div- 2. E E -" - Tutal Div. 3• -"•~ -- ~ 3 70• - - 2' '- ~ ~ - - ----- - - _ - IIfIH1tiRti or w Nlvr l r.scrl iCh t e e etl mltomnhi CS ar@ tu br. n rd are "Plrasurc awl Ilusiness" s" for private passrnger I E~P-.~~~_ _~ NO ; ~. , - EN h!. ---~- ----~ amJ "Cumtut•rc•ial" for cnmmrrrial or truck type. 1'his rntloru•ment Inmu a part of the policy to which altarh f m it l ff tiv f i l t d h i SI'F.C. C(JV. and - E. 5 . - - --- -- -° _ --.~ .---- -- a , e ec e ro s ( e o ssue m tss ot erw a se stalt'lI !IPrri1L (JrlJorrnatinn hrlnw required only whrn rn- F.NI?OflSEMENT:F '~ ~ I --- - - ------ --- d rs~ •n1tr/ tr is issued sub.crquenf tn preparation of policy.) 2 Y ' ~-- - - --~87 _ - - - - -- '-- - -• ~-- 1•: rd.7AfY Pnl. No. I AL I 12I nRRY F.nil. Nn. Namt•d Insurnl P H 1 L 1 P ~~. R R 1 S 1 N C, ~ ,~~ ~~ (-----"-"-'-" - --- -- -- l1 U T.TA Th e fEfna Casualty and Surely Compatrtty Hartford, Connecticut (11177•A) COUnterSignetl 5~1 A • 7•f~% 2Q7~7.o9• Allthnri2ttl Agent. P"ndau. 2040025743
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The automobiles described on the reverse hereof under Entry Numbers corresponding to those indicated below are mortgaged as follows and Loss, if any, under Compreheruive, Fire, Theft or CoUision shall be payable, as their interest may appear, to the named Insured and mortgagee - named below Entry ' Down Due Date of Na. • Payment Final Payment Name of Mortgagee Entry No. Down Payma -Due Date of Final Payment i_ Name of Mortcattee ( { J _ ,( The fol low!ng parts of the schedule are for use with Comprehensive and Schedule policies only )-• '~ 2 Hired Automobiles j LIABII.ITY • .) > > Ptenium Buis°• Cost of' Hire • , . • • , i •_ ', 't Rata per f1T0 ' - Advance Premtums ' Loranons where autmrobilea ' Types Purpoaes Ertimated t ') Bodily Property ` Bodtly Propety wJf be pnnctpally used 7 I-Lred of Use' Ceu of Fhre - Injury Damage . Injury ( Damaae )(!f other than in declatatton 1 Y Liabiltry L:.b luy ;I abiliry Liab bry . _ ...t 'State "a"-for °Pteasure and Busine.ss"; "b" for "Cotttmercial" 3 Non•Owned Automobiles remium tasR. Gass I Persons and ayts 2 ~mplovees -l -t Advance Prantums aaas iiPasonr Location of Hsadqnhten of J J.1 . Bodily Property l Name of Eadt Persons @Oamed Hnein I Injury _ Damage l• ( If other than in declaratson 1) -1Jabiliry Llabthty - 1 t i C .~ 1 .- _i .~ .., j .~ .1 ..~ C) 1 ~ ~ -; 1 1 . ^ :t •I 7 y L y ~p ~ J ~ - Class 2 Empiovea ~( Aeadquarren of Eanmated Average hiumber ~ • Gase-2-farekrvees ^( Q other tF~iart in declaration 1) _a -_ r- Rates pv_Emp~osx : , , Bodtiy ~ P~opartY I Bodily -~ Intury t ~ Damage ~ J Inlury Liabdtry- I LAbilny I _Liabiiu,v I Propeay Damage Lubihcy 2040025744
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iY i"D t4(,PZtilf D4rft.YI; :.t:P~`iL:: IEI3T ?HE STAT-_ CJRFJRATICi1 CJMaSSIU?: STA r OF KANSAS Doc!cet NQ. 15600 "It is uaderstood and agreed that the policy to which tnis endcrsemer.t '_s attaened i: written in oursuar.ce of and such policy shall fulfill the insurance i•e, irements of r-ection 66-1, 123, General.Statutes of Kansas 1935, or as t:ay . be hereafter amended and the rules and regulations of the State Corporation L;c=mussion adopted thereunder with respect to liability for injurieo t.) persons (except employees of the assured injured in the course of their es.pieyment) ^n.l for damage to property (ex_cept Targo). The obligations and promises of tYis cndorsement, howev,:r, shall be effective on].y while the equipment covered by this policy is being operated within the State of Kansas.° "It is further understood and agreed that the com;any waives a description of th.; notor vehicles, trailers or semi-trailers insured hereunder and the policy is hereby amended and extended so as to cover any and all motor vehicles, trailers and semi-trailers operated or used by the assured pursuant to the certificate, permit or license issued by tne State Ccrporation Comm~Asion of hansas." "Nothiagcontained in the policy or any endorsement thereon, nor the violation of any of the provisions thcreof by the assured, shall relieve the company frcm liability thereunder as an insurer; provided that nothing herein shall be con- strued to prohibit the company from providing for tne right of reimbursement or subrogation as between itself and the assured in cases where the carrier is ,iperating equipment in violation of the permit, license or certificate issued to him by the Commission." "The cancellation of the policy to which this endorsement is attached shall not take effect until after ten (10) days notice in writing, by the Company, shall have first been given to the State Corporation Commission of Kansas, at its office at Topeka, Kansaa. Said ten (10) days notice to commense from the date notice ia actually received at the office of the Commission." Attached to and forming part of policy number 1AL13219RRY of the rcTFJA CASUALTY & SURETY COt3PANY of NEW YIRK aame of insuring Company issued to P HIL IP t1e'W/ 9 1 t. Ca ^ M-13 2 G1a @.A 2040025745
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FORM 5-INS REVISEO 60 , THE PUSUc UTILITIES COMMISSION OP THE STATE OF COLORADO UNIFORM PUBLIC LIABILITY AND PROPERTY DAMAGE ENDORSEMENT The policy to which this endorsement is attached is written in pursuance of, and is to be con- strued in accordance wtth- any one or more of the following laws of the State of Colorado: C. R. S. 1953-CHwPTER ' 15-9-19 C. R. 5. 1953-CNArTER 115-11-17 C. R. 5. 1953-CHAPTER 115-10-28 and the rules and regulations of the Public Utilities Commission of Colorado adopted thereunder. In consideration of the premium stated in the policy to which this endorsement is attached. the Insurer hereby waives a description of the motor vehicle or motor vehicles to be insured thereunder. and agrees to pay any final judgment within the limits set forth in the policy or endorsements attached thereto. for injury to, and/or death of persons (with the exception of any employee of the Insured) and damage to property (excluding' property of the Insured or property which is rented or leased by the Insured or property other than the baggage or passengers in the custody of the Insured or carried in or upon any automobile of the Insured) resulting from the ownership. maintenance or use of any and all motor vehicles and/or trailers. pursuant to a Certificate of Public Convenience and Necessity or a permit issued by the Public llttiities Commission of Colorado. and further agrees that upon the failure of the Insurer to pay any such final judgment, such judgment creditor may maintain an action in any court of competent jurisdiction to compel such payment. It is understood and agreed by and between the Insurer and the Insured that the right of any person to recover hereunder shall not be affected by any act or omission of the Insured or of any employee of the Insured with regard to any condition or requirement of said policy, but all the terms and conditions of the policy shall remain in full force and be binding as between the Insurer and the Insured: and the Insurer shall be reimbursed by the Insured for any loss. costs or expenses paid or incurred by the Insurer which the Insurer would not be obligated to pay under the provisions of the policy independently of this endorsement. MINIMUM SCHEDULE 'On each motor vehicle used for the transportation of persons and/or property: PasseaQer Not to Exceed for Dcath or Injury to Property Capacity Any One Person All Persons Datnape 12 or less .......................................... $25,000 $ 50,000 i5'.0oo 13 to 18. inclusive ............................ 25,000 70.000 5,000 19 to 24, inclusive ............................ 25,000 90,000 5.000 More than 24 .................................... 25,000 100.000 5.000 e'On vehicles used for the transportation of property: For death or injury to any one person. $25.000: all persons.S5o.o00; property damage. i5.000• All conditions and provisions of this policy, and any statements or agreements contained therein or endorsed thezeon in conflict with this endorsement are. by agreement of all parties hereto, held null aad void insofar as they are in conflict herewith. The policy to which this endorsement is attached shall not be cancelled until after ten days' notice in writing shall have first been given to the Public Utilities Commission of Colorado. at its office at Denver. Colorado, said ten days' notice to commence to run from the date notice is actually received at the office of the Commission. Attached to and forming a part of Policy No ................. lAL1.321.3RRY................... issued by the tiTt1A CASUALTY P:. SUPETY Ca:,IPAtdY Insurance Company _ ................................................... __................. .......................... ._..... _............................... .....-----............. to .............................. _............. ................................... •Etlminate tetererce to traasportatloa of paa.ea~e n.hen endorsement is attached to polley luutd to a ptroperty earrter oaly. ••Ellminate reference to trwsportatlon of properiy .txa endortement la attaehed to policy Isauad to a paaatncer carrier only. Full• eehedule applies to carner of both pauenYera aad property. This form of Endortement is required to be attacted to the pollcy ot Public Liability A Property Damge Insurance but sot to the Certitieate of Insurance. wC 2133 E 2040025746
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The automobiles described on the reverse hereof under Entry Numbers corresponding to those indicated below are mortgaged as follows and Loss, if anv, under Comprehensive, Fire, Theft or Collision shall be payable, as their interest may appear, to the named Insured and mortgagee named below Entry Down Due Date of Na. Payment ~ Final Payment ~ Name of Mortgagee ~ Entry No . Down Payment Due Date of Final Payment Name of ~fortgagee ~ ~ ~ 4 - (The following parts of the schedule are for use with Comprehensive and Schedule policiesTttly). 2Hired Automobiles Lncanom rhese automobila a be pnnccpally used r, ll LIABILIIY Premium Baai's - Cast of Hire ' Rates per $IOU Advance Premlums Typea Purpoae Eatimated Bodily Property Baddy Property Hired of Uae. Cost of Hue Injury Damyte In7ury Damage f" ( If other than in declaration 1) , Liab hry Esabiliry L abdiry Gab:hry ~' - _ ..~ . . r- •~tate "a" for "Pleasure and Business", "b" for "Commercial" 3tiD8on-Owned Automobiles Qau I Penoaa Name of Each Premium Ba.sis-qass I Petsons and Cra4s 2~Employees IvcaeSoa of H.adquarren of P"oAs ~Iamed Heseia . :~ .( If other th.n in declaratien 14 Advance Prcmu+ms Bod,ly Injury Liabiliry Property Damage Liability TI J 7 .. ~ ~) .i .. . ~ I .C ~ -. ~ . .a c> t.: ~- a t. £ - ; L lf = l > . L•. 1 r_~ . . _. _. e . = L ..] ~ C•] L- C; ~ Rate per EmpIQye< I ~ Claas 2 Empioyce Lacation of Headquarters of Boddy - PlppetlY i Bodily ~ Property - Esanated AvetaQe Number Clasa 2 Employees Inlury I Damage Injury I Damage ( If other than in declaratton 1) Liabtbtg Labihry Iliab,iiry Labil.ry 2040025747 l
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1)_IE_S(:ItIi'tl0_N 0_1' 1IA7•AItI)S:I-O-M A 1~ nlry Yf.Nrw ._. .. T li:ding Cla.cificatinn Li.t No, o! or Tradr N:mu• Tnnk(:nllnnaAl; Prira t(hl Usrv . Ruc 5ra/iut; Caparily Purrhnslrl ~ `I`n+ck Siir Cost lo For all automobiles mortgaged when covered for Comprehensive, Fire,'Il\eft or Collision, show all Informallon called for on reverce hcreof. r. o. ialy I pr au M«lrl Irn1l1(ca1lnu N nsurnl Tnwn and State where principally /~afAgC<I all(I TCR;C-odP •Linlit of Liability Co'mp., Fire and 71xft PRF.MIUMS-(PREMIUM BASIS-PER AUTOt•10RILE1 Each coverage below applies only with respect to automobiles opposite which a.prcific premiwu charge Is shown for such coverage. R«lily Inlury Automobile Property Damag ~TE- Compre- Llabllity Mod. Pay. Liability ire hensivP Fire Theft Collician t UNDER DI I81ON I CF HE D SCRIPTION 0 FIAZARD ' , To HE MAINT NANCE OR U E 0 ALL OWNE AUTOMOD) E8 AND UNDE R DI 1810N 2 OF HE DESC RIPTtO OF HAZA DS T THE USE OF A L HI ED AUTOM081 E9 AND UNDE R DI ISION.-3-OF__ HE DESC RIPTIO OF HAZA D8 TO THE SE F AL NON-OWNE AUTOMOBIL __ ALL VEHIC ES NUMBER O F - RAT E PER EHICLE ADV NCE DEFINED A OVE VEHICLE S PRE IUM 81 PD 81 PD - -544..~-- --- --- -- P 54• 51 27.11 P 296 3.44 1 2 . 04 N - E .2 17 6 - - --- - E 20.69 1 - 1 - ' - • -- --- - - •- • --- - • , a . •Unless otherwise stntrvl in Ppch entry Ihe Limit of Liability (or (.MHplOhPll\ivP, Firr, nnd Theft Coverages is •'ActuAl • ry-nlal Div. 1 -E __-__.._ -- ~ r ~ -44 ~-__ y_ ~52Cj404- - (.asfl Va1111;. . 1'ur p(rses for which the Alave describal autamobiles arr _Tnla1 Div. il F 68~ _- to be us.(1 are "Pleasure and Uusiness•" for private pnssenger and ••Commercial" frlr commefcial or truck type . l(It~I~~Y f~9 - -- - r7 .8 1 f -- 2. `~ r~ -- -- ' -" Tlus Pndorsement fonnx :1 part af Ihe policy to which ntlarlud, e/fcc•live frnm its date of issue unlrss otherwise stated herein. (Information hela(u required only IuAen Pn- --' -- SPEC. COV. -~-a)~ -.7tL- - -~~------- -- - - - - --•--- --• . dnrsemrnt is issued suhsrquent to preparation n/ pnlicy.) and E 1-_ - -- ---- - F•:nd. F.If.) •~ I'~'~11. Nn. I AL I 32 I 9RRl~nd. Nu. RNI)ORSEMENTS Namalh\sorr•d PH1L1P MORRIS INC. TERM (-1-61 TO 1-1-62 CRAND TOTAL I1• 0 E T~ ~ __ 7.2D The ~tna Casualty and Surety Company ~ Hartford, Connecticut (1]177) Countersi ~ ., .. Authorized Agent. Pruidtrw. 2040025748
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The autom.•rnlea descnbed on the reverse hereof under Entry Numbers corresponding to those indicated below are mo.:haged as follows and Loss, if any. unde Comprehensive. Fire. Theft or Collision shall be payable, as their interest may appear, to the named Insured and mortgagee named beln.. Entr. Down Duc• Date of ` No. Paymer,t Final Pavment Name of Mortgagee Entry I No• I Down Payment Due Date of A'ame of Alortgagee Final Payment - . - i . ~ ' ., i - , -- - , I . ! (The following parts of the sehedulf are for use with Comprehensive and Schedule policies only). .~ ,. 2 Hired Automobiles LIABILITY i ~ ~ -' ~- Ram per $100 ~ I> Advance Prem,oms ~ I.o?anons vher( aura~bila ~ - Types I Purpos~ EatSmaeefl Bodily - JFooeay Bodily Properry : will Ix yns.cipi(ly uscd ~ Hirad of LJse° Caaita~ FLie _ Injury Damage . Inpury Damage ( Iff other than in declaration 1) Gabiliry Liability -I Liability Labdbry . . ~ . - 1 °~ .~ - ) 'Sate='a" for Plerure and Btuinesr't '' fot "Commercial" 3 Non-Ch.~ed Autcmbbiles - j ,, U I ` Preatium Basis-Qass I Persons and Class 2; Etrt>jloyees Advance Praniums Qaaa I Peraoaa Lceadac of Headquenen of •• Bodily Property Name of Each' Penwrrs Named Hszeio - Iniury Damage (If other than in declaration 1) •.t Liability L.bihry .t I U L. ~ W < .~ ~ - Clasa 2 Employea -- Estimated Average Number I 1 Locaoon of He.dquaners of Class 2 Employees (If other than in declaration 1) -:I C •Prenium Bisis - itbsr of Hire Rarea pe9 Emp~osee ' L fSodiiy -~ pfnpe..•• I Bodily L.. Intury 'LDamage j Ia;ary ~Liabiitry ~I Labilmy 1 Liabilay 2040025749 I '
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t tl tit 1r ti, I Ir1N Of' I IA"LAlti )$- 1•(~n..l Mm•io,•Ldr. 1 ~~t~r I T N. •. r I ~ de Nwnr •I'ank (ll nu:tgr; '1'ra de ~L~d lr.,yl SSuc Sratint; Capat•i1y •1'nnrk Siir I f Iftxly'1'ypr IJrnlilirdimt No. 1 ! t htu anJ nLxlrl For all automobiles mortgaged wha( covered for Comprehensive, Fire, Thcft or Collislon, show all Information called for on revr•rie hereof. List Tnwn Stalc an d 1`AEMIUMS-(I'RF.MIUM BASIS-PF.ft AUTOMOBILE) ifi b l h h l l4ir hrrr prittcipall w ' a+ptr c ies nnly with respect to antomo i es opposite w ic Each rnverage below app e crr. (.rw1r and l garaRal premium charge is shown for such coverage. Cast ln Incun•d -- • Limil of Liability (~omp., Fire AATE pre Dnl [Sahly lntury Atdnmobtle Property Damagi Com S 1 L 6) nmp-Firc I Fire Thefl r II' FAM F ia 1 ity tenstve n nioo ia rSlily Mn Pay f rEt and Th . . . - ( . _ 1'PC ' O{ OF UNI N0 S LDCaT IIlN R TE PER UNIT DVA fCE P EM. . . ._ . _.__ ._ PD PD - RICNMOND 78.9A 3•34 292: - 53'3 ~ ~ 4• n VA. E ~ ~ ~ 6 126 1 38 ~;: 9 6n o . -_-- -- -- -- ~ . 7 - - , r~ 6 E 26. 6 E 1 b 6. ' It; 9: '~ 6 ~ i a~ 4~' 3!~8 - ~`y ----- - --- 20 - ~ ~~ - E . zI 3 . 59 E I 20 20. WINCTER 5:1v 25 4 : 0 25•33 - -_ --- _ - .33 5 P VA. E . E I. DANVILLE 4 ' 0 4 : 0 5,33 " -- ------ - - - 5 ~ ~ 25.33 5 P I N VA. . 5• 231• 8 P - 4 M • 2 NEwPORT 4'7 ' 2•37 - --- ----- --- 4 P 1 h NEWS VA. E .0I 2. E 7. 1 1. RISTOL vA• j----- 45:io 25 33 45: 0 5- 33 P --- ------ - -- ~ - - ~ E . • E . - - I . -'(lnlr.. ntherwise St0t1YI in rach entry Ihe Lhnfl nf LiabilitY (or Cuuqvohru.avo, i~irt•. .md 'I6ef1 Coveragrs Is '•Aclual .. ' 7:Mal Dir^. I 4 $ 20(!,7 ,`16- _ -_ 409 ~,~,,. (:.,.I, ~ t'urpu.v. (or wlrich lhe abUVl• ISPSCrllle(1 atqomnbSSes nrr - Tntal-D'sv_ 11 .--_- 4 .4 --_ - - - -- - _ _--- -^-- _-. __ - _- - - - __ tu hr mrd are '•Plrasurr aud tlmmess'• (or private passenger :otd mturrrial" fot eunmu•rofol or Intck type. Total Div. 111 - I Itis rndorsrment fnnna ;t part of the policy to which -- - - -- - -- atl.u-hal, rllrrlive from ils d•de of issuc unicss olhcrwier -- -- - --- -- - ---- (!nA'rutntinn brlotu requirerd only tnhat en_ tt.t hrrrtn L SI'EC COV . : dnrs~•mr~'i( tc i.~.~t`rd suLsrqnrnt (o prepnratinn oJ pnficy. ) . . and 1d. I•:ll i-D fl'nl. Nn. I AL132 IqRRY:nd• Nn. ENDORSEMENTS - -"- N.unrd luwnvl Pfl I L I P I"~ORR I 8 INC • ~ TERM 1-I-61 TO 1-1-62 CflANDTOTAL 3`r71 •2[~ 2047•76 _ _ q.0, The IEtna Casually and Surety Company I-lartford, Connecticut tuurt R O. 2040025750
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The automobiles described on the recerse hereof under Entry NumbetS corrrspoAding to those indihted below dre mortgaged as Fpllows and Loss, if an•r•, under Comprehensive, Fire, Thef-t or Collision sball be paya-ble, as their interest may appear, to the named Insured and mortgagee named below. •• Entry Down Due Date of No• Payment Final Payment N~te ~M~ a - g g~ Eutry $do• Hown Payment - Due Date of • Final Payment ' • T'~ ee of Mortgagee __1 tl' .• .. •, 'L. - r - ,i- . (The following parts of the schedule are for use with Comprehensive and Schedule policies only). 2 Hired Automobiles LIABII.ITY Bu•u - Cost of Hire Preatium "Raes per $tOp Advance Prem,ums r 'Locaaons where auramabile. • ,'l;ype. , Purpos , F}rimared ' ~dy . Ploperty - BodrlY ~ Propem wdl be principally used I~ued r ~ of Uaea ~ C•oi'•yf Hsrq 7 IDNry ~++oaite• _ Intury Dam.ge ( If other than in declaration 1) Liabiliq Liability •' Ltabiliry I Liab•bry • 1 Y. 0 t 2 "Pleastue and Busineu^,1''b" fot "Commetcial" Automobiles 11''= !- '•' t j 3•; (7ass 1 Penooa Name of Each u Y t_j "~ Premivta Buis-Cliis I Petsons-atid Qus 2 Employees - • ~ t: Advance Premmms Lot.rioa of Headquarten of . t Bodily Property . ~tnons Nlfned Hersin Damage (iFother than RC declaratton 1) -i Liability LSabilny JJ U 7 - - Aata Rr Empioyee j , - Uut 2' Eo+piqyees I Locatson of Headquartm of Bodsly Propercy Bodily ; Property - . Esnnated Average Number ! Ctass 2 Employees Irilury Damage In7ury• Damage ( If other than in declaration 1) Lia6shq Liabiluy ~ Liabdny Lu6d¢y I 2040025751 u t 1 I
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IItSrJttf'ttuN clt' IIA'LAI+I,ti i.(l.,nr,I A,.,.•i a,d,~, huU. Nu. l Yr AL,I 9'im 1'r Nrw 'l /s(vl ha+rd AI(1. aJ(' N.n •I'ru(lc Sur B(Nly-fypr all(I AI(NI('I Ilalint; (aaaifiralinn 'I'ank (:alInuagr: Ih(c Sralinl; Capa(ity ldcnli/io:di(m Nn. I.iN I' rirr Coct to brsnml '1'own and State whrrr Principally ~garagr•<I and Terr. (:(>clr •Liwit of Liahility-- Cmnp., Fire ar(rt Theft 1'RF.MIUAIS-(PREMIUAt IIASIS-PF.I( AUTOMORII.EI prcific Eanc ~nveraFe below applicc nnly with respecl to automobiles oplwsiu~ which remium charge is shown for such coverage. -r•c _ bndilyInjury Autnmohilc p ProertyD AAT_E ~mFire Fire ~rPr~ ' Lfahilily Mal. Pay. Liabllltyamage ~ hrnsivc TheftCnDllisinnlFAM . P _ A I~YI E F VEHICLE N0. OF UNI TS LOCATION RA E PER NIT DVA CE P EM. ~ --- -- -- ---- --- ---•- Po ~ e I Po - Ro~qNCKE J5fi 7 2 ~` 4~ 2 -- V " E 0 •3T 3 9 ^ ( - ----- --- - ~ - _ ~ ~ - - - - _ V4_ BA91C_ LIMIT3 DEBI T~ o- VA. INC. IMIT8 CREDI T I o _ F E7 0fsc. E 23•4~° - -= = . -- - I - - -- - r - i i ( . . _- I -- - ~ ---- - .. . • • ~ . 'th(Ir.v n,henvise stntr(I in ca<h entry the 1.imit of Liability fur Cnmprrhrnsivr, Firr• and 'fhcft Caveregcs is 'Aclunl Total Div. 1 - t - - G(.h Valuc... 1'nrpu%ec fur whi<'h thc aLovr drFttihed antnmohiies arc tn 6r u.('rl are "Plras'rr(• and Ilucinrss" for private passrnger _:uNl "Cnnm(rrrial" fhF cnmmrrci:J or tmck type. ~ Total Div. 11 ------------ Total Div. III '----- - --- ---- -- - ----- - - --- - - - --- --- - --- - I hi. rndonrmeut funn% a p ut of Ihr policy to which :d(•Ilrct(ce from ih d:rtc uf isur unlrss nlhrnvi.r• ~I:drel h(•rriu / M/i(rninhnn L(dmu rrquirr•d ordy ruhcn rn• dursr•n(rnt is issurrd subrrqurnt (n preparation oJ troficyJ -.---- •--- ~ SI'EC. COV, anrl ----- --- -- --- - --~~.-- --- ------- - ---. -_.-._ - .._•-. -- ---- --- - --- - -- -- -- - - - - - n. F:nd 1:11I-I-6'~d.N,( IALI3219RR1Fnd.N N.uu(vlln,mcil PHILIP MORRIS INC. h:NDORSEMENTS - -- - - - - - - - ° -- -- - TERM 1-1-61 TO 1-1-62 • GRAND TOTAL The /Etna Casualty and Surety Company Hartford, Connecticut 111N71 Conntersignod For all automobiles mortgaged when covered for Comprehensive, Fire, Theft or Collision, show all Information called for on revrrsr herenf. R 0. 2040025752
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i The automobiles described on the reverse hereof under Entry Numbers corresponding to those indicated belt)•w are mortgaged as. follows and Loss, if any, under Comprehensive, Frre, Theft or Collision shall be payable, as their intetest tmy appear, to 'the named Insured and mortgagee named below. Entry Down Due Date of No. Payment i Final Payment Name of Mortgagee Entry No. Down Payment Due Date of• Final Payment ' Name of htortgagee ~ - I I I ' ~ , . ~ . . _y ~ ;` (The following parts of the scheduli are for use with Comprehensive and Schedule policies only). 2 Hired Automobiles LIftBILI-IY i Ptemium Buis - Cost of I-iire i Rara Per 100 Adv+r+c: Prcmiums. Lec+nonr where auromobilea .tll be pnnopally usad • (lf other than in declaration 1) • Types ! Hued i Puepo+as of Use' Earimarad Cost af Hue Hodily Injury Liabihry 'kropaty 1 lamage Liability -~ Bodily Injury L a6Jiry Properry Damage Uab,bcy "State "j" for "Pleasure and Business", "b" for "Caaunercial" 3 Non-Owned Automohiles ' Premium Basis-C7ast I Persons arid Class 2 Employees I Advance Pranmmt . - t7w I Pasom Ioorim of Headquarr.s of Bodily Property _. Name of Each Perwns Named Herein . Injury Dama6e , ( lf other than in declaration 1) > r liabiGty Lbbilny - - . . ~! ~ ~- i - i - . ' ~ - - . . ' - - - ( ' ~ . - ~-..._ 2040025753 -' ` Rarer per Employee ~ - ~ - ' Clw 2 Fcnp)oyea - . - ' cLocaoaei d Hea~quanen of Bodily, Preyrrry ' Bodi1Y• p~Y E-se maqd. - j maqd. Avera;e Number i ` Clw 2•Ea~loy.es '. Ie3~Y~ Damage InSury DamaQe . ~ - 1 ( If. other than in declaration 1) liabiliq Liabiliry =~ Liabil ry Liabiliry ^ ~ ' _ - = -1 - -t - - ,
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A(1T0(`iOBILE ENDORSEMENT 399 bSLSZ00bOZ As RESPECTS, CtiR(,,H.YATEs 1423 JANIE AvE NASHV(LLEtTENN. _ It is cEreed that such insurance es is efforded by the policy-for Bodily'Injuzy Liability and for-Prcperty D=age Liability. applies in accord:nce with the Financirl Responsibility L:ws of the State of TE ~"= 5tEc `[and that the Ccmpany has filed a Financicl Responsibility CertifiDz:te as required by such Inw: Gdditional Prcmitlms: 5.28 ~ Eodil,y Inju:y $ 3.92 Property Damage $ 1.36 This endorsement forms a part of the policy to which attached, effective from its date of issue unless otherwise stated herein. (T/sr information betoza is required onfyukew this endorstment is issutd subsrquent to preparation of the ¢olicy.), AL A Endorsement effective Policy No. _I_..........I ..32.I ...,~...._.~RRY _._.,,. Fndorsement No. . Named Iroured _.__P H.L.l~b.P......M9.R.F~.1.$...J .P1 C.,..__......._._.._.... __.___._._._. _ .... _ .- ... ~ _.___ Issued by one or more of The Mtna Casualty and Surety Company The Standard Fire tnsurCompan Hartford, Connect 41/ - j'q Aesident. Countersigned ........ ......____..... _ .... ~ -"" ....... _..... __ ................... Authorized AYent. otu..ol lr•1-MF-1524 A
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AL'TOMOBILE ENDORSEMENT )QD= J77 As RESPECTS THOMAS F. "EURKE, cE. SPRING ST. WINOOSKI, VERMONT = it is agreed that such insurence as is afforded by the policy for Bodily Injury Liability nnd for Property D=e.ge Liability applics in accord,:nce vith the fiinancia]. Responsibility Iavs of the 5tete of V ER M 0 N T and that the Ccmpany he.s filed a Financial Responsibility Certificate as ioQuired. by such Iav: Additionnl Premi=s: 5. 28 •- Bodilx InJuty $ 3.92 Hartford, Connecticut This endorsement forms a part of the policy to which attached, effective from its date of issue unless otherwise stated herein. (The iR/ortna{ioo below is required only when this endorsement is is.nud subsequent to preparotion of the policy.) „ Endorxmmt e(fective_1 . - -I 6 I Policy Endorsement No~~_~/__ Named Insured __ ~~ pHl.L LP..._ h1QR.R.1.S....a.t1C.--_.- ._... _ _... ...__......__ ~._.__.._......._..____ Issued by one or more of The /Stna Casualty and Surety Company n gA, Th. Standard Flre Insurancn t7lfennanx (tt]!6-G) Property Domnge $ t.36 rrendent. ...___.........._._...... .... ...................... -- Authorized Agent 41-Ng'-1524 A 2040025755
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rt1 F~ .ii3COL_ri :r - '==A It is agreed that t: .. _= V, :~ or Autor.dbile Liability and Medical Pa,r^mer.ts a_..o:yance with the following procedure: 1. Virgir.ia Automobile Liability Standard Premit.m: Such premium pertaining t o Vir~;tia computed in accordance with the provisions of the policies designated in paragraph 4 hereof, other-than this endorsement and exclusive of the application of a:v :t .o- spective rating plan shall be known as the Virginia Automobile Liability Standard Premium. 2. Total Standard Premium For A11 States: The Automobile Liability and Medical Payments premium computed in accordance trith the provisions of the policies designated in para- graph 4 hereof, other than this endorsement and exclusive of the application of any retrospective rating plan, any Automatic Premium Adjustment Endorsement, any Premium Return Plan Endorsement, or other Premium Discount Endorsement, shall be known as the Total Standard Premium. 3. Premium Discount - Virginia: (a) The Virginia Automobile Liability Standard Premium shalll be subject to the applicable discount percentages for the Total Standard Premium obtained from the current Table of "Virginia Premium Discounts" contained in the CompanSrts Manual. For Policy periods of more than one year, an average annual Total Standard Premium for the policies shall be determined by dividing the Total Standard Premium for the policy period by the term of said policies in years and fractions thereof and applied to said Table of "Virginia Premium Discounts" to determine the applicable discount percentage. (b) If retrospective rating is applicable to a part of tne premium, the amount of premium discount applicable to the Virginia automobile liability standard pre- mium exclusive of any Virginia automobile liability premium subject to retro- spective rating shal]l be the difference between (1) the discount determined by applying to the entire Virginia automobile liability standard premium, the Virginia premium discount percentage shown in the appropriate table for the Total Standard Premium, and (2) the discount determined'::J applying to that portion of the Virginia automobile liability standard premium which is subject to retrospec- tive rating, the Virginia premium discount percw r.tage sh(rvm in the appropriate table for so tm.ich of the Total Standard Premium as is subject to retrospective rating. 4. Policy Numbers Estimated Standard Preaiums IAL1321C)RRY TO BE DET. This endorsement forms a part of the policy to which attached, effective from its date of issue unless otherwise stated herein. a.~~ (Tht informatioK below ir required on/y wGen thi,r endorteeunt is iaswd rabttquent to preparation of the policy) ~ ~~ Endorsement No. .... ..:....... ••••-••--- Endorsement effective ..._...._..-.-_..._,... .._ Policy No. ...... ._.__..._..._.................. ..... ..... _. \Tamed Insured 7ha Atna Casuatty and Surety Cempany Hartford. Connecticut .(12"2---i 1 CountersiQned .__............ ........ ......._..... _......__.._....._..... 2040025756
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- 2 - A _ Premiun Discount Percentages Applicable to New York Stanjard Premina Column (1) - Total Standard Premium for all States. ^ (2) - Discount Percentage for General Liability. " (3) - Discount Percentage for Automobile Liability - Garages. ^ (4) - Discount Percentc_ze for Automobile Liability - Tazia, Livery, Buses, and Long Haul Truelohen. ^ (5) - Discount Percentage for all other Automobile Liability. - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - (1) (2) (3) (4) (5) (1) (2) (3) (4) $1,000 or 0.0% 0.0% 0.0% 0.0% 4.600 8.3 3.9 0.8 less 4,800 8.4 4.0 0.8 1,050 0.7 0.3 0.1 0.3 5,000 8.5 4.1 0.9 1,100 1.2 0.6 0.1 0.5 5,200 8.8 4.3 1.2 1,150 1.6 0.7 0.1 0.7 5,400 9.1 4.5. 1.4 1,200 1.9 0.9 0.2 0.8 5,600 9.3 4.7 1.6 1,250 2.3 1.1 0.2 1.0 5,800 9.5 4.8 1.8 1,300 2.6 1.2 0.2 1.1 6,000 9.7 5.0 2.0 1,350 2.9 1.4 0.3 1.2 6,200 9.9 5.1 2.2 1,400 3.1 1.5 0.3 1.3 6,4oo 10.1 5.3 2.3 1,450 3.4 1.6 0.3 1.4 6,600 10.3 5.4 2.5 1,500 3.6 1.7 0.3 1.5 6,800 10.4 5.5 2.6 1,550 3.8 1.8 o.4 1.6 7,000 10.6 5.6 2.8 1,600 4.0 1.9 0.4 1.7 7,200 10.7 5.7 2.9 1.650 4.2 2.0 0.4 1.8 7,400 10.9 5.8 3.0 1,700 4.4 2.1 0.4 1.9 7,600 11.0 5.9 3.1 1,750 4.6 2.2 0.4 2.0 7,800 11.1 6.0 3.3 1,800 h.7 2.3 0.5 2.0 8,000 11.2 6.1 3.4 1,850 4.9 2.3 0.5 2.1 8,200 11.3 6.2 3.5 1,900 5.0 2.4 0.5 2.2 8,400 . 11.4 6.3 3.6 1,950 5.2 2.5 0.5 2.2 8,600 11.5 6.3 3.6 .2,000 5.4 2.6 0.5 2.3 8,800 11.6 6.4 3.7 2,100 5.6 2.7 0.5 2.4 9,000 11.7 6.5 3.8 2,200 5.8 2.8 0.6 2.5 9,200 11.8 6.5 3.9 2,300 6.0 2.9 0.6 2.6 9,400 ]1.9 6.6 4.0 2,400 6.2 3.0 0.6 2.7 9,600 12.0 6.7 4.0 2,500 6.4 3.0 0.6 2.7 9,800 12.1 6.7 4.1 2,600 6.5 3.1 0.6 2.8 10,000 12.2 6.8 4.2 2,700 6.7 3.2 0.6 2.9 10,500 12.4 6.9 4.4 2,800 6.8 3.2 0.6 2.9 11,000 12.5 7.1 4.5 2,900 6.9 3.3 0.7 3.0 11,500 12.7 7.2 h.6 3,000 7.1 3.4 0.7 3.0 12,000 12.8 7.3 - 4.8 3,100 7.2 3.4 0.7 3.1 12,500 12.9 7.3 4.9 3,200 7.3 3.5 0.7 3.1 13,000 13.0 7.4 5.0 3,300 7.4 3.5 0.7 3.2 13,5oo 13.1 7.5 5.1 3,400 7-5 3.6 0.7 3.2 14,000 13.2 7.6 5.1 3,500 7.5 3.6 0.7 3.2 1l,,500 13.3 7.6 5.2 3,600 7.6 3.6 • 0.7 3.3 15,000 13.4 7.7 5.3 3,700 7.7 3.7 0.7 3.3 16,000 13.6 7.8 5.5 3,800 7.8 3.7 0.7 3.3 17,000 13.7 7.9 5.6 3,900 7.8 3.7 0.7 3.4 18,000 13.8 8.0 5.7 4,000 7.9 3.8 0.8 3.4 19,000 13.9 8.1 5.8 4,200 8.1 3.8 0.8 3.5 20,000 14.0 8.2 5.9 4,400 8.2 3.9 0.8 3.5 21,000 and Over Refer to CosspanTle Hannal (5) 3.5 3.6 3.7 3.9 h.i 4.3 4.4 4.6 4.7 4.8 5.0 5.1 5.2 5.3 5.4 5:5 5.6 5.7 5.7 5.8 5.9 6.0 6.0 6.1 6.2 6.2 6.3 6.4 6.5 6.6 6.7 6.8 6.9 7.0 7.0 7.1 7.2 7.3 7.4 7.5 7.5 7.6 7.7 If the Total Standard Premium is between two of the amounta ohown in Column (1)• the preaium discount percentage applicable is that shown for the lower of•such anounta. For attachment to and forming part of Policy No. [AL I 321 9R RY , dated 1- 1 -61 / issued to PHILIP MORRIS iNC. THE AP*iA CASIIALTI AND SURETY COIT-ANY Hartford, Connecticut " ' Kh9-2-D) 2040025757
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- 1 - PR°.•SdItJM DISCOUNT E:ZDORSEI~NT - NEW YORK (Automobile and General Liability Insurance) It is agreed that the prerium pertaining to New York for Liability and Medical Payments insurance is subject to discount in accordance with the following procedure: 1. New York Standard Premium. Such premium pertaining to New York computed in accordance with the provisions of the policies designated.in paragraph 4 hereof, other than this endorsement and exclusive of the application of any retrospective rating plan, shall be known as the NeA York Standard Premium. 2. Total Standard Premium For All States. The liability and Medical Payments premium computed in accordance with the provisions of the policies designated in paragraph 4 hereof, other than this endorsement and exclusive of the application of any retrospective rating plan, any Automatic Premium Adjustment Endorsement, any Premium Return Plan Endorsement, or other Premium Discount Endorsement, shall be known as the Total Standard Premium. 3. Premium Discount - New York (a) For policy periods of one year or less - The New York Standard Premium, exclusive of any premium subject to any retroepective rating plan, shall be subject to the applicable dis- count percentages for the Total Standard Premium obtained from the Table of "New York Premium Discounts." (b) For policy periods of mor* than one year - The Nex York Standard Pre- -------___-._.-------------------------- mitms, exclusive of any pre- mium subject to any retrospective rating plan, shall be subject to the applicable discount percentages stated in said Table of "New York Pre- mium Discounts" opposite the total standard premium for the policies for each anxma.ll period or portion thereof during the po2icy period. (c) If retrospective rating is applicable to a part of the premium pertain- ing to New York, the amount of premium discount applicable to the New York Standard Premium, exclusive of any premium subject to any retro- spective rating plan, shall be the difference between (1) the discount determined by yapplying to the New York Standard Premium the applicable percentages stated in said Table opposite the Total Standard Premium and (2) the discount determined by applying to that portion of the New York Standard Premium which is subject to retrospective rating the applicable percentages stated in said Table opposite so much of the Tota1 Standard Premium as is subject to retrospective rating. (d) The provisions of this endorsement shall not apply in the event the New York Standard Premium is $100 or lese and in no event shall the application of the provisions of this endorsement result in an earned premium of less than $100 as applicable to NeR York. 4. Policy Nos. Estimated Standard Premium IAL13219RRY TO BE DET. 2040025758 (C-1549-1-1) (Cont'd)
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r rnEP'SL".d DISCGUI.P LL~Oc~SE!~'I - tiGKfH C,-RGi..It1A (Autor.nbile and General Liability Insurance) It is agreed that the premium pertaining to North Carolina for Liability and Medical Payments insurance ie subject to diacount in accordance with the following procedure: 1. North Carolina Stendard Premium. Such premium pertaining to North Carolina compute in accordance with the provisions of the policies designated in paragraph 4 hereof, other than this endorsement and exclusive of the application of any retrospective rating plan and exclusive of any premium under any Automobile Liability Policy applicable with respect to automobiles claseified as "Livery", "Buses", or "Long Eaul Truckmen", shall be lmown as the North Carolina Standard. Premium. 2. Total Standard Premium For All States. The Liability and Medical Payments premium computed in accordance with the provisions of the policies deaignated in paragraph hereof, other than this endorsement and exclusive of the application of any retro- epeotive rating plan, any Automatic Premium Adjustment Endorsement, any Premium Re- turn Plan Endorsement, or other Premium Discount Endorsement, shall be known as the Total Stanflard Premium. 3. Premium Discount - North Carolina (a) For policy periode of one year or less - The North Carolina Standard Premium, exclusive of any premium subject to any retrospective rating plan, shall be subject to the applicable discount percentages for the Total Staadard Premium obtained from the Table of "North Carolina Premium Discounts." (b) For policy neriods of more than one year - The North Carolina Standard Prenium, exclusive of any premium subject to any retrospective rating plan, sha1Jl be subject to the applicable discount percentages stated in said Table of "Nortn Carolina Preaium Discounts" opposite the total standard premium for the policies for each annual period or portion thereof during the policy period. (o) If retrospective rating is applicable to a part of the premium pertaining to North Carolina, the amount of premium discount applicable to the North Carolina Standard Premium, exclusive of any premium subject to any retrospective rating plan, shall be the difference betveen (1) the discount determined by applying to the North Carolina Standard Premium the applicable percentagee etated in saL Table opposite the Total Standard Premium and (2) the discount determined 'oy applying to that portion of the North Carolina Standard Premium which is subjec' to retrospective rating the applicable percentages stated in eaid Table oppo®it, so much ~f the Total Standard Pre=um as is subject to retrospective rating. h. Policy Numbers Eetimated Standard Premium IA1.132fgRRY TO BE DET. 'rotal t .C-1557-1-A) (Continued) -- ~ 2040025759
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r PRa'rNM DTSCOUNT ENDORSEMENT-TEXAS AI7TaMO®¢.E LIASII.ITY II4SIIAl,HCE IAf f^~IODRY P lp ^ Rls I)c R - •c....~. ~o. ~ ~. -° issued to H I L, ~ ..................... . .. ............. ^-,•.••""` ~ASUALTY AND SUR ;, ETY COMPANY _y ...c . . _.. ..... _..... Aoenr, _(Nar,.e of Insurance Company) HARTFORD ' j-~~ located !cay and stqte) CONNe .~-.._--..~-_ ' -..- - and is eLreatve from -~j __.._...,-_ .. ~ ... . l12:D1 A. M. Stcnaa;d T::nsl (The In(ormation abo.e is requl»d only ..bea thls eadanwment Is issued subsequeat to preparatfoo of the polioy.) This endorsement fcrms a part of the policy to which attached• effective from its date of tssue unless otherwise stated herein. It is aoreed that the premium pertairuaq to Ter.oa (cc Automobtle Liability _and Mfdtcal Payments tnsurance ts subtect to discount m oecordanc' with the following Pcocedure: 1. T.xm Automobile Liability Standard Premiu>a Such premium pertainmq to Texas computed in accordance wnh ihe provisions of the pottcter designated in paragraph 4 hereof. other than this endorsement and exclusrve oJ the application of any retrospective rating plan. shall be known as the Texas Automobile Liability Seandard Premium. 2. Total Standard tremium for AU Srates, The Automobile Liability and Medreal Payments Premium computed in accordance with the provw stons of the policies designated in paragraph 4 hereoL other than this endorsement and exclusive of the application of any retrespecttve rating plan, any Automattc Premium Adwstment Endorsement, any Premium Return Plan Endorsement. or other Premium Discount Endorse• men6 shall be known as the Total Standard Premium. 3. Premium Dtscount-Texas ' ' (a) FoT policy periods of one year er less-The Texas Automobile Liability Standard Premium shall be subtect to the applicable discount percentages for the Total Standard Premium obtained from the "Table of Texas Premium Dtscount :Perceqtaqes (Automobde Lcbduy)" set out on the reverse side hereof. - fb) For poUey pedodm of meee t)km oae year-The Texas Automobile Liability Standard Premium for each annual period or portion thereof during the policy p.nod shall be subject to the applicable dtscount pernntaqes stated rn said 'Table of Tesas Premrum Discount Pen centaqes (Automobile Lrabihty)" opposite the Total Standard Premium for the poltcies for each such period or portion thereof durtnq the policy period. . , _ . (e) 11 retrospedrv, rating is applicable to a part of the premlum peneininq to Texas, the amount of premium di.count applicable to the Texas Automobtle Lrabtlrty Standard Premium. e.clusive of any premium subject to any Retrospectrve Rating Plan• shall be the drlference between (1) the discount determined by applying to th. T.xas Automobile Ldabilrty Standard Premium the applicable percentoqes stated in said Table opposite the Total Standqrd Premtum• and (2) the discount determined by applying to that portion of the Texas Automobile Liability Standard Premium which is subtect to retrospecltve rating the applicable percentage atated m said Table appoute so much o( th. Total Standard Premium as is subject to retrospective rating. 4. Tdicr Nuaben . • _ Fatlmated 5taadard Premiurn_ j?~.!.32l.jRRY TO BE._,DET._ _ Applrcable premium percentages based on total estimated advance standard premium: Tastcabs. Ltvery. Buses and Long Haul Truckmen Garage Liability All other, including School Buses. SEE Sh1rSR5E SIDE FOR FSIATfIEIIt '?$OVISIONS FORM 2S.-PREMIUM DISCOUNT ENDORSI3`SE2QT-TEXAS Texas Standard Automobile Endonr.mmt Revised No..mber 1. 1959 By .. . ~GftiYwr % - . ' ..... . ... . . (Du)y Authorized Representative) 2040025760
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7ZXAS PREMIUM DISCOUNTS-AUTOMOBILE LIABILITY INSURANCE : _ in- 'rrem:..m :i^.ui ciudmq See Truck- School 11.1. 'll men Garaaes Buses T.]St. ccos. Livery. Buses All 'val and Other Stan=rd Long - In- _ Prem,um Haul ' • cludincT• ~. • See Truck• - r' 'School Noae f l l men Garaqes Buses -o>;,. Cats• L,very, Buses Al, Total and ^•.".er Standard Lonq ~In, Premiurr>. - •(•iaul . See Truck- Sc:^.ocl No-e (t)} men Ga:aqes Buses (Ii '2) (3) (4) " (1) (2) (3) (4) ' ll) (2) ;3) (4) 51000 00'= 00%% 0u": S6490 23`+ 57: 52% S60000 ?7': ,29:: 122': 1.050 4 3 6.600 2.5 5 8 5 3 52.500 8 8 130 ! 2 3 1,100 I 6 6 5800 26 5.9 5.4 65.000 89 13.1 125 1,150 1 B 7 7 000 2.8 6.1 5.5 67.500 9 0 13.3 126 1,200 ' 2 10 9 7200 2 9 6.2 5 6 70.000 9 l 134 127 1.250 2 1.2 1.1 7,400 3.0 6.3 S.7 72.500 9,1 13.5 128 1.300 2 1.3 1.2 ' 7,600 3.1 6.4 5.8 75.000 9 2 136 130 1,350 3 1.5 1 4 7.800 3.3 " 6.5 5.8 80.000 9.3 13.8 132 1,400 3 1.6 1.5 8,000 3.4 6.5 5.9 85,000 9 4 140 133 1,450 3 1.8 1.6 8,200 3.5 6.6 6.0 90,000 9.5 14.1 13.5 1.500 3 1.9 1.7 8.400 3.6 6.7 6.1 95.000 9.6 14.2 13.6 1.550 4 2.6 1.8 8.600 3.6 6.8 6.1 100,000 9 6 143 137 1.600 4 2.1 1.9- 8.800 3.7 6.9 6.2 105.000 9 7 144 13.8 1.650 4 2.2 2.0 9,000 3,8 6.9 6 3 110.000 9.8 14.5 139 I,700 .4 2.3 2.1 9,200 3.9 7.0 6.3 115.000 9 8 14.6 14.0 1,750 .4 2.4 2.2 9.400 4.0 7.1 6.4 120.000 9 9 14.7 14 1 1.800 .5 2.5 2.3 9.600 4.0 7.1 6.4 125.000 9 9 14.8 14.2 1,850 .5 2.6 2.3 9,800 4.1 7.2 6.5 130.000 10.0 14.8 14.2 1,900 .5 2.6 2.4 10.000 4.2 7.3 6.6 135,000 100 149 14.3 1.950 .5 2.7 2.5 10.500 4 4 74 6.7 140.000 10.0 14.9 14.4 2,000 5 2.8 2.6 11.000 4.5 7.5 6.8 145.000 10.1 15.0 144 2,100 5 2.9 2.7 11.500 4.6 7.6 6.9 IS0.000 10.1 15.1 14.5 2,200 6 31 2,8 12,000 48 77 70 162.500 102 152 146 2.300 6 3.2 2 9 12.500 4.9 7.8 7.0 175,000 10.2 15.3 14.7 2,400 .6. 3~ 3.0 13.000 S.0 7.9 7.1 ~ 167.500 103 I S 3 14.8 2.500 • 6' 9.J 3.0 13,500 5.1 8.0 7.2r 200,000 10.3 15,4 149 2.600 6 3.4 _3•1 __ 14,000 5.1 8.0 _. .72-._ _- ---212,S06 -• 104-- 15.5 149 7 2.700 .6 ' 3 5 ' 32 14,500 5.2 8.1 7.3 225.000 Jrc 10.4 15.5 15.0 2800 6 3.6 32 15,000 5.3 8.2 7.4 237.500 10.4 1S6 ISO 2,906 .7' 3 6 3.3 16.000 "- 5.5 8.3 , 7.5 . - 250.000 10.5 15.6 15.1 3.000 7 37 3.4 ,..17.000 ; S.6 8.4 , 7.6 262.500 10.5 15.7 . 15.t•. 3,100 7 3.8 3.4 , 18.000 5.7 8.5 . 76 275.000 10.5 . 15.7 152 3.200 .7 38 3.5 19.000 58 8.6 = Z7 287,500 10.5 15.7 • 15.2, 3,300 " 7' 3 9 3,5• 20,000 5.9 " 8.6 ' 7.8 " 300.000 •• 10.5 15.8 ~ 15.2 3,400 .7 3.9 3.6 21,000 5,9 87• 7 8 312.500 10.6 15.8 153 3.500 7 4.0.• 3.6 ' • v -22.000 6.0 8.9 '- -7.9 325,000 °' 10.6 15,8 " 15.3, 3,600 7 4 0 36 ' 'c' '~3,000 6.1 89' '' 7.9 ,' -337.500 10.6 15,9• • r 15.3 t' tc` 3.700 T '4Q" 3.7 24,000 6.1 8.9 t 8.0 350.000 10.6 15.9 ' 15,3 3.800 7 4.1.- 3.7 25,000 6.2 8.9 8.0 362.500 10.6 15.9 15.4 3,900 .7 4 I 3.7 ' 81 P 1Oi 27.000 6.3 , 9.0, 33.1' 375.000 10.5. 15.9, - 15.4, 4.000 ' B'" 4.2 3 8' ~ 6 Y~= 30.000 6 6 9.4 8.5 387.500 10.6 15.9 154 4,200 8 4.2 3.8' 32.500 6.9 9.9 9.0 400.000 10.7 16.0 15.4 4.400 8 - 4.3 3.9' lu '~ 35.000 7 2 10.3 9.5 412.500 10.7 16.0 . 15.4 =• = 4,600 8 4.3 3.9 37,500 7 4' 107 9.9 " 425,000 10.7 16.0 '. 15.5 .• 4,800 8' 4 40,000 ,7,6, ,, 11.1 10.3 437.500. ..10.7.4 16.0 . 15.5 5.000 ".9 I.S ' 4.1 " 42,500 7.8 11.4 10.6 450.000 10,7 16.0 15.5 <. .,: 5.200 ac' S,400 iesa, ~5.600 5.800 1.2 4.7` 43•'` "°cr'"O:h~"45,000 8.0 ,.1,1.7 1019 tr,ua__ ,.._462.500c10.7, ' 16.0. 15.5-„ 1-.1 4,9 47,500 _ 8.2; • 11.9 ; 1t.2 .475,000 _s r•10.Z 160: ,.15.5 r 1:6 5.l 4.6 ~ Z r 50.000 8.3 12.1 114 487.500 10.7 16.0 15.5 500.000 S.. Note (2),-. -; ,r , ; z. 1.8 5.3 4.8 $2,500 8.4 124._ . ll.fi : , ., _„- ; "''""' 6.000 20 5.4' ' 4.9 '"` y" 55,000 ' B.5~- 112.5 1'1,8 and over 6,200 2.2 5 6 5.0 57,500 8.6 12.7 12.0 e,, ;c,l ,,~. tc Ilf'a'~es`:'('I1 if the Total Standard Premium is botween two ol the amounts shown in column (1).rthe premrum d,rscount percentage applLcabj& is that $baXR.loelhpclpw*pol.pueh amounu.••• r..~•sq .rr,..-,ta.et to bL•t-er:.-r. •, N+ .: .. (2) If the Total Standard Premium is 5500,000 or over, the premium discount perce,qtagk„apphcable, ~or, edcl~ eubdtvision of lo~toq ,_ automobile liabthty mseraneetshqll;)Se detJC'cmtRed as the weighted averaqe o( the percentacje Is$owh in (b) for the ftrst $500.000 ot Total Standard Premium and the percentage: shown,in (c) (or the portion at Total Standard Premrum over $500,000: . ~ oA Irr . Subdienio. ns o( Adtombb(Id•' First Portion over Liability Insurance 5500,000 $500,000 (b) ~' li t f I b Taxicabs, L:very. Buses and Long Haul Truckmen ytLLJW:.. -. r:YJ1TL':.:re_Li'.10:7fA Garage Liability All other' tncludmg School L..Js ....... ............ ".. ,1. ......... ..15.5 13 2040025761
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r -,i:"GlytGgiLE.. ENDORSa.dEN'T (Va. A•oc tALIC-SCNED.LE- CCNrat/rE4SiVE -GARa FAMIILY PROTECTION COVERAGE ENDORS1r~1EtiT ltitotnobile Bodily Injury Liability and Property Damage Liability - V'irginia) (Specified Car Basis) In consideratton of the pa}ment of the premium for this endorsement, the Company agrees with the named Insured, subject to the limita < liability, ezclusions, conditions and other terms of this endorsement and to the applicable terms of the policy: SCHEDULE llesi8nated .{utomobile ALL VA. REGISTERED VEHICLES COVERED UNDER THE POLICY LI:,tITS OF LIABILITY: Bodily Injury SI5,000 each person; f30,000 each aecident Property Damage SS,000 each accident INSURING AGREEMENTS I. Damages for Bodily Injury and Property Damage Caused by Uninsured Automobiles To pay all sums which the Insured or his legal representative shall be legally entitled to recover as damages from the owner at operator of an uninsured automobile because of: (a) bodily injury, sickness or disease, including death resulting therefrom,hereiaafter.called "bodily injury;'susained by the Insured; (b) injury to or destruction of an insured automobile and its eontents, hereinafter called "property damage"; caused by accident and arising out of the ownership, maintenance or use of such uninsured automobile. II• Definitions (a) Insured. The unqualified word "insured" means: ~ (1) the named Insured; (2) any person while occupying an insured automobile; and (3) any person, with respect to damages he is entitled to recover for care or loss of services heuuse of bodily injury to which this endorsement applies. . The insurance applies separately with respect to eaeh.Insured under this eadorsement, but neither this provision nor application of the insurance to more than one Insured shall operate to increase the limits of the Company's liability. (b) Insured Automobil•. The term "insured automobile" means an automobile designated in the schedule while being uud by or with the permission of the named Insured aa stated in the policy. (c) Uninsured Automobile. The term "uninsured automobile" means: (1) an automobile with respect to the ownership, maintenance or use of which there is, in the amounts speci6ed in the Virginia Motor Vehicle Safety Responsibility Act, neither (i) cash or securities on file with the VirYinia Commissioner of Motor Vehicles nor (ii) a bodily injury and property damage liability bond or insurance policy, applicable to the accident with respect to any person or organization legally responsible for the use of such automobile; or (2) a hit-and-run automobile as de8ned; , but the term "uninsured automobile" shall not include: (i) an automobile defined herein as aa "insured automobile"t (if) an automobile owned by the named Insured; (iii) an automobile which is owned or operated by a self-insurer within the meaainQ of any motor vehicle financial reaponaibiliry law, motor carrier law or any similar law; (iv) an automobile which ia owned by the United States of America, Canada, a state,  politieal subdi.ision of any such govern- ment or an aQenc7 of any of the foregoing; ' (v) a land motor vehicle or trailer, if operated on rails or erawler-treads or while located for use as a residence or premises ' and not as a vehicle; or • (vi) a farm type tractor or cquipment designed for use principally off public roads, except while actually upon public roada. (d)'Hit•and•Rua Automobile. The term "hit-snd-run automobile" means an automobile which causes bodily injury to an Insured or property darnage arising out of physical contact of such automobile with an insured automobile, provided: (i) there caneot be ascertained the identity of either the operator or the owner of such "hit-and-run automobile"; (ii) the Insured or someone on his behalf 5hall have reported the ateident withio S days or as roort as practicable to the Commissioner of Motor Vehicles, and shall have filed with the Company withio 30 days thereafter a statement under oath that the Inaured or his legal representative has a cause or causes of action arising our of such accident for dama`es against a person or persons whose identity is uoascertainable, (Cewtiwurd .. reoerre side) This endorsement forms a part of the policy to which attached, effective from its date of issue unless otherwise stated herein. (TGe iaforreatioR betao is reqairrd a.fy u•brns rAiu r.d.rremewt ii irurrd rsrbrrq.rnt to trrjoatiax af tht foliry) {-I 6{ IALl32l9RRY ..... . Endorsement effective ...............__j ..._. .......,. ........... ...........Poliey No. ............. .........._........... ........_.......... - Endorsement No.......... ................ Named Insured ...... ,,.. P H I L 1 P f~0 R R 1 S I . N .. C .. . . ;tdditional Premium f) N CL . I N., , TO T ....... ..... ........... ... .. .........._...._. .... ........,..... .......... .. ..,......... The Atna Casualty and Surety Company Hartford Connecticut ~4 Countersitne _ .............. ........................ ..... _._.... ......................... :.-................ •luthorired .lgenr .(13149-A) 5-59 FOR COMt•ANY UfE CLASa CODe TtRRlYORY CODE DAT[ Of IOLICr ' T[RN tSItRATION I ~ 1007 I 2040025762
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e. 7 r-h rnc :acts in eupport thereof; and ii,i at a:e Company's requent, the Insured or hu legal represencuti- macea ...,...~ .._. .nsoecuon me automooile s.nun the lnsured ssas occupytng at the time of the accident. , ._rr:ops.ng Ine s•ord 'uccupying" means in or upon ur ontermg into or alighting from. .. ttatc. i he ..ord '•cate" includen the District of Columbia, a terrstory or possession of the United 5tates, and a province of Canada, lII. Policy Period, Territory rhie endorsement applies unl,v to accidents sshtch occur on and after the edectise date hereof, during the policy period and wiebin the United ~taxs of Jmertca. its terrttories or possessiorts, or Canada. EXCLf;SIONS I'his endorsement does not apply: (a) tu the tirat tssu hundred dollare of the total amount of all property damage as the result of any one accident; (b) to uodily injury to an Imurcd, care or loss of services recoverable by an Insured or injury to or destruction of property of an Insured, s'ith respect to sshich such Insured or his legal representative shall, without writter, consent of the Company, make any •e«lement with any person or organization who may be legally liable therefor; tc) so as to inure directly or indirectly to the benefit of any workmen's compensation or disability benefits carrier or any person or organization qualifying as a self-insurer under any workmen's compensation or disability benefits law or any similar law. CONDITIONS 1. Policy Provisions• None of the Insuring agreements, Exclusions, Conditions or Other Provisions of the policy shall apply to the insur- ance afforded by this endorsement except the Conditions '•Notiee" or •'Notice of Aceident," "Subrogation," "Changes;' •`Assignment,' ••CanceUation" and •'Deelarations:' , 2. Premium, If during the policy period the number of Virginia dealer's license plates issued to the named Insured ehanges, the named Insured shall notify the Company during the policy period of any change and the premium shall be adjusted in accordance with the rnanuala in use by the Company. If the earned premium thus computed exceeds the advance premium paid, the named Insured shall pay the excess to the Company; if less, the Company shall return to the named Insured lhe unearned portion paid by such Insured• 3. Proof of Claim. As soon as practicable, the Insured or other person making claim shall give to the Company written proof of elaimr under oath if required, including full particulars of the nature and extent of the injuries, treatment, and other details entering into. the determination of the amount payable hereunder. Proof of claim shall be made upon forms furnished by the Company unless the Com- pany shall have failed to furnish such forms within 1f days after receiving notice of elaim. The injured person shall submit to physical examinations by physicians selected by the Company when and as the Company may reasonably require and he, or in the es•ent of his incapacity his legal representative, or in the event of hia death his legal reprnenta- tive or the person or persons entitled to sue therefor, shall upon each request from the Company execute authorization to enable the Company to obtain medical reports and copies of records. The Insured or other person making claim for damage to property shall file proof of loss with the Company within sixty days after the occurrence of loss, unless •uch time is extended in writing by the Company, in the form of a sworn statement setting forth the in- rerest of the Insured and of all others in the property affected, any encumbrances thereon, the actual cash value thereof at time of loss, the amount, place, time and cause of such loss, and the dncription and amounts of all other insurance covering such property. Upon the Company's request, the Insured shall exhibit the damaged property to the Company. 4. Notice of Let(sl Action. If, before the Company makn payment of loss hereunder, the Insured or his legal representative shall institute any legal action for bodily injury or property damage against any person or organization legally responsible for the use.of an auto- mohile involved in the accident, a copy of the summons and complaint or other proeess served in connection with such legal aetion shall he fornarded immediately to the Compaqy by the Insured or his legal representative. , S. Limits of Liability. (a) The limit of bodily injury liability stated in the schedule as applicable to "each person" is the limit of the Com- pany's liability for all damages, including damages for care or loss of •ervice>, because of bodily injury sustained by one person as the result of any one accident and, subject to the above provision respecting each penon, the limit of such liability stated in the schedule as . applicable to "each accident" is the total limit of the Company's liability for all damages, including damages for care or loss of services, because of bodily injury sustained by two or more persons as the result of any one accident. Ib) The limit of property damage liability stated in the schedule as applicable to "each a¢ident" is the total limit of the Company's liability for all damages arising out of injury to or destruction of all property of one or more Insureds aa the roult of any one accident• (c) If claim i• made under this'endorsement and claim is also made against any person who is 'an Insufed under the Bodily Injury ) • Liability or Property Damage Liability coverages of the policy because of bodily injury or property damage sustained in an accident by a person who is insured under this endorsement• • (I) any payment made under this endorsement to"or for any vtuh person shall be applied in reduction of any amount which he may he entitled to recover from any person rvho is an Insured under the Bodily Injury Liability or Property Damage Liability coveragee; and (2) any payment made tinder the Bodily Injury Liability or Property I)amage Liability coverages to or for any such person shall be applied•in reduction of any amount which belmay.be entitled, to recover under. this,endorspmetu.l C (d) :\nv amount payable to an Insured under the terms of this endorsement shall be reduced by (1) all sums paid to such Insured fpr Iwdilv injury or property damage by or on behalf of the person legally liable therefor and (2) the amount paid and the present calue of all amounts payable to such an Insured under any workmen's compensation law, exclusive of non-occupational disability • ' henehts• 6. Other Insurance, With respect to bodily itljurv to an Insured, if the ln.ured has other •imila[ insurance available to him against a loss covered ly this endoroement, the C'ompan•v h'all not be liable under this endorsement for a greater proportion of such loss than the applicahlc limit of liabilirv hereunder bears to the total applicable limits of liability of all valid and collectible insurance against such loss. \\'ith respect to property damage, the insurance afforded under thi, endorsement shall be exeese insurance over any other valid and eollecrihle in.urance agarnsr such property damage. ' 7e Pasment nf Loss bv the Companv. ,\n,v amount due hereunder is payable to the Insured or his legal representative. ' - 4Jt\c:inn ~@ainst Cnmoans. acrinn .hall Ii• a¢'+in.t the ('nmoanv unle•• a- a condition preeedent therero. eh _ur-d nr his Ic¢at •e. 2040025763
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ALiit?JfOBi?E i:NikIR_ENtENT C.'.. G:. iS. 'L. E•5a5 A ~ - jt: -. FAMILY PROTECTION COVERAGE (Automobile Bodily Injury Liability - Specified Car Basis) In rnn5rderauon of the pavment of the premium for this endorsement, the Company agrees with the named Insured. sub(ect to tne ltmtrs a.:a~.. exclusions, cond:uons and other terms of this endorsement and to the applicable terms of the polscy: SCHEDULE Designated Automobile / / Limits oi Lab:itry ALL VEHICLES REGISTERED IN N.Y. CALIFo N.)-IAMP. EachPerson EachAcuaect AND OREGON ' NYsCALIFe ~vi't1AMP f10s000 3LOs000 The additional premium for this endorsement is SI N CL. 1 N TO T A L bREGON 5,000 10,000 INSURING AGREEMENTS I. Damages for Bodily Injury Caused by Uninsured Automobiles. To pay all sums which the Insured or his legal represenur. , shall be legally entstled to recover u damages ftom the owner ot operator of an unansured automobile because of bodily sntury, sickness disease, tncludsng death resulung therefrom, hereinafter called "bodily injury," sustained by the Insured. caused by accsaent and arsstng our the ownership, maintenance or use of such uninsured autortsobile; provided. for the purposes of ehis endorsement. determination as to aherf the Insured or such representative is legally entitled to cecover such damages, and if so the amount thereof, shall be made by agreement 't tween the Insured or such reptesennuve and the Company or, if they fail to agree, by arbitration. II. Definitions. (a) Inrured. The unqualified word "Insuted" means: (1) any petson while occupying an ituured automobile; and (2) any person, with respect to damages he is entitled to recover for care or loss of services because of bodily injury to which this endor: menr applies. The insurance applies separately with respect to each Insured under this endorsement, i2ut neither this provision nor application ot the mat ance to more than one Insured shall operate to inctease the limits of the Company's tiability. (b) Iaaured Auromobile. The term "insured automobile" means an automobile designated in the Schedule while being used by or with r permission of the named Insured as stated in the policy but shall not include an automobile while used as a public or livery conveyant (c) Uninsured Automobile. The term "uninsured automobile" means: (1) an automobile with respect to the ownership, maintenance or use of which there is no bodily injury liability bond or insurance poli applicable at the rime of the accident with respect to any person cr organrutson legally responsible for the use of such automobde: (2) a hit-and-run automobile as defined; but the term "uninsured automobile" shall nor include: (i) an automobile defined herein as an "insured auromobile": (ii) an automobile owned by the named Insured u suted in the policy; (iii) an automobile which is owned or operated by a self-msurer within the meaning of any motor vehicle financial responsibility lamotor carrier law or any similar law; (iv) an automobile which is owned by the Ursited States of America, Caaada, a state, a politicaa subdivision of any such government or : agency of any of the foregoing; (v) a land motor vehicle or trailer, if operated on rails or crawler-rreads or while located for use as a residence or premises and not as vohscle: or (vi ) a farm rype traaor or equipment designed for use principally off public roads, except while actually upon public roads. (d ) Hit-and-Aun Automobile. The term "hit-and-run automobile" means an automobile which causes bodily injury to an Insured arising out t physical contact of such automobile with an automobile which the Insured is occupying at the time of the accrdent, provided: ( 1) there rar not be ascenatned the identity of either the operator or the owner of such "hit-and-run autornobile"; (2) the Insured or someone on h behalf shall have reported the accident within 24 hours to a poltce- peace or judicial officer or to the Commissioner of Motor Vehscles, an shall have nled with the Company within 30 days thereafter a statement under oath that the Insured or his legal representative has a nu: or causes of action arising out of such accident for damages against a person or persotu whose identity is unascercamable. and setting fort the taas in support thereof; and (3) at the Company's request- the Insured or his legal representative makes available for inspection eF automobile which the Insured was occupying at the rime of the accident. (e) Oecurrinj, The word "occapysn8 ~ means in or upon or entering into or alighting from. (f) Scace. The word "snte" includes the Distria of Columbia, a territory or possession of the United States, and a province of Canada. III. Policy Period, Territory. This endorsement applies only to accidents which occur on and after the effective date hereof, during the polic period and within the United Srares of America, its territortes or possessions, or Canada. (Conrina.d on re.arae tide) This endorsement forms a pan of the policy to which anuhed, effective from its date of issue unless otherwise stated herein when this endorrement rs utr+r Jrr tr urnt to prepnanon of r e o rr ) (The mJormmron beloru u reyrrrd ....... on.'.._...._.. Policy No. ~ A~.J...~R.RY .................. Endorsement No. ~~f ~.r..~... .Y........ Endorsement effective ..............]r L.-.6a ............. t~ Named Insured .......... ....P.H.I.L.I.P....:r ).Q.R.fLL.S.....(.N.Q.Q.R.? O..R.A.T..ED..........------................._...._°------....------........ ....,............. ............... ........... The IEtna Casualty and Surety Company Hartford, Connecticut President. (t1t17) Countersigned . ... . Authorseed Agent .................................................. ........ .. For Company Use i Claas Code ~ Territory Code I 1007 Date nf Policy Term Exprraeon 2040025764
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: his endorsement m.es nor acph - EXCLUSIONS f a t to mt-r•. w ..n c,..rcJ. ur care or mss of :crvtcc• rncoserabte oy an Insured, crsch respect to which such lnsurea. his iecal represes;auve or snc person cn:::.c.: :o pasmenr cndcr this cndorscmcnr .ha:i. wirhout written consent of the Company, maxe any setticment atth or prose• cutc :o t_s.ment .rny aaton autnst any person or nrcintunnn 0.'ho may be legally lsable therefor; ' tb: so as to inure a~rrct:v or mdtrectly to the bener•.t ot sny ssorkmen s compensation or disability benefits carrier or any person or o:3an:zanon quautymq as a ie.t.msLrer under any workmen s compensauon or disability benerits law or any similar iaw. CON DITIONS L. Policy Provisions. \`one sr :he msurm3 aereements: exc:usions or conditions of the policy shall apply to the insurance at{ordeS by this endorse• menc except the Coniwons \uttce" or \oace of Acadcnt• -"Asststance and Cooperation of the Lnsured;' "Changes;" **Asstgnment,' "Clncella• tton" and Declar.tnons.' 2. Proof of Clasm; 7Nedical Reports. As soon as praatcable, the Insured or other person making claim shall give to the Company written proof of clatm. under o.trh if requ:red, including full particulars or the nature and extent of rhe injuries, treatment, and other details entering into the determination oi the amount payable hereunder. The Insured and everv other person making claim hereunder shall submit to examtnattons under oath by any person named bv the Company and subscribe the same. as often as may reasonably be required. Proof of claim shall be made upon forms furnished by the Company unless the Company shall have failed to furnish such forms within 15 days after receiving notice of claim. The injured person shall submit to physical examinations by physicians selected by the Company when and as often u the Company may reasan- ably require and he. or sn the event of his incapacity his legat• representatsve, or m the event of his death his legal representative or the person or persons entitled to sue therefor, shall upon each request from the Company execute authorization to enable the Company to obtain medical reports and copies of records. 3. Notice of Legal Aceicn. If. before the Company makes payment of loss hereunder, the insured or his legal representative shall institute any legal action for bodily injury against any person ot organrvrion legally responsible for the use of an automobile involved in the accident, a copy of the summons and complaint or other procesr served in connection with such legal action shall be forwarded immediamly to the Company by rhe • Insured or h.s legal representative. 4. Limits of Liability. (a) The limit of liability stated in the schedule as applicable to "each person" is the limit of the Company's liability for all damaFes, rncluding damages for care or loss of services, because of bodily injury sustained by one person as the result of any one accident and, sub- jea to the above provision respecting each person, the limit of liability stated in the schedule as applicable to "each accident" is the total limit of the Company's liability for all damages, including damages for care or loss of services; because of bodily injury sustained by two or more persons as the result of any one acctdent. (b) If claim is made under this endorsement and claim is also made against any person who is an Insured under the Bodily Injury Liability cover- sge of the policy because of bodily injury sustained in an accident by a person who is an Insured under this endorsement: (1) any payment made under this endorsement to or for any such person shall be applied in reduction of any amount which be may be eari- tled to recover from any person who is an Insured under the Bodily Injury Liability coverage; and '• (2) any payrnent made under the Bodily Injury Liability coverage to or for any such person shall be applied in reduction of any amount which he may be entitled to recover under this endorsemetu- (c) Any loss payable under the terms of this endorsement to or for any person shall be reduced by the amount paid and the present value of all amounts payable to him under any workmeds compensation law, exclusive of non-occupational disability benefits. 5. Other Insurance. If the Insured has other similar insurance avaliable to him against a loss covered by this endorsement, the Company shall not be liable under this endorsement for a greater proportion of such loss than the applicable limit of liability hereunder bears to the total applicable limits of liability of all valid and collectible insutance against such loss. ' 6. Arbiceacien. If any person making claim hereunder and the Company do not agree that such person is legally entttied to recover damages from the owner or operator of an uninsured automobile because of bodily injury to the Insured, or do not agree as to the amount of payment which may be owing under this endorsementt then, upon written demand of either, the matter or matters upon which such person and the Company do not agree shall be settled by arbttranon in accordance with the rules of the American Arbitration Association, and judgment upon the award rendered by the arbitrators may be entered in any court ha.ing jurisdiction thereof. Such person and the Company each agree to consider itself bound and to be bound by any award made by the arbitrators pursuant to this endorsement. 7. Trvac Aareement. In the event of payment to any person under this endorsement: (a) the Company shall be entitled to the extent of such payment to the proceeds of any settlement or judgment that may result from the exercise of any rights of recovery of such person against any person or organization legally responsible for the bodily injury because of which such pay- ment is made; (b) such person shall hold in trust for the benefit of the Company all rights of recovery which he shall have against such other person or organiza- tion because of the damages which are the subject of claim made under this endorsement; (c) such person shall do whatever is prtsper to secure and shall do nothing after loss to prejudice such rights; (d) if requested in writing by the Company, such person shall take, through any representative designated by the Company, such action as may be necessary or appropriate to recover such payment as damages from such other person or organization, such action to be taken in the name of such person; in the event of a recovery, the Company shall be reimbursed out of such recovery for expetues, costs and attorneys' fees incurred by it in connection therewith; (e) such person shall execute and deliver to the Corapaqy such instruments and papers as may be appropriate to secure the righa and obligations of such person and the Company esnblisfled byrthii ptpvisiqo. - _ , 8. Pajmenc of Low bx che Company. Any amount due hereunder is payable m ~te Iqsured, oi (b) if the Insured be a miatir to his parent or guarilnn, or (c) lif the Insured be becessed to his >ttrviving spouse, otherwise (d) to a-person authorized by law to receive such payment or to a person legally entitled to recover the damages which the payment represents; provided, the Company may at its option pay any amount due here- under in accordance with division (d) hereof. 9. Action Against Company. No action shall lie againu the Company unless, as a condition precedent cherem, the Insured or his legal tepresenta- tive has fully complied with all the terms of this eadotxmenc. 2040025765
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AU I OMUIiII.L SCI IL•1)ULI? LIABILI 1'Y- 1'I IYSICAL I)AN1A(ils For all automobilrs morigag c.) vhcn covcr.d for Colnprrhrnsive DIiSCRIP IION Inh entry tlre Limit of Liability •Unlas utherwlsestutrd eac Compre heluive, for heluive, Fire, and Theft Coverages is "Actual Ca.h Value." ~ ' Purprucs fur which the above described aulumobiles are ~~.. for private passenger and "Commrra•fal" for cummercial or Inlck lype. ~ which UIIICS] Ot11L'rWl)f• to br used are "Pleasuie and Business" This ruJonelnent funns a part of the policy to attached, effective frUlll its J:IIC 1/f issue du.rrrnrut is ixrurd su6sryucnf to End. ba(I Nunn•11 lusun d dalal hrrrin. (LI/ornmtiun Gelutu rcyaircd unly when en• prepurutiml u/ pu/icy.) , ~~~11. Nu. ( AL I 32 I 9RR~ J. Nu. PHILIP MORR18 INC. OF ti AZARI) S: AZAR I)S:I N~ - uf, tal Ruc ~ Yr. w uor Ust•tl hascJ . Mu radr N:Inlr - - ' ruc in. y I' S • daly'I'Yfu uud M d ific.rliun Ton Ilaling l, (: ,dlnnage;Cl,.l++ific.rli undl++ific.r liunnnage; dw Scatinti C:Ipncily --' -- -- IJenlilic;liion No. wn anJ Statr 1 ist I/riua•ipall where I'rice 'g6 e Iru al an<I'1'rrr. r Cosl lu •Lilnlt of Liabllity - InvueJ Cunlp., Firn and Theft - I'l1E~lll1\IS-(PNEMIUAi BASIS-1'1•:H AU'I'OAIONI --- 1.i•.1 Each coverage belaw applies uuly with respect tu mrtumubiles uppusnv wbnh a+pruli, p{emiuln charge is sbuwn fur such c•ovrmgr. - - -- -- -• - - •- ' NATE. ('oul xc- U,.I duJily lujury AUI1/111UhIIC Property lllag'l', -- bih Y Med. Pa Llablh nlp Fur hensive Firr I'I hrll Cudli,lnu t h - ~ -UNUER-Bf T91ON-1-CR TNE L''>iORi'P'T`ioN- F HAZ(1 D9, TO THE MAIN A-0J4 DB T OR THE SE USE F AL OF A .4WN L III D ED - . ALToMC1Rj Fa AMO-(JNQ R D l9 ON OF HE DEO RIP710 OF HA7.A D9 TO THE BE F AI! ADV N C E - EF-1Ni0- So1fE-1LJaitC PRE IUM r BI PD 81 PD = : 53 39 76 9 P z8 23 8 14 348 : : • 1 ~. E , I I . .10 - • AL -sx~r: uaTxi - EE 17.0o EE 9 14 . EX CPTION 0 THE STATE9 __ ME 'i'IONED B LOM ~" , - r,..,~ • -- s .~ - _. IH .-1@52YE.•B TEe ARE-_NOT- NY FP 180 -~- AP LIOABLE I N THE STATE ORE FP 10 r OF MASe• AN VIRGINIA CALIF FP 126 , ~ , ; -- - Total Div. I i Total Div. 11 . .. - --- - - " -- " Total Div. 11{ • -" - - SPEC. C:oV. and ENDONSEAfENTS ~• -" -U.5 ~• ~ _~ j ~~ '~~l ' --- ---" _ - - " -'- - " ' - 2 04002 5766 CNAND TOTAL -- - - --`-'- , Fire, Theft or Collision, slww all iufomraiinn cxll,<I fur nn rcvenr brn.,f 32 The AEtna Casual/y and Sua'cfy Company TERM ~~0 TO I ••yJ%( E~n - Hartford, Connecticut / / J/ //'l~
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O The nutomobiles described on the revene hereof t~nder Ntunbers correspondittg tp those indicated low• are rnortgaged.as follows and Loss, ~ 7 if ae~y, under Comprefsensive, Fire, Tbeft or Glollisio~[ be p~yable, a~ ther-3nterest ma~ appurr, to the n}med Insured and rtlortgdgee nam ow. + - ntry Down Due Date of ame of stgagee ~ Entry t- Doum " Due ate of ;- _ p~eQf Mortgagee_ TjTo. Payment Final Payment No. Pavt~ent Final ayment 1= - /1ll J L ' ~ ~ ~ ~ a { ~f I C I ~, I tJ.l 11 lu. _ (The following parts o( e sehedule are tor' use with (~mprchenstve and Schedule 1 tlscresorlll) .~ •_ ~ = ~ ' L ~B ILIIY • : C 2 Hired Automobiles I I- Premi utn Btsis • Losi of Hin ~ ~ ~ R es per1j100, ?4dvanct Premiums- ~ r{' Locanom s_.`bete automobills ~, Types t Purpo sea 1 i:{timattd - Bodi PropenY Sods4Y - Pro{ietv rill be pnncip.1)y used ' % f-Iind • of i C•a;•of.I'S~e ( : In'ryry ~akage InryrY . aamsRe ~/ (If other tlun in declaration 1) r Liability Gablhn• Lrabiltrv - Labtbry . _ r . . . . . . ,.~, i T . C' , ^~ L •. •State "a" for'rPleasure and Business", "b" foc:`rComraerdal" t 3 SonaOwned ;Atitomobiles r ~ ~ ~.~ i -.: r :. Piemaun' $asis - Qass I Persons end Class-2 Emplovett Advance P remwms . Tl u I Pasms : ; - ocatian of He.dquarten of L ' • Bodily Propcrry _ ' -ame of fiah S`l Persons Named Herem , ~. lury Damage - _ ;, 1 (If other than in declaration 1) j r , -I Ii+bi4ry L+ abilny ~ I . . . • _ - . C` C 20400257 67 • , i . . ^ -' • _ ~ Rares ~yer Err•pioq<c • • Cla 2 Employes ~• I- - Lou~n cl }3eadouarrers a! ' I Boddp PropertY ~ Bodtly j Prope.rty Estimated Average Number + Class 2 E mpiovee• I Injury -'~amagc ' Injury i D.mage ' r • I ( lf othc tlian~in declaranon 1 abilrry tiabiltq• a b i lrry Li Labdrrv Lubdnv -- -_ 1
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AU-fC>MOI31LLi SCI iLDULl: LIABILfI'Y-IPI IYSICAL DAMAGE .__j DESCRIPTION OF HAZARI)S: I-O--J AIU . Ldo Ent No Yr. Alou[d PllrC r. , UNor sc•r cw )Cll ~tu. Trade Name Tme--c Siie Body'1'ylx und Model Rating Classification Tank Callonage; Seating Capacity Identification No. P ice C-ost lu inwred Town and Stulr. ' whcre priucipallY araged and •1'err. Code •Lunit of Li.lbility Comp., Fire auJ Thcft 1'REA11U~1S-(PREMIUM BASIS-PElt Alri'(7MOIN1.1•.I - --- Each coverage below elow applies only with respect to uulutnubilcs nllpu.nc wln~b a stleulil i h I f 1 prem ulu c arge is s wwn ur suc 1 coverage. NATF Budily Injury tu+nubile Prollr.rty Damage --- mp Fue ( O1Ohfe I ire fhch I> d Liability Med. Pay. Liability hensive I Cvlll.iuu N N M tj R IYP E 4L Lonr ~T1ON R TE PER VEHICLf: AD ANC PRE . 0 l1 ------ ITS .._ _ _. VEHICLE _ _ ,. I PD -- - - RICHMONO - I26. 117. 57 8 .I 1 22.9; - -- - y,~: - -_ E I 1. b. I ~: - - „ 63 58•79 I 76.37 - .6 =, 7. b ---- p. 58. 33•97: 12 . 13•37 - - - _ - R I:aTo6 u-A. 4 •9 23-52 , •9 23•5, T 0 , ~ . . -- gpArtnuE 4 • 30.04 . . E VA. E I.0 P 53•3 30-04 I 9•9 ~ _ VA. • ~' . _ P 44'9 23'52 4'9 •5 VA. E . D , ' 0 • . -- - •Unless otherwise stated in each entry the Limit of Liabilily and Theft Coverages Is "Acluul for Compreheosive Fire Total Div. I , ,. Cash Valua.'• es fnr which the above described automobiles are P r o Total Div. 11 , u p s to be used are "Pleasure and Business" for private passenger crommercial or truck type. Imd "Conmlercial" (or Total Div. lll „ , This endorsement forms a part of the policy to which -- --- uttachexl, effective from its date of issue unless otherwise sluted herein. (ln/ormation below required onfy when en- dursement is issued subsequent to preparation oJ policy.) SPEC. COV. and - - - - - 204 0025 Eud. F:If Na. i AL I 32 I 9R R9~SId. No. ~p L ENDORSEMENTS 7 68 ,: Nanled Ionurl~6V PHILIP MORR18 INC. CRANDTOTAL The IEtna Casualty and Surcty Company Hartford, Connecticut TERM tl; Fur all automobiles morlgugerl when covered fur C:unlprch/•nsi.r, Fire, Theft or Collisioo, show all infonnution calial for un reverac hcnvd.
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,f T}te automobiles described on the revetx hereof dnder En>4y Numtiers corr.e-spondinp--oo those indicated~below ue.mort aged as follows and Loss, = s, if any, under Comprehensive, Fire, Theft r C;olliston >:hall be luyable, as theit wterest may appFar,,to the t0am! Insured and mortgagee ~ ~named below. _ } - ~~ntry Down Due Date of i Name of Mortgagee . Entry Down I Due Date of I Name of Mortgagee 1 o. Payment Final Paymept i No. I Payment Final Paymen `t ? t 1 ; - _ ~ I ! I 1" - _- - •~p ".: l~ 4;;} .='JOa ! ~- QO - _- . I . . . . _ • j A t - 5Y 2 Ffired Automobiles (The followin` parts of the schedule are forluse with Comprehensive and Schedule policies only ). (I ; ' . . ~ ` - . LTABILITY 1 Pretnitun Basis'-Cost of Hire 1 l% ~' IVRates per'SI{W Advance Prcaanums' Locatioro wherc suromobilea ~ ! Types' Pfutppses E unar ed rs ; ~d+lY eProP~ Y : Boddy Prcrsy a v,11 be pnncipally uaed Hired ot l.l;e• Cac_of 1-Gre; -, ~3eturY `D+mage - Inrvry ~ Dama¢e (1f other than in declantion 1) ~~ liab;Itry Li:biluy [.Gabiluy j.Ltabdtw " a " f !$tate or " Plnscue and Business b " for ')C ornmercial " , ' `/'~lon-Owned Automobiles ~ : Ll,n 1 Pencaa _N:me of Eaih - ' ' ='Premium ,Basis-Class I Petsons'and Clui 2 Empl oveee ' Ad~•ance Premscros Locadon of`Headqusnen of Bod Ly Propecty Persons Named 1-:erein InlurY Damage M (If other than in dec.uatfon 1) Liabiltty ~ Liabiltry I 2040025769 " - 'Class 2 Employeei Eara+ated Average Number Locaion of Headquarters of Cln 2 E-piocee• ( lf other than iu declaratton 1~ , Rares per Emplovee ' Boddy Inryry Liabibty Property Damage ' j Lutrilir), Bod.ly Imury Ltab,6p• Property Damage L,abdtty
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DISCRIP'110N OF IiAZARI)S: I•0-d Abdr, Fnlq, No. Yr. of rch - c New ur usr d use u. M Trade Name nC IZC Ba)YTYIx' and Model Ilaling Cla+,ifeadiuu 7 auk Callun rgr Bus Sratrng ('apacrty dentificatiun No. . L"t Price :osl to Insured '1'ownwidStutr where principally uab~ and d r Crr. Code Limd uf Liability Gnnp., Fire and Theft PI(EMIU%IS-(PNEMIVAI 11ASIS-1'F.II AIYI'OMUISILI~1~~------~ - Each coverage below applies only with respect to aulumuLiles uppu,nr wLi,L a .pr•rdir premtum charge is shown I ur suct I coverage. & xlilyInjury Ardomobile PropcrlyDamage )~~d om Flre (,o'ulrrr~- Fire 'I~hrft bility Med. Pay. LiaLility /'' hensivr Culli,iun ~' r -- R TE PER UN 1 T DVA CE P EM, - I P 44•9 23•52 44 90 23•5 WINAHAEBTER V. E 4,,0 4 03 ~, - - ORT ~~ 1 ~ P 0 0 4~• g 30.0 . a . 4 . 4 3 . -- . >_ -- ~ ~_ _-I. ~ - ~#R --N - -XEX ~F - . B 8 C DE r - 1 T o - EXCEDB C EDIT 27 .. i i . -- •Urdeas otherwise slat in eac enlry the 1 rt of Liability and The$ Covenges is "Actual for Comprehensive Fire Total Div. I , , Cash Value." % uaes for which the above descdbed automobiles are Pur Total Div. 11 - p to be usod are "Pleasure and Business for private passenger and "Commercial"' Ipr commercial or truck type. Total Div. I I I _ This rndorsanert (omts a part of the policy to whtch attached, effective from its date of issue udess otherwise (InJo.mution below required only when en- sutal herein SPEC CUV -'- . doraemerrt is isrued rubsequent to preparation of policy.) . . and End. ER. 01 . No. Q d. No. ~r' ` ~ ENDORSEMENTS ` 2040025770 ~21 RR ' I IALI' Named hifJRd'-"J ~ PHILIP MORRIS (N0. CNAND TOTAL Th(l. ~tna Ca:ualty and Sur®ty Company Hartford, Connecticut . (qt771 Countersigned . Fur all uutuauubilcs nmrtgu ~~,rd vhru ,uv,-r,.t Irn t rmipn i~, nv., , Fire, Theft or Culliston, show all iulunnutinu c.dh•d lur un rcvvr r hr r„ f 4 ~/ Authuriznd Agrnr. _ ui--- - 2
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Theutomobile3 desmbed on the reverye hereof ander En>fi} Numb r ~rs corres~ono those itdicatc~ bclow ~~t> t ding ?Srtgaged as follo.vs and Loss. ~jtf atiy, under Comprehens'tve, Fire, eh or t~Ollision I be interest may appe their 'u ,:to ehE~ yabfe, at amo rtgagee ed Insured and d below. ` n Down Due Date of ameof ortgagee Entry Down Due Date of Nameaf Mortgagec V avment Final Payment N. Psyment Final Payment :. : -- ~ -~ - ~--~ -- ~ __ . . _ -- tL ~ •J (The iollowtnQ parts of he schedu le are forluse w,th omprehens,ve and hedule lici.es on ly ). - ~ ~IL I ' ~ -i.I A$Ii ITV - - 2 Hired Automobiles Premi um Basu Cost of Hire - Rses r F100 ~fdvance Premsams ' ttanons haR aumcb8es Typea I Purpb Proprsry will be pnnapally used Hir<d of l.tfea Coat of. H,R , amage - InNrY Damage - ( If other than tn declaradon 1) 'IiabiGry ~bd,ry , •L,abiry tiabrry 'Sute "a" for "Pleasure and Basiness", "b" for 'K'rommer~" ' 3 NonJOwned Automobiles Premium Basis • Qass t~ercons •an3=Qass 2 Employees _ • . • Advance Premiums ~aa 1 Penona • Lccarion of Hatdquarten of Bodily - P+~P~y llame of Eat'h Penosss Named Herein • ) _ , ,lajury Damage ( If other than in t7eclaration Ia , :_ ~• ~ C. ^biliry Liabiliry ~ _ _ __ . • c~. 1`> ~ jc - ~ - - - ~ - • • _ r ~ . ~ - - °--' -- --- - ~ - ~ - - .~ _ _ _ _ - J f• X . _ - _ ._~-- -_ _ -• t:'j~ taLL . < - _ ••~ - ? r: -t 1t~ x r i i•••; w 2040025771 . , . . L ~ _ • . _ _ C' ' . - : ' . _ - •. ~. Rues per Emoloyee -, _ - Clus'•2~playee; C~cenon of Heedo,uaners of • Boddy Propecry• Bod,ly Properry . :. Estimated Average. l~wnher 71 a Class 2 Emplovees Injury Damage Injury Damage : - `t' f I~ other than in declaratton 1) Liabilicy Llablliry Lubdity Liability ' -.~. . : .--- . ~ ~ .. • - • • - - • ' - - -, ~ ~
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f SUPPLEMENTARY RETROSPECTIVE RATING ENDORSEMENT- PLAN D (PREMIUM COMPUTATION) IT IS AGREED THAT THE PREMIUM FOR INSURANCE AFFORDED BY THIS POLICY IS TO BE COMPUTED IN ACCORDANCE WITH THE PROVISIONS OF ~J THE PREMIUM COMPUTATION ENDORSEMENT (RETROSPECTIVE RATING PLAN 0) FORMLL6Q A PART OF POLICY ICt4993RR AND RENEWALS THERE- OF, SUBJECT T0. THE LIMITATIONS SPECIFIED HEREIN: (1) (2) (3) PLAN D DOES NOT APPLY TO THE PREMIUM IN THE STATE OF CALIFORNIA. PLAN D DOES NOT APPLY TO THE PREMIUM FOR ANY LIMITS OF LIABILITY IN EXCESS OF $25,000- EACH PERSON, $25,000. EACH ACCIDENT AND $100s000. AGOREGATE. PREMIUM SUBJECT TO PLAN D IS OESIGNATED-IN THE DECLARA- TIONS AND ANY SCHEDULES BY THE LETTERRPR, PREMIUM NOT SUBJECT TO THE PLAN D 18 DESIGNATED BY THE LETTER *E~. This endorsement foreu a part of the yolicT to which attached, efFective from its date of issue unless otherwise stated herein. (The infor.notion below is reqs<ired only when this endorsement is is.tved svbrequenl to preparation of the policy.) Endorsement Effective Policy No. Endorsement No. 5 Named Insured PREMIUM: Additional; Return $ Tho IEtng Casualty and Surety Company .: - Countersigned ........~.. ~ ~ ° ! ._..._ ....... .. .. .... ._........ Authorized Agent Hartford. Connecticut President. Terntory Code Premmm Jr. Kind (State L County or City) Polie7 Yew Tmn EzDtp Form Clau Accounta E.perieuv (90-) Ed. 2/S9 2040025772
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ADDITIONAL INTEREST IT I8 AGREED THAT THE POLICY AL80 APPLIES TO THE ADDITIONAL INSURED NAMED BELOW BUT ONLY WITH REEPECT TO THE PRODUCTS HAZARD COVERED BY THE PCLICY. NAME OF ADDfL. INSURED ELMO ROPER This endorsement forms a part of the policy to which attached, effective from its date of issue unless otherwise stated herein. (Tlu inJonnation below +t rrqeirrd only when thit endorsement u issued subsrqurnt to preparation of the policy.) 6 Endorsement Effective Policy No. Endorsement No. Named Insured PREMIUM: Additional $ Return $ The I€tna Casualty and Surety Company Hartford, Connecticut ~ Countersigned Authorized Agent jr. Kind Terrsory Code (Sute k County or City) Politr Year Term Ezp,ry Form Claa Prem,um Aaounu Ezpenenc (90455) Ed. 2/59 ~ I Pruident. e 204p02S773
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(0 1 NSl3R f N6 AGREEMENT 1 V AMENDED IT 13 AGREED THAT PARAGRAPH IV OF THE INSURING AGREEMENTS OF THIS POLICY 18 EXTENDED AS FOLLOWS: °THIS POLICY ALSO APPLIES TO ACCIDENTS WHICH OCCUR DURING THE POLICY PERIOS ANYWHERE ELSE IN THE WORLD, PROVIDED THE CLAIM ANO SUIT WITH RESPECT TO SUCH ACTION 18 BROUCHT AND EKFORgED WITHIN THE UKITED STATEB OF AMERICA.x CONDITtON 6 4MENOED IT 18 AGREED THAT THE FIRST SENTENCE OF CONDITION *G0 aNOTICE OF ACCIDENT, CLAIM OR SUfT" OF THE POLICY IS AMENDED TO READ AS FOLLOY8E f "WHEN AN ACCIDENT OCCtlRS, WRITTEN NOTICE SHALL BE CIYEN TO THE COMPANY AS SOON AS PRACTICABLE AFTER KNOMLEOGE OF SUCH ACC1DEIiT 13 RECEIVED BY AN EXECUTIVE OF THE IN8URED.° CONOITIOd 13 AMENDED IT 13 AGREED THAT REFERENCE TO FIVE DAYB IN -CONDITION 13, CANCELLATION, 18 AMENDED TO READ *SIXTY DAYB.A This endorsement forms a part of the policy to which attached, effective from its date of issue unless otherwise stated herein. (The information below is required only when tlsis rndorsement ia issued ivbztquent to preparation of tlse policy.) Endorsement Effective Policy No. Endorsement No. 7 Named Insured PREMIUM: Additional $ Return $ Ths AEtna Casualty and Surety Company Hartford, Connecticut Countersigned _:..._..._.__.._~.,..f.~.~r..~ Authorized Agent T rrtu<y Code Premium - Jr. Kind (Stue & County or City) Pohay Year Tarm Ezptq Furm Class Accounts Expenene, (90a5S) Ed. ?/59 2040025774
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r r 1NSUR{NG AGREEMENT 11I AMENDED IT IS AGREED THAT INSURING AGREEMENT III aDEFINITION OF INSURED" IS AMENDED TO fKCLtIAE THE FOLLOYINQS (A) ANY IND•IVfDUAL ACTING IN BEHALF OF TI{E INSURED IN WHOSE NAME THE {MBUREDB PREMISES ARE RENTED OR LEASED, BUT ONLY AS REBPECTB ACCIDENTS ARISINQ OUT OF THE OYNER9HIP, MAINTENANCE OR USE OF SUCH RENTED OR LEASED PRENf8E8. This endorsement forms a part of the policy to which attached, effettive from its date of issue unless otherwise stated herein. 8 (The iwfonnatioa below is required only wheri this endorsrment is isavrd subsequent to preparation 01 the policy.) Endorsement Effecti.e Policy No. . Endorsement No. Named Insured PREMIUM: Additionaf = Return; Countersigned Tho IEtna Casualty and Surety Connpany Authorized Agent Hartford, Connecticut Jr. Kind Terncory Code (State & County or Citr) Policy Year Ter® E:tnp Form Cl+u Premium Aecouots E:I+erienn (90455) Ed. 2)59 2oapo25775
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SPECIAL I-T IS UNDERSTOOD AND AGREED THAT IN THE EVENT OF CANCELLATION OF THE POLICY TO WHICH THIS EN- DORSEMENT IS ATTACHED, BAME BHALL NOT TAKE EFFECT UNTIL TEN (10) DAYS AFTER NOTICE IN WRITING SHALL FIRST HAVE BEEN GIVEN BY THE INSURED TO THE SECRETARY OF STATE, STATE OF ILLINOIS, SPRINGFIELD, ILLINt)18. t This endorsetnent fornu a part of the policy to which attached, effective from its date of issue unless otherwise stated herein. (The infonnation below is required only when tbia endorsement Lr itsued rubteqnent to preparation of tbe poficy.) Endorsement Effective Policy No. Endorsement No. 9 Named Insured PREMIUM: Additional $ Return $ The JEtni Casualty and Surety Company Hartford, Connecticut (Auntersigneo 47frr)Q%~tG+.........--- Authorized Agent Preridcnt. T<rrncry Code Premmm Jr. $ind (State @ Cuunty or Gty) Polic7 Year Term E:Dtr7 Form Ctass Acccunts EsMriena (90155) Ed. 2/59 2040025776
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POLICY GONDTION N0. II AMENDED IT 18 AGREED THAT POLICY CONDITIDN ND. II is AMENDED. TO READ AS FOLLOWS: IT IS AGREED THAT SUCH INSURANCE AS 18 AFFORDED BY THE'POLtCY APPLIES ONLY AS EXCESS INSURANCE OVER ANY OTHER VALID AND COLLECTIBLE INSURANCE AVAILABLE TO THE INSURED. I This endorsement {ornes a part of the policy to which attached, effective from its date of issue unless otherwise stated herein. (The ie(orrwtion below ir required only when tl,u endorsernent ir issued subsequent to ¢re0aration of the policy.) Endorsement Effective Policy No. Endorsement No. 10 Named Insured PREMIUM: Additional; J _.~ Countersig Tha /Etna Casualty and Surety Company Hartford, Connecticut Authorized Agent Prerident. Terrmterr Code Premtum - Jr. Kind (State 4 Countr or Citr) Peltcr Year Term Expqq Form Clau Aecounu Eapermnei {90455) Ed 2/59 Return $ 2040025777
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r ADDITIONAL INSUR m S 1T !8 AGREED THAT THE POLICY AL80 APPLtEB TO THE FOLLOMINB ADDITIONAL IN8l1RED81 BEN80N & HEDGE8, A CORPORATION SAW !(1f LL REALTY CORPORATI 061 585 WATER STREET REALTY CORP. i This endorsement forms a part of the policy to which attached, effective from its date of issue unless otherwise stated herein. (The information below is reqwired only when this endorse+nent is itsued avbseqweet to preparation of the policy.) Endorsement Effective Policy No. Endorsement No. ~ ~ Named Iasured PR€MIUM : Additional $ Return $ Ths JEtns Casuatty and Surety Company ~~ ~%f .~~ ~~'' i _._.... •.L~. 1 Countersi8ned Authorized Agent Hartford, Connecticut Prerident. T iory Code Premmm Jr. Kind I (Seatel~ Councy or City) Policy Year Term Eapip Fom Cla.. Accounts Ecpenena (90f55) Ed. 7/59 204002577g
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r, tNSURmS OPERATIONS DCCLUDED r 'iT 18 AGREED THAT THE POLICY DOES NOT APPLY TO OPERATIONB FOLLOMING INBtlREDi 1~ "b'~.LPRtMT, INC.* • 2S BEN80N & HED8E8^ (CANADA) LTD.) 3 POLYMER 1NDIISTRIES, INC. 4) POLYMER ADHESI VES, INCORPORATED 5) POLYMFR SOUTHERN, INC. 6) POLYKER OF FLORIDA, INC. OF THE This endorsement forms a part of the policy to which attached, effective from its date of issue unless otherwise stated herein. (The inforwwtion below ir required only wfiers this eadorsement it issued subseqr<ent to preparation of the policy.) Endorsement Effective . Policy No. Endorsement No. 12 Named Insured PREMIUM: Additional; Countersigned ....1L The IEtna Casualty and Surety Company Hartford, Connect(cut ...~t (90455) Ed. 2/59 Return $ Tmn Exp ry F«m Clan President. Premmm Accounta Eaprrience 2040025779
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r ENDORSEt~EFai-,,.'`r=._K'••..., ~`"D L I~E' L iTY 1 <S:~RA.`,CE FRU`1 iiM iiliREtfiENT (FOR ATTACHMENT TO POLICY N0. IAL13219RRY) THE tTNA CASUALTY AND SURETY COMPANY (HEREIN CALLED fETNA) AND PHILIP MORRIS INCORPORATED (HEREIN CALLED SNSURED) MUTUALLT AGREE, AS RESPECTS (1) THE FOLLOWING INSURANCE POLIClEB AND RENEWALS THEREOF tSSUED BY EETNA TO THE INSURED: POLICY NUMBERS: IC171 ORR 1C171 9RR IC14993RR IAL13219RRY IFA212638RR• ISJ30577RR LIMITS OF LIABILITY COVERAGE LIMITS OF LIABILITY A- BODILY INJURY LIABILITY-AUTOMOBILE $25,000. EACH PERSON 25,000. EACH ACCIDENT B- PROPERTY DAMAGE LIABILITY-AUTOMOBILE 25,000. EACH ACCIDENT C- BODILY INJURY LIABILITY-EXCEPT AUTOMOBiLE 25,000. EACH PERSON 25,000. EACH ACCIDENT 100,000.AGGREGATE PRODUCT8 D- PROPERTY DAMAGE LIABILITY-EXCEPT AUTOMOBILE 25,000. EACH ACCIDENT 100,000. AGGREGATE OPERATIO 100,000. AGGREGATE PROTECTI 100,000. AGGREGATE PRODUCTS 100,000. AGGREGATE CONTRACTI AND (2) OTHER POLICIES WHICH THE PARTIES MAKE SUBJECT TO 'fHiS AGREEMENT BY SUPPLEMENTAL AGREEMENT, THAT THE PREMIUM FOR SAID POLICIES FOR THE LIMITS OF LIABILITY STATED ABOVE SHALL BE COMPUTED AND ADJUSTED AS STATED HEREIN, FOR THE PERIOD JANUARY (, 1960 TO JANUARY 1, 1963 SUCH PREMIUM IS HEREINAFTER CALLED THE RETROSPECTIVE PREMIUM. THE PORTION OF THE RETROSPECTIVE PREMIUM TO BE ALLOCATED TO THE COVERAGE DESCRIBED IN ITEMS (B) AND (E) OF SECTION III HEREOF SHALL BE THE DTFFER- ENCE BETWEEN (1) SUCH RETROSPECTIVE PREMIUM AND (2) THE EUN OF THE PREMIUMS FOR SAID POLICIES, FOR THE LIMITS OF LIABILiTY STATED ABOVE AND FOR OTHER THAN THE COVERAGE DESCRIBED IN ITEMS (B) AND (E) AFORESAID, COMPUTED AND ADJUSTED IN THE ABSENCE OF THIS AGREEMENT. (1) CONTiNUED. 2040025780
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f r I. ELEMENTS USE7 iN Tn5: ~FPU?A-r : °: :F hE c:ETROSPECTIVE•PREMIUM (A) STANDARD PR EsIUM: THE 8UH OF THE PREMIUMS COMPUTED IN ACCORDANCE WITH THE PP.OVISIONB OF tAID POLICIES FOR THE LIMITS OF LIABILITY STATEC ASOVE EXCLUSIVE OF THE APPLICATION OF ANY RETROSPECTIVE RATING PLAN OR PREMIUM DISCOUNT PLAN. POLICY PREMIUMS: THE SUM OF THE PREM.IUMS COMPUTED IN ACCORDANCE WITH THE PROVISIONS OF SAID POLICIES FOR THE LIMITS OF LIABILITY STATED ABOVE EXCLUSIVE OF THE APPLICATION OF ANY RETROSPECTIVE RATING PLAN. (C) BASIC PREMIUM: 24,.1% OF THE STANDARD PREMIUM (D) ONCURRED LOSSES: THE SUM OF THE ACTUAL PAID LOSBES AND THE RESERVES AS ESTIMATED BY kTNA FOR UNPAID LOSSES, SUBJECT TO THE LIMITS OF LIABILITY STATED ABOVE PLUS ALLOCATED LOSS EXPENSE EXCEPT FOR WORK- MEN*S COMPENSATION INSURANCE TO THE EXTENT THE TOTAL DOES NOT EX- CEED THE FOLLOWING LIMITATIONS: (I) $25,000 EACH ACCIDENT FOR WORKMENtS COMPENSATION OR EkPLOYERfS LIABILITY INSURANCE. RESERVE AND PAID LOSSES ARISING OUT OF OCCUPATIONAL DISEASE, INCLUDING DEATH AT ANY TIME RESULTING THEREFROM, SUSTAINED BY ANY ONE EMPLOYEE SHALL BE DEEMED TO ARISE OUT OF A SINGLE ACCIDENT. (2) $25,000 EACH ACCIDENT OR EACH OCCURRENCE IF THE POLICY WAS WRiTTEN ON SUCH A BASIS INCLUDING ALLOCATED LOSS EXPENSE, FOR GENERAL LIABILITY INSURANCE AND AUTOMOBILE LIABILITY INSURANCE. nALLOCP,TED Loss EXPENSE" MEXNS ACTUAL PAYMENTS AND RESERVES AS ESTIMATED BY fETNA FOR ITEMS OF EXPENSE DIRECTLY AND DEFINITELY CHARGEABLE TO A SPECIFIC CL.A!M INVOLVING LITIGATIOi OR POSSIBLE LITIGATION WHEN NECESSARY TO DETERMINE T!E INSUREDSS LIABILITY, BUT DOES NOT INCLUDE THE COST OF' IIQVESTISA71Cil AND ADJUSTMENT OF CLAIMS BY fETNA'S SALARIED EMPLOYEES. (E) t!~) !I. LOSS CONVERSION FACTOR: 1.15 MODIFfEF3 LOSSES: THE INCURR2D LOSSES MULTIPLIED BY THE Loss CONVERSION FACTOR. TAX MULTfPLiER: 1.031 THE RETROSP ECTIVE PREMIUM SHALL BE THE SUM OF: (A) THE BASIC PREMIUM AND (B) THE MODIFIED LOSSES, MULTIPLIED BY SNE TAX MULTIPLIER. HOWEVER, IN NO EVENT SHALL THE RETROSPECTIVE PREMIUM BE LESS THAN THE MINIMUM RETR08iPECTIVE PREMIUM OR MORE T'iAN THE MAXIMUM RETROSPECTIVE PREMIUM STATED IN THIS AGREEMENT. CONTINUED. (2) 2040025781
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r lllu THE M .' :: •i.~: -C_ PREMIUM OR THE SUM Gt= .._ :'-._ .l?'i SHALL BE j0o0% OF THE .S'TANDARD (A) THE 1IORk!HENfS COMPENSATION AND EMPLOYERBt LIABILITY INSURANCE RETROSPECTIVE PREMIUM DEVELOPED UNDER'POLICIES IC17189RR AND ICI4}93RR, (B) 1% OF THE WORKMEN'S COMPENSATION AND EMPLOYERSt LIABILITY INSURANCE PDLiCY PREMIUMS FOR THE STATE OF MONTANA, (C) 100% OF ALL OTHER WORKMENTS COMPENSATION AND EMPLOYER8t LIABILITY INSURANCE POLICY PREMIUMS, (D) THE GENERAL LIABILSfrY ASQD41 AUTOMOBtLE LlABIL1TY INSURANCE RETROSPECTIVE PREMiUM DEVELOPED UNDER POLICIES N0. 1AL132)9RRY, IFA212638 AND iSJ30577Rg (E) 1% OF THE GENERAL LIABILITY AND AUTOMOBILE LIABILITY INSURANCE POLICY PREMIUMS FOR THE STATES OF CALIFORNIA AND MONTANA AND ., (F) 100o OF ALL OTHER GENERAL LIABILITY AND AUTOMOBILE LIABILITY INSURANCE POLICY PRE1[IUMS, WHICHEVER 13 GREATER. 1V. THE MAXIMIUM RETROSPECTIVE PREMIUM SHALL BE 135.0% OF THE STANDARD PREMIUM OR THE 8UM nF ITEMS (A) THRO'1GH (F) IN SECTION I11 OF THIS AGREEMENT, WHICHEVER IS GREATER. V. COMPUTATIONS OF THE RETROSPECTIVE PREMIUM. kTNA SHALL EVALUATE THE INCURRED LOSSES AS OF JULY 1, 1961 FOR THE FIRST TWELVE MONTHS OF THIS AGREEMENT. JULY 1, 1962 FOR THE FIRST TWENTY-FOUR MONTHS OF THIS AGREEMENT. JUL.Y 1. 1961 FOR THE FULL THIRTY-SIX MONTHS OF THIS AGREEMENT.. JULY 1, 1964 FOR THE FULL THIRTY-SIX MONTHS OF TH18 AGREEMENT. JULY 1, 1965 FOR THE FULL THIRTY-SIX MONTHS OF TNIS AGREEMENT. Vlo AND SHALL COMPUTE THE RETROSPECTIVE PREMIUM PROMPTLY AFTER EACH OF SAID DATES. THE FIRST AND SECOND COMPUTATIONB SHALL BE MADE AS IF THIS AGREEMENT APPLIED ONLY TO EACN OF THE PERIODS USED IN SUCH COMPUTATIONS AND THE RETROSPECTIVE PREMIUM DETERMINED BY THE FIFTH COMPUTATION 8HALL BE THE FINAL RETROSPECTIVE PREMIUM UNLESS FURTHER COMPUTATIONS ARE RE- QUESTED BY THE INSURED OR BY /ETNA YITHIN 60 DAYS FROM THE COMPUTATION OF THE FIFTH'OR ANY SUBSEQUENT COMPUTATiON. PAYMENT OF PREMIUM. IF THE RETROSPECTIVE PREMIUM DETERMINED BY THE FIRST COMPUTATiON 18 MOR THAN THE AGGREGATE PREMIUMS PREVIOULY PAID, THE INSURED SHALL PAY THE E CESS TO /ETNA; IF LESS, kTNA SHALL RETURN THE DIFFERENCE TO THE INSURED. CORRESPONDING ADJUSTMENTS SHALL BE MADE AFTER EACH SUBSEQUENT COMPUTATI OF THE RETROSPECTIVE PREMIUM. CONTINUED. (3) 2040025782
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V11. CAN CP-'_L rT '•C'_ C'= _~ . ..~ ES .__.._CT TO TH1S AGREEMEidT. (B) (A) IN THE EVENT OF CANCELLATION BY THE INSURED, (1) THE STANDARD PREMIUM FOR THE POLICIES SHALL BE THE SUM OF THE ACTUAL STANDARD PREMIUMS FOR ALL COMPLETED POLICY YEARS AND THE SHORT.RATE STANDARD PREMIUMS FOR EACH INCOMPLETE POLICY YEAR. (2) THE BASIC PREMIUM SHALL BE 24.1% OF THE STANDARD PREMIUM SO COMPUTED. (3) THE MINIMUM RETROSPECTIVE PREMIUM SHALL BE THE STANDARD PREMIUM AS COMPUTED UNDER SUBDIVISION (1) OF THIS #UB- SECTION OR AS STATED IN SECTION III OF THIS AGREEMENT, IiHICHEVER 13 GREATER. (4) THE MAXIMUM RETROSPECTIVE PREMIUM SHALL BE AS STATED IN SECTION IV AND SHALL BE BASED UPON THE STANDARD PREMIUM COMPUTED AS THE SUM OF THE AUDJTED STANDARD PREMIUM TO THE DATE OF CANCELLATION AND THE ESTIMATED STANDARD PREMIUM FROM THE DATE OF CANCELLATION TO THE END OF THE THREE YEAR PERIOD. THE MAXIMUM RETROSPECTIVE PREMIUM 80 DETERMINED SHALL NEVER BE LESS THAN THE SUM OF SUBSECTIONS (A) THROUGH (F) IN SECTION III OF THIS AGREEMENT. IN THE EVENT OF CANCELLATION BY lETpA, THE STANDARD PREMIUM FOR THE PERIOD SAID POLICIES WERE IN EFFECT SHALL BE THE SUM OF THE ACTUAL STANDARD PREMIUMS FOR ALL COMPLETED POLICY YEARS AND THE PRO RATA STANDARD PREMIUMS FOR EACH INCOMPLETE POLICY YEAR, AND THE RETROSPECTIVE PREMIUM SHALL BE COMPUTED ON THE BASIS OF SUCH STANDARD PREMIUM, BUT IN THE EVENT OF CANCELLA- TION BY rtTNA BECAUSE OF NON-PAYMENT OF PREMIUM, THE MAXIMUM RETROSPECTIVE PREMIUM SHALL BE AS STATED IN SUBDIVISION (4) OF SUBSECTION (A). (C) IN THE EVENT'OF CANCELLATION OF ALL POLICIES BY kTNA OR THE INSURED, THE INITIAL EVALUATION OF THE INCURRED LOSSES AND COMPUTATION OF THE RETROSPECTIVE PREMIUM SHALL BE MADE SIX MONTHS AFTER THE DATE OF CANCELLATIONj THE NEXT, EIGHTEEN MONTHS AFTER THE DATE OF CANCELLATION; AND THE FINAL, THIRTY MONTHS AFTER THE DATE OF CANCELLATION. VIII. CANCELLATION OF COVERAGE ON ONE OR MORE (NOT ALL) EXPOSURES BY INSURED. (A) IF COVERAGE IS CANCELLED BECAUSE THE EXPOSURES COVERED NO LONGER EXIST, THE STANDARD PREMIUM AND THE INCURRED LOSSES FOR THE PERIOD SUCH EXPOSURES WERE COVERED SHALL BE USED IN THE COM- PUTATION OF THE RETROSPECTIVE PREMIUM. CONTINUED. (4) 2040025783
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( B) i F TH_t_ i I E ~ E: ' _--::;ESTS CAtQCELLATf QN OF COVERAGE ON EXPOSURES VH:CM STILL EXIST, THE INSURED HAVING ELECTED TO SELF-INSURE THEM OR INSURE THEM ELSEWHERE, kTNA MAY CONSIDER THE REQUEST FOR SUCH CANCELLATION AS A REQUEST FOR CAlFL'ELLATION OF ALL POLICIES 8Y THE INSURED. IN WITNESS WHEREOF, THE PARTIES HERETO HAVE CAUSED THIS AGREEMENT TO BE EXECUTED BY THEIR RESPECT1dE DULY AUTHORIZED OFFICERS. BY THE kTNA CASUALTY AND d COMPp VICE PRESIDENT PHILIP MORRIS INCORPORATED BY 2040025784
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~...~.:Fi~.-';T r "AL" Pol:aes) A635,A636,A8 Go3" "COST OF HIRE" DEFINITION AMENDMENT (Premium Condition), It is agreed that the definition of "cost of hire" in the Premium Condition is amended to read as follows: The words "cost of hire" mean the amount incurred for (a) the hire of automobiles, incl:uding the entire remuneration of each employee of the named Insured engaged in the operation of such automobiles subject to an average weekly maximum remuneration of $100, and for (b) pick-up. traaspartation or delivery service of property or passengers performed by motor carriers of propertp or passengers for hire, other than such services performed by motor carriers which are subject to the security requirements of any motor carrier law or ordinance. The rates for each $100 of "cost of hire" shall be 5% of the applicable hired automobile rates, provided the owner of such hired automobile has purchased automobile Bodily Injury Liabiffity and Property Damage Liability insurance covering the interest of the named Insured on a direct primary basis as respects such automobile and submits evidence of such insurance to the named Insured. The /Etna Casualty and Surety Company Hartford, Connecticut ~~~lC%~ Pretidenr. ttawol 2040025785
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?.liTOMOBILE E`DORE( _1 tiT t tva•; _ 6aSIC-5'MEDu CDNIRtNt4S•VC -: F.A-MFLY F:;OTFC T:+_m`: CO`= ERiGF ENrJrJr^.SE3iENT iAutotnobi)e Bodily lniury Lieciiea ;nd P-oper- Detnsge Lisbility-Virginia, (Specified Car Basis) in consideration of the pa.mcnt of the premium for this endorsement, the Company agrees with the named Insured, subjeet to the iia Iiability, exclusions, tvndition• and other terms of this endorsement and to the applicable terms of the policy: SCHEDULE llesignated Automobile SEE SCHG. LIMITS OF LIABILITY: Bodily Injury 115.000 each person; 530,000 each aeddeat Property Damage $5,000 each accident ' INSURING AGREEMENTS 1. Damages for Bodily Injury and Property Damage Caused by Uninsured Automobiles To pay all sums which the Insured or his legal represenati.e aha1l be legally entided to recover as damages from the owm operator of an uninsured automobile because of: (a) bodily injury, sickness or disease, including death resulting therefrom, hereinafter called "bodily injury;'sustained by the Insu (b) injury to or destruction of an insured automobile and its contents, hereinafter called "property damage"; cau,ed by accident and arising out of the ownership, maintenance or use of such uninsured automobile. 11. Definicions +~ (a) Insured. The unqualified word "insured" means: _ (1) the named Insured; (2) any person while occupying an insured automobile; and (3) any person, with respect to damages he is entitled to recover for care or loss of services because of bodily injury to w this endorsement applies. , The insurance applies separately with respect to each.Inaured under this endonement, but neither this provision nor application of insurance to more than one Insured shall operate to increase the limits of the Company's liability. (b) Insured Automobile. The term "insured automobile" means an automobile designated in the schedule while being used by or ' the permissios of the named Insured as stated in the policy. (c) Uninsured Automobile- The term "uninsured automobile" means: /1) an automobile with respect to the ownership, maintenance or use of which there it, in the amounts specified in the Virs Motor Vehicle Safety Responsibility Aet, neither (i) cash or securities on file with the Vir;inia Commissioner of M. Vehicles nor (ii) a bodily injury and property damage liability bond or insurance policy, applicable to the accident t respect to any person or organization legally responsible for the uae of such automobile; or (2) a hit-and-rue automobile as defined: but the term •'uninsnred sutomobile" shall not include: (i) an automobile defined herein as an "insured automobile"; (ii) an automobile owned by the named Insured: (iii) an automobile which is owned or operated by a self-insurer wishin the meaning of any motor vehicle financial respottaibi las., motor carrier law or any similar law; (iv) an automobile which is owned by the United States of America, Canada, a state,.a political subdirisioo of any such Bove ment or an agency of soy of the foregoing; ., !v) a land motor vehicle or trailer, if operated on rails or txawler•treade or while located for ose as a residence or premi •• and not as a vehiele; or . (vi) a farm type tractor or equipment designed for use principally oE public roads, except while actually upon public roads• {d) Hit•aad-Run Automobile. The term "hit-and•ruo automobile" means an automobile which causes bodily injury to an Insured P , roperty damage arising out of physical contact of such automobile with an insured aueomobile, provided: (i) there cannot scertained the identity of either the operator or the owner of such "hit-and-run automobile"; (ii) the Insured or someone on hehalf shall have reported the accident within S days or as soon as practicable to the Commissioner of Motor Vehicles, and ah have filed teith the Company within 70 days thereafter a statement under oath that the Insured or his legal representative has cause or causes of action arising out of such accident for damages against a person or persons whose identity Is uaaseertainat (Cowtiarrd or reverse ridt) This endorsement form• a part of the policy to which attached, effective from its date of issue unless otherteise stated herein. (TGr ieJ.rmation below is rrqrirrd oa/y u•Gnt t4it tad.rfratert ir i+frtd sr6reqrrat ra trrjaraliaa a( t/re pafiry) n onemen e eedYe I -}.-:~'r ............ (AL13219RRY l= :... .:.....Poliey No . .............. ...... __............_............ .• Endonement No............ .... .•.•...••...•. P H I L I P :.C ? P• ( S ~.., . ... Vamed Insured . . • . ~:I c. .. . ... .................... ldditional Premium f.. .... .......... .. . . .......• .. . .. The A-tna Casualty and St'trety Company Hartford, Connecticut - ,, .(13149-A) 5-59 ~' ~ ~O~~ ~~/~ -~ ~ ~"L .v ... ._. _ r. _ ...................... ........... Countenigned,L:.r ~'V~z j~ ` .luthorized .\ge • FOR COMt+ANY UfE I CLAff COOE TERRITORT CODE ' DATE OF IDUCT I TEnR I, Ea/1RATION ~ 1007 lll t z040025786
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.tnd •etting foren the taer• ,n oupport thereof, and , iii) at the Company's request, the Insured ur his !egai rcorr,en;a^.e -:c•, „adaulo lor -pectton the automootle whicn the Insured aan occupying at the time of the acetdent, ~Uccup.mR. Ihv „ord uecupying" means in or upon or entering into or alighting from. f t ~!ute. 'I'he .,ord rate ' includes the llistrict of Columbu, a rerrttory or possession of the United Statee, and a p;e, t:cc of Car.:..a III. Policy Period, Territory rhis endorsement applie, unls to accidents .,hich occur on and after the e6ectise date hereof, during the polioy period and within the L'nitcd :tate• of .lmeri(a,its territories or possessions, or Canada. EXCLUSIONS I'his endonement does nut appt.: (a) to the nrst t„v hundred dollar>.of the total amount of all property damage as the result of any one accident; • tb) to bodily inruq tu an Insured, tare or lass of services recoverable by an Ia.ured or injury to or de.truction of property of an in.ured, s.ith re~pect to ahich .ueh Insured or his legal reprexntative shall, without writtet: consent of the Company, make any •e«lement svtth any person or organization who may be legaffy liable therefor; (c) su a, to inure directly or indirectly to the benefit of any worYmea's compensation or disability benefits carrier or any person or organszation qualifying as a self-insurer under any workmen's compensation or disability benefits law or any similar law. CONDITIONS 1. Policy Provisions. None of the Insuring Agreements, Bxelusions, Conditions or Other Provisfons of the policy shall apply to the insur- ance atfurded by this endorsement except the Conditions "Notice" or "Notiee of dtxideat," "Subrogation," ••ChangesJ' "Assignmant," ••Cancellation" and "Declarations." , 2. Premium• If during the policy period the number of Virginia dealer'. license places issued to the named Insured ehanges, the named Insured •hall notify the Company during the policy period of any change and the premium shall be adjusted in accordance with the' rnanual, in use by the Compan-v- If the earned presaaum thus computed exceeds the advance premium paid, the named Insured shall pay the ezcess to the Company; if less, the Compaay shall return to the named Insured the unearned portion paid by auch Insured• 3. Proof of Claim. As soon as practicable, the Insured or other person making claim shall give to the Company written proof of claim, under oath if required, including full particulars of the nature and extent of the injuries, treatment, and other details entering into. the determination of the amount payable hereunder. Proof of claim shall be made upon forms furnished by the Company unless the Com- pany •hall hace failed to furnish such forms within 1S days after receiving notice of elaim• The injured person shall submit to physical examinations by physicians selected by the Company when and as the Company may «asonahly require and he, or in the event of his incapacity his legal representative, or in the event of his death his legal representa- tive or the person or persons entitled to sue therefor, shall upon each request from the Company execute authorization to enable the Company to obtain medical reports and eoptes of rernrds• . The Insured or other person making claim for damage to property shall file proof of loss with the Company within sixty days after the occurrence of loss, unless .uch time is extended in writing by the Company, in the form of a sworn statement suting forth the in- terest of the In,ured and of all others in the property affected, any encumbrances thereon, the actual cash value thereof at time of loss, the amount, place, time and cause of such loss, and the description and amounts of all other insurance covering such property. Upon the Company's «quest, the Insured shall exhibit the damaged property to the Company. 4. Notice of Le;al Action. If, before the Company makes payment of loss hereunder, the Insured or his legal representative shall institute any legal action for bodily injury or property damage against any person or organization legally responsible for the use-of an auto- mobile involved in the accident, a copy of the summons and complaint or other proceas served in connection with such legal action .hall I.e fonsarded immediately to the Company by the Insured or his legal representative. • 5, Limits of Liability. (a) The limit of bodily injury liability stated in the schedule as applicable to "each person" is the limit of the Com- pany', liability for all damages, including damages for care or loss of services, because of bodily injury sustained by one person as the resu)t of any one accident and, subject to the above provision respecting each person, the limit of such liability stated in the schedule as I applicable to "each acctdent" is the total limit of the Company i liability for all damages, including damages for care or loss of services, because of bodily injury •mtained by t..o or more persons as the result of any one aecident• • (b) The limit of property damage liability stated in the schedule as applicable to "each accident" is the total limit of the Company's liability for aIl damages arising out of injury to or destruction of all property of ooe or more Insureds as the result of any one accident. . . tc) If claim i• made under this endorsement and claim is also made against any person erho is-an Insured under the Bodily Injury i. Liability or Property Damage Liability coverages of the policy because of bodily injury py property damage sustained in an accident by a persnn svho is insured under this endoriement• (1) any payment made under this endorsement to or for any +uch person shall he applied in reduction of any amount which he mav he entitled to recover from any person who is an Insured under the Bodily Injury Liability or Property Damage Liability coverage,; and . . f2) any payment made under the Bodily Injury Liability or Property namage Liability eoverages to or for any sueh person shall be applied in reduction of any amount which he may be entitled to recover under this endorsement• (d) Anv amount payable to an Insured under the terms of this endorsement shall he reduced by (1) all sums paid to such Insured fpr Iwdilv injury or prnpertv damage by or on behalf of the person legally liable therefor and (2) the amount paid and the present value of all amnunt% payahle to •uch an Insured under any workmen's compensation law, exclusive of non-occupational disability n ,. benefits. . . . . ., •. d,u Uther Insurance, With re•pect to bodily injurv to an Insured, if the Insured has other similar insuranee available ib liim against a loss covered Iw thi, endor.ement, the Corrtpan}• hall not be liable under this endorsement for a greater proportion of such loss than the applicable limit of liabilitc hereonder bears 'to the total applicahle limits of liability of all valid and collectible insurance against sueh loss. With re.peet to property damage, the insurance afforded under this endorsement ~hall be excess insurance over any other valid and collectible insurance against •uch property damage. 7• Pasment nl Loss hs the Companv, Any amount due hereunder is payable to the Insured or his legal representative- ,; ,. K, "actirsn 4:ainst Compane. aorinn hall lie again+t the Company unless, a, a'condition precedent thereto Insured or his*le¢al rep- re•entatice ha• fP,ll, -mp .„irh all the term, of this endor.ement. 2040025787
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A(:TOMOBILE ENDORSEMENT CA, CS, 'S, TC. aL E-885 '.1 !:C9i FAMILY PROTECTION COVERAGE (Automobile Bodily Injury Liability - Specified Car Basis) In considetation of the paymeat of the pcemium fa this endorsement, the Company agrees with the named Insured, subject to the ii of liability, erclusions, conditions and ocher terms of this endorsemenc and to the applicable terms of the policy: SCHEDULE Designated Automobile ALL V EH I CL ES R EG I STERED I IJ .:Y Limits of Lisbility ,C,ALJF.r ORE ii ;J. HA'4P.EachPerson Each Accident ;,lY,CALIF.& i'..HA~?P• (0,000 = 2;,r~CG The additional premium for this endorsement is S I N C L e 1 N' S I ' .. O R E 5 s 000 J0,600 a ' INSURQQG AGREEMENTS 7. Damages fer f3odily Injtrry Caused by Uninsured Automobiles. To pay all sums which the Insured a his legal representa shall be legally entitled to reco.er as damages from the owner oL operator of an unin#uced guiomobile because of bodily-injury, sickness or disease, including death resulting therefrom, hereinafter called "bodily injurY", sustained by the Insured, caused k accident and arising our of the ownership, maintenance or use of such oninsnred avtomobtle• peo.ided,for the purposes of this endorsement, determination as to whether the Insured cr such representati.e is legally entitfed to recover such damages, and if the amount thereof, shall be made by agreement between the Insured or such representative and the Company or, if they fail to t agree, by arbitration. II. Definitions. (a) Iasured. The unqualified word "Insured" meanst ~ (1) any person while occupying an insured automobile; and (2) any person, with respect to damages he is entitled to recover for care cc loss of ser.ices because of bodily injury to whieh this endorsement applies. The insurance applies separately with respect to each Insured under this endorsement, bui neithet this provision nor applicaiior the insurance to more than ooe Insured shall operate to increase the limits of the Company's liability. (b) Insured Automobile. The term "insured automobile" means an automobile designated in the Schedule while being used by or with the permission of the named Insured as stated in the policy but shall not include an'aucomobile while used as a pt3r7 : or livery conveyance. " .. . • . ,, (c) Uninsured Automobile. The term "uninsured automobile" means: ••,o: (1) an automobile with respect to the ownership, maintenance or use of which there irho:bodilT injury liability bond or•• F insurance policy applicable at the time of the accident with respect to any person a arganization legally responsible for the use of such automobile; oe , (2) a hit-and-run automobile as defined; . ' but the term "uninsured automobile" shall not include: (i) an automobile defined herein as an "insured automobile"; (ii) an automobile owned by the named Insured as staced in the policy; (iii) an automobile which is owned cc operated by a self-insurer within the meaning of tny motor vehicle financial responsibility law, motor carrier law or any similar law; (ivJ an automobile which is owned by the United States of America, Canada, a state, a political subdivision of any such government or an agency of any of the foregoing; (v) a land motor vehicle or trailer, if operated on rails or crawler-treads or while located for use as a residence or premises and oot as a vehicle; ar , (vi)  farm type cractor or equipment designed for use principally off public roads, except while actually upon public tads.; (d) Hic-snd-Run Automobile. The term "hit-and-run automobile" means an ateomobile which causes bodily injur7 to an Insured arising out of physical contact of such automobile with an automobile which the Iosared is occupying at the time of the accident, provided: (1) there cannot be ascertained the identity of eicher the operator at the owner of such "hiaandt•an automobile"; (2) the Insured or someone on his behalf shall ha.e reported the aeeident wirhin 24 hours to a police, peace•a • judicial officer or to the Commissioner of Motor Vehicles, and shall ha.e filed with the Company within 30 days thereafter a statement under oath that the Insured a his legal representative has a cause t: causes of action arising out of such acciden for damages against a person or persons whose identity is anascertainable, and setting forth the facts in support thereofi a1s (3) at the Company's reqttest, the Insured or his legal representative makes available for inspection the automobile which' the Insured was occupying at the time of the accident. t (e) Occupying. The word "occupying" means in or upon or entering into or alighting from. (f) State. The word "state" includes the District of Columbia, a territory ar possession of the United States, and a province ol Canada. jjl. Policy Period, Territory. This endorsement applies only to accidents which occur on and after the effective date hereof, •, during the policy period and within the United States of America, its territories t: possessions, o< Canada. (Continuad oa ra.eesa sida) This endorsement funu, a part of thc fwlicy to which attached, effective from its date of issue unless otherwise stated herein. , The in/ortnunun J•Jut. rr r.•qnvrd ,nt1}• t:hrn tl,it :,tdorarmtnt is ir.rnrd .ru5sr,ryrnt to preparation of the pofiey) ~`'- ~ 5 ..-........... Endnrsement etiective 1-1 -O l. . ... .. ................... Policy No. ... 1.AL.L ~~.L~At~Y......._._. Endorsement Yo. ..........L. :..............._1 \amed 6i.ured . . pti I L .L.P ."r14R..°. I.S.....L.'.'.C. ...... ........... , . .........: .........•...•.. ..._._............ .... ..• __................... The AEtna Casuatty and Surety Company -(13137) Hartford. Connecticut President. ,. ( . _ . . Cuwuer.igned `-~~~~.v.s.~. Authorized AQen( For Company Ure , Ctas Code i Terr.rory Code ; Date of Pol,cy ' Term I 1007 ~ ~ E:p,ranon 2040025788
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EXCLUSIONS "~a cneeac~cnt does not apply: ,._ ..ntu:v to an Insured, or care or loss of se••vices recoverable by an insured, with respect to which suca Insured, his r:atcptcsencattve or anv. person entitled to payment under this eadorsement shall, without written consent of the Campany, ^aRe irtv settlement wtth or prosecute to 1udgrnent any action against any person or organization who may be legallv liable ib1 co dc to inure directly or indirectly to the benefit of any workmen's Lompensattoa or disability benefits carrier ot any person or organization qualifying as a self-tn'sure= under any workmen's compensation or disability benefits law or any similu !aw._ . C01rDITIONS 1. Policy Provtstons. \ooe of the insuciag acreemenrs, emc)osions or conditions of the policy shall apply to the insurance afforded by this endorsement e=cepr the Conditions "Nottce" or "Nottce of Accrdent," "Asststance and Cooperation of the Insured," "(hanges," "Assrgnment,, *'Cancellatron" and "Declaturons". 2. Proof of Claim• Medical Reports. 1s soon as practicaole,che Insured or other person making claim shall give to the Company wrttten proof of claim, under oath if required, including full particulars of the nature and extent of the injuries, treatment, and other details entering into the determination of the amount payable hereunder. The Insured and every other person making claim hereunder shall submit to examinations under oath by any person named by the Company and subscribe the same, as often as may _ reasonably be required. Proof of claim shall be made upon forms furnished by the Company unless the Company shall have failed to furnish such forms within 15 days aftet receiving notice of claim. ' ' The injured person shall submit to physical examinations by physicians selected by the Company when and as often as the Company may rcasonably requi:e and he, or in the event of his tncaoacity his legal representative, or in the event of his death his legal representative or the person or persons entitled to sue therefor, shall upon eacb-request from the Company execute cl authorization to enable, the Company to obtain medical reports and copies of records, . 3. Notice of Lesal Action. If, before the Company makes payment of loss hereunder, the insured or his legal representative shall institute any legal actioa for bodily injury against any pers-n or organization legally respoasible for the, u5e of an automobile involved in the accident, a copy of the summons and complaint or ocher process served in coonectionwtt)i sucbleg;j acfion~sfialj be forwarded immediately to the Company by the Insnred or his legal tepresentative. " '' 4. Limits of Liability. (a) The limit of liability stated is tbe• schedule as applicable to "each person" in the limit of the Com_ v pany's liability for all damages, fncluding damages for care or loss of services, becausrof bodily injury sustained by one perses as the result of anr one accident and, subjece to the above provision respeetina each person the limit of liability stated in the schedule as applicable to "each accident" is the total limit of the Company's liability for a~l damages, including damagets.for care or loss of services, because of bodily injury sustained by two a more persons as the resulcof any one accident. •-q (b) If claim is made tmder.this endtusement and claim is also.made against any person who is an Insured under the Bodily Injtey l•iability coverage of the policy because of bodily injury sustained in an accident by a person who is an Insured under this endorsement: (1) any payment made under this endorsement to a far any such person shall be applied in reduction of any amount which he may be entitled to recover from any person who is an Insured under the Bodily Injury Liability eoverqge; and .,, (2) any payment made under the Bodily Injury Liability covetage to or for any such person shall be applied in reduction of , any amount which he may be entitled to recover under this endorsement. (c) Any loss payable under the terms of this endorsement to or for any person shall be reduced by the amouni paid and the present value of all amouats payable to him under aay workmen's compensation law, exclusive of non-occupational disability benefits. ' 5. Other Insurance. ff the Insured has other similar insurance available to him against a loss covered by this endorsement, the Company shall oa be liable under this endorsement for a greater proportion of such loss than the applicable limit of liability hereunder bears to the total applicable limits of liability of all valid and collectible insurance against such loss. 6. Arbitration. if any person making claim hereunder and the Company do not agree that snch pbrsoti is tegallretitled to recover damages from the owner or operator of an uninsured automobile because of bodily initay ra tbe• Insured, or do not agree as tathe amount of pa,vmenr which may be owing under this endorsement, then, upon written demand of either, the matter or matters upoa which such person and the Company do not agree shall be settled by arbitration in accordance with the rules of the American Arbitration Associacion, and judgment upon the award rendered by the arbitrators may be entered in any court havina jurisdiction thereof. Such person aod the Company ea•ch agree to consider itself bound and to be bound by awsrd made by the ubitratorsl' pursuant to t}iis endorsement. ' ' `'t' ' " ' 7• Trust Agreement. in the event of payment to any person under this end'orsement: o( (a) the Company shall be entitled to the extent of such payment to the proceeds of any settlement or judgment that may result from the exercise of any rijthcs of recovery of such person against any person or organization legally responsible for the bodily injury because of which such payment is made; (b) such person shall botd in trust for the benefit of the Compaoy all rights of recovery which he shall have against such other " i1~ person or organizatioa because~of'the damages which ue the subject of claim made under this endorsement; (c) such person shall do whatever is propet to secure and shall do nothing after loss to prejudice such rights; (d) if requested in writing by thr Company, such person shall take, througb any representative designated by the Companyi such action as may be necesssry or.appropttate to recover such paymentas damages ftomsueh.otbet person or organization, snchao action to be taken in the namrof such persm; in the event of a reco.ery, the Company shallbqreimbursed out.of.auch te,r • covery for expenses, costs aad attorneys' fees incurred by it in connectiun therewith; „- ttvnc ;- •.. 1- - .•• .- p). (eC)'such person shafl'e:ecu{e and deliver to the Compfay such instruments and papers's•s may 6E4¢(uopr}ate to securertbeiy' • rights and obligatiods of such pErson and the Company tstablished by this provisioni'~)- =V-• u•^cc i: -• •t t-.w'•a~ut~t!+e & Payment of Loss by the Company. Any amount dtte heretmder is payable (a) to the (nsured, or (b) if the Insured be a minor to =p4o ceceive sueh paymetit ar(to a ptrrson legally eataled to reco et the damages which the payment represeo s; p u: a a d l6ey law Company may at its option pay any amount due hereunder in accordange witb,division (4) hereof. . ' 9: 'AtPon•Against Compaey. No action shall lie against the Company unless, as a condition preeed.nt thereto, the•Insured or bi4 ~ legal representative has fully complied with all the terms of this endorsement. • • I . . : i . • t r. . , . •rtsrts 2040025789
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- 1 - PREMIIJM DISCOUNT ENDORSEMENT - NEW YORK (Automobile and General Liability Insurance) It is agreed that the premium pertaining to New York for Liability and Medical Payments insurance is subject to discount in accordance with the following procedure: 1. New York Standard Premium. Such premium pertaining to New York computed in accordance with the provisions of the policies designated,in paragraph 4 hereof, other than this endorsement and exclusive of the application of any retrospective rating plan, shall be known as the NeW York Standard Premium. 2. Total Standard Premium For All States. The liability and Medical Payments premium computed in accordance with the provisions of the policies designated ia paragraph 4 hereof, other than this endorsement and exclusive of the application of any retrospective rating plan, any Automatic Premium Adjustment Endorsement, any Premium Return Plan Endorsement, or other Premium Discount Endorsement, shall be known as the Total Standard Premium. 3. Premium Discount - New York (a) For policy periods of one year or lees - The New York Standard Premium, exolusive of any premium subject to any retrospective rating plan, shall be subject to the applicable dis- count percentages for the Total Standard Premium obtained from the Table of "New York Premium Discounts." (b) For policy periods of more than one year - The New York Standard Pre- -------_____~-------------°----------- miua, exclueive,o£,any pre- mium subject to any retrospective rating plan, shall be subject to the applicable discount peroeatages stated in said Table of "Nex York Pre- mium Discounts" opposite the total standard premium for the policies for each annual period or portion thereof during the policy period. (c) If retrospective rating is applicable to a part of the premium pertain- ing to New York, the amount of premium discount applicable to the New York Standard Premium, exclusive of any premium subject to any retro- spective rating plan, shall be the difference between (1) the discount determined by yapplying to the New York Standard Premium the applicable percentages stated in said Table opposite the Total Standard Premium and (2) the discount determined by applying to that portion of the New York Standard Premium which is subject to retrospective rating the applicable percentages stated in said Table opposite so much of the Total Standard Premium as is subject to retrospective rating. (d) The provisions of this endorsement shall not apply in the event the New York Standard Premium is $100 or lese and in no event shall the application of the provisions of this endorsement result in an earned premium of less than $100 as applicable to NeR York. 4. Policy Noa. Estimated Standard Premium IALI•'D21aRRY TO SE DETER. 2040025790 (C-1549-1-A) (Cont1d) EnDT. "'.o. 15
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- 2 _ 5. Table = xex Tork Prea.iaa Diacounts - B Preaims Discount Percentages Applicable to Xer Terk Standard Prenins Colunai R * • • (1), - Total Standard Preaita for all Stat.s. (2) - Discount Percentage for General Liability. (3) - Discount Percentage for Automobile Liabilit7 - Oarages. (4) - Discount Percentage f or Automobile Liability - Tazis, Li.ery, Busea, and Long Haul Tracks,en. (5) - Disconnt Percentage for all other Antorabile Liability. r - - - - - - - - - - - - .- - - - - - - - - - - - - - - - - - - - - - - - - - - - - (1) (2) (3) (4) (5) (1) (2) (3) (4) (5) $1,000 or 0.0% 0.0% 0.0% 0.0% 6,200 9.9 5.1 2.2 4.7 lese 6,lt00 -10.1 5.3 2.3 4.8 1,050 0.7 0.3 0.1 0.3 6,600 10.3 5.4 2.5 5.0 1,100 1.2 0.6 0.1 0.5 6,800 10.4 5.5 2.6 5.1 1,150 1.6 0.7 0.1 0.7 7,000 10.6 5.6 2.8 5.2 1,200 1.9 0.9 0.2 0.8 7,200 10.7 5.7 2.9 5.3 1,250 2.3 1.1 0.2 1.0 7,400 10.9 5.8 3.0 5.4 1,300 2.6 1.2 0.2 1.1 7,600 11.0 5.9 3.1 5.5 1,350 2.9 1.4 0.3 1.2 7,800 11.1 6.0 3.3 5.6 1,400 3.1 1.5 0.3 1.3 8,000 11.2 6.1 3.4 5.7 1,450 3•4 1.6 0.3 1.4 8,200 11.3 6.2 3.5 5.7 1,500 3.6 1.7 0.3 1.5 8,400 11.kL 6.3 3.6 5.8 1,550 3.8 1.8 0.4 1.6 8,600 11.5 6.3 3.6 5.9 1,600 4.0 1.9 0.4 1.7 8,800 11.6 6.4 3.7 6.0 1,650 4.2 2.0 0.4 1.8 9,000 11.7 6.5 3.8 6.o 1,700 4.4 2.1 0.4 1.9 9,200 11.8 6.5 3.9 6.1 1,750 4.6 2.2 0.4 2.0 9,400 11.9 6.6 4.0 6.2 1,800 4.7 2.3 0.5 2.0 9,600 12.0 6.7 4.0 6.2 1,850 4.9 2.3 0.5 2.1 9,800 12.1 6.7 4.1 6.3 1,900 5.0 2.4 0.5 2.2 10,000 12.2 6.8 4.2 6.4 1,950 5.2 2.5 0.5 2.2 10,500 12.4 6.9 4.4 6.5 2,000 5.4 2.6 0.5 2.3 11,000 12.5 7.1 4.5 6.6 2,100 5.6 2.7 0.5 2.4 11,500 12.7 7.2 4.6 6.7 2,200 5.8 2.8 0.6 2.5 12,000 12.8 7.3 h.8 6.8 2,300 6.0 2.9 0.6 2.6 12,500 3.2.9 7.3 4.9 6.9 2,400 6.2 3.0 0.6 2.7 13,000 13.0 7.4 5.0 7.0 2,500 6.4 3.0 0.6 2.7 13,500 13.1 7.5 5.1 7.0 2,600 6.5 3.1 0.6 2.8 14,000 13.2 7.6 5.1 7.1 2,700 6.7 3.2 0.6 2.9 14,500 13.3 7.6 5.2 7.2 2,800 6.8 3.2 0.6 2.9 15,000 13.4 7.7 5.3 7.3 2,900 6.9 3.3 0.7 3.0 16,000 13.6 7.8 5.5 7.4 3,000 7.1 3.4 0.7 3.0 17,000 13.7 7.9 5.6 7.5 3,100 7.2 3.4 0.7 3.1 18,000 13.8 8.0 5.7 7.5 3,200 7.3 3.5 0.7 3.1 19,000 13.9 8.1 5.8 7.6 3,300 7.4 3.5 0.7 3.2 20,000 14.0 8.2 5.9 7.7 3,400 7.5 3.6 0.7 3.2 21,000 14.1 8.2 5.9 7.7 3,500 7.5 3.6 0.7 3.2 22,000 14.2 8.3 6.0 7.8 3,600 7.6 3.6 0.7 3.3 23,000 14.2 8.3 6.1 7.9 3,700 7.7 3.7 0.7 3.3 24,000 14.3 8.4 6.1 7.9 3,800 7.8 3.7 0.7 3.3 25,000 14•4 8.5 6.2 8.0 3,900 7.8 3.7 0.7 3•4 27,500 14.5 8.5 6.3 8.1 4,000 7.9 3.8 0.8 3.4 30,000 14.8 8.8 6.5 8.3 4,200 8.1 3.8 0.8 3.5 32,5oo 15.3 9.2 6.8 8.6 4,400 8.2 3.9 0.8 3.5 35,000 15.7 9.5 7.1 8.9 4,600 8.3 3.9 0.8 3.5 37,500 16.1 9.8 7.3 9.2 4,800 8.4 4.o 0.8 3.6 40,000 16.4 10.1 7.5 9•4 5,000 8.5 4.1 0.9 3.7 h2,500 16.7 10.3 7.7 9.6 5,200 8.8 4.3 1.2 3.9 45,oo0 16.9 10.5 7.8 9.8 5,400 9.1 4.5 1.4 4.1 47,500 17.1 10.7 8.0 10.0 5,600 9.3 4.7 1.6 4.3 50,000 17.3 10.8 8:1 "'- 10.1 5,800 9.5 4.8 1.8 4.4 52,500 17.5 11.0 8.2 10.3 6,000 9.7 5.0 2.0 4.6 55,000 17.7 11.1 8.3 10.4 2040025791 (ContI d) ENDT. Plo. ib •(C-1549-3-D)
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3 (1) (2) (3) (4) (5) (1) (2) (3) (4) (5) $57,500 17.8 11.2 8.4 10.5 t80,000 18.8 12.0 9.0 11. 60,000 18.0 11.3 8.5 10.6 85,000 18.9 12.1 9.1 11. 62,500 18.1 11.5 8.6 10.7 90,000 19.0 12.2 9.2 ].1. 65,000 18.2 11.5 8.6 10.8 95,000 19.2 12.3 9.2 lh.! 67,500 18.3 11.6 8.7 10.9 100,000 19.3 12.4 9.3 11.! 70,000 18.4 11.7 8.8 10.9 Over (See (See (See (Seo 72,500 18.5 11.8 8.8 11.0 100,000 Xote 2) Note 2) Note 2) Not( 75,000 18.6 .11.9 8.9 11.1 li0."ES: 1. If the Total Standard Premiua is betveen two of the amounte shown in column (1), the premiwa discount percentage applicable is that shown for the lover of such amoants. 2. If the Total Standard Preaiua is over $100,000, the discount percentage applicable for each kind of insurance shall be determined as the weighted average of the percentage shown for the first $100,000 of Total Standard Premiua and the appropriate percentage for the portion of Total Standard Premium over $100,000 as follovst Preid.un Discount Percentag for Standard Premium in Kind of Ineuraace excess of $100,000 General Liability 26.7% Automobile Liability - Garages 17.5 Taxis, Livery, Buses and Long Haul 1Yuclaoen 14.0 13.1 other Automobile Liability 16.5 For attachment to sod forming part of Policy No. IALI32I9RRY , dated 1-1-60 iD511ed to PHILIP MORRIS INCORPORATED THE MA CASUALTY AND SURSTY COMPAN7 Hartford, Connecticut V ier Praidtwt ENDT. N0. 16 2040025792 .(C-15D9-4-D)
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( PnL'!LTL."4 DISCOtUP h:i.~ORS?!~'NT • NORPH CA*0Li"A (Automobile and General Liability Ineurance) It is agreed that the premium pertaining to North Carolina for Liability and Medical Payments ineurance is eub,)ect to discount in accordance with the following procedure: l. North Carolina Standard Premium. Such premium pertaining to North Carolina coWput in accordance with the provisions of the policies designated in paragraph 4 hereof other than this endorsement and exclusive of the application of any retrospective rating plan and exclusive of any premium under any Automobile Liability Policy applicable with :espect to automobiles classified as "Livery", "Busee", or "Long Haul TruclQnen", shall be lmovn as the North Carolina Standard Premium. 2. Total Standard Premium For All States. The Liability and Medical Payments premium computed in accordance with the provisions of the policies designated in paragraph hereof, other than this endorsement and exclusive of the application of any retro- spective rating plan, any Automatic Premium Adjustment Endorsement, any Premium Re~ turn Plan Endorsement, or other Premium Discount Endorsement, shall be lrnown as tht Total Standard Premium. 3. Premium Discount - North Carolina (a) For policy periods of one year or less - The North Carolina Standard. Premium, exclusive of any premium subject to any retrospective rating plan, shall be subject to the applicable discount percentages for the Total Standard Premium obtained from the Table of "North Carolina Premium Discounts." (b) For policy neriods of more than one year - The North Carolina Standard Premium, exclusive of any premium aubject to any retrospective rating plan, shall be subject to the applicable discount percentages stated in said Table of "North Carolina Premium Discounts" opposite the total standard premium for the policies for each annual period or portion thereof during the policy period. (o) If retrospective rating is applicable to a part of the premium pertaining to North Carolina, the amount of premium discount applicable to the North Carolina Standard Premium, exclusive of any premium subject to any retrospective rating plan, shall be the difference between (1) the discount determined by applying to the North Carolina Standard Premium the applicable percentages stated in ®ai Table opposite the Total Standard Premium and (2) the discount determined by applying to that portion of the North Carolina Standard Premium which is subjec to retrospective rating the applicable percentages stated in said Table oppoeit so much ~f the Total Standard Premium as is subject to retrospective rating. 4. Policy Numbers Estimated Standard Premium lAl.t3219RP.Y TO EC DET. _ Total EraDT. :'o. {' .C-1657-1-A) (Continued) 2040025793
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- 2 - 'able - North Carolina Premium Discounts - B Premium Dit.count Percer.tages Applicable to North Ca-ro lina Standard Prc-miurt~ Co1n.-an (1) - 11 iu Total Standard Premium for all States. Discount Percentage for General Liability. Discount Percentage for Automobile Liability - Garages. Discount Percentage for Automobile Liability - Taxis. Discount Percentage for all other Automobile Liability (except Livery, Buses, Long Haul Truckmen) - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - (1) (z) (3) (4) (5) (1) (2) (3) (4) (5) $1,000 or 0.0% 0.0% 0.0% 0.0% 6,200 11.2 7.5 2.1 7.1 less 6,400 11.5 7.8 2.3 7.4 1,050 0.7 0.4 0.1 0.4 6,600 11.8 8.1 2.4 7.7 1,100 1.2 0.7 0.1 0.6 6,800 12.1 8.4 2.6 7.9 1,150 1.6 0.9 0.1 0.9 7,000 12.4 8.6 2.7 8.2 1,200 - 2.0 - 1.2 - 0.2 - 1.1 7,200 - 12.6 - 8.9 - 2.8 - 8.4 1,250 2.3 1.4 0.2 1.3 •.7,400 12.9 9.1 2.9 8.6 1,300 2.6 1.5 0.2 1.4 'r7,600 13.1 9.3 3.1 8.8 1,350 2.9 1.7 0.2 1.6 7,800 13.3 9.5 3.2 9.0 1,400 3.2 1.9 0.3 1.7 :$,000 13.5 9.7 3.3 9.2 1,450 - 3.4 - 2.0 - 0.3 - 1.9 8,200 - 13.7 - 9.9 - 3.4 - 9.4 1,500 3.7 2.2 0.3 2.0 8,400 13:9 10.0 3.5 9.6 1,550 3.9 2.3 0.3 2.1 s,6oo 14.1. 10.2 3.6 9.7 1,600 4.1 2.4 0.3 2.2 8,800 14.2 10.4 3.6 9.9 1,650 4.3 2.5 0.4 2.3 9,000 14.4 10.5 3.7 10.0 1,700 - 4.5 - 2.6 - 0.4 - 2.4 9,200 - 14.5 -10.7 - 3.8 -10.2 1,750 4.7 2.8 0.4 2.5 9,400 14.7 10.8 3.9 10.3 1,800 4.8 2.8 0.4 2.6 9,600 14.8 10.9 4.0 10.4 1,E50 5.0 2.9 0.4 2.7 9,R00 15.0 11.1 4.0 10.6 1,900 5.1 3.0 0.4 2.8 10,000 15.2 11.3 4.1 10.8 1,950 - 5.3 - 3.1 - 0.4 - 2.9 10,500 - 15.5 -11.5 - 4.3 -11.0 2,000 5.5 3.2 0.5 3.0 11,000 15.7 11.8 4.4 11.3 2,100 5.7 3.3 0.5 3.1 11,500 16.0 12.0 4.6 11.5 2,200 5.9 3.5 0.5 3.2 12,000 16.2 12.2 4.7 11.7 2,300 6.1 3.6 0.5 3.3 12,500' 16.4 12.4 4.8 11.9 2,400 - 6.3 - 3.7 - 0.5 - 3.4 13,000 - 16.6 -12.6 - 4.9 -12.1 2,500 6.5 3.8 0.5 3.5 13,500 16.8 12.8 5.0 12.3 2,600 6.7 3.9 0.6 3.6 14,000 17.0 12.9 5.1 12.4 2,700 6.8 4.0 0.6 3.7 14,500 17.1 13.1 5.1 12.5 2,800 6.9 4.1 0.6 3.8 15,000 37.3 13.3 5.2 12.7 2,900 - 7.1 - 4.2 - 0.6 - 3.8 16,000 - 17.6 -13.5 - 5.4 -13.0 3,000 7.2 4.2 0.6 3.9 17,OO0 17.8 13.7 5.5 13.2 3,100 7.3 4.3 0.6 4:0 18,000 18.0 13.9 5.6 13.4 3,200 7.4 4.4 0.6 4.0 19,000 18.2 14.1 5.7 13.5 3,300 7.5 4.4 0.6 4.1 20,000 18.3 14.2 5.8 13.7 3,400 - 7.6 - 4.5 - 0.6 - 4.1 21,000 - 18,5 -14.4 - 5.8 -13.8 3,500 7.7 4.5 0.6 4.2 22,000 18.6 14.5 5.9 13.9 3,600 . 7.8 4.6 0.7 4.2 23,000 18.7 14.6 6.0 14.1 3,700 7.8 4.6 0.7 4.3 24,000 18.9 L4.7 6.0 14.2 3,800 7.9 4.7 0.7 4.3 25,000 19.0 1419 6.1 14.3 3,900 - 8.0 - 4.7 - 0.7 - 4.3 27,500 - 19.2 -15.1 - 6.2 -14.5 4,000 8.1 4.8 0.7 4.4 30,000 19.5 15.4 6.5 14.8 4,200 8.2 4.8 0.7 4.5 32,500 19.9 15.7 6.8 15.1 4,400 8.3 4.9 0.7 4.5 35,000 20.2 16.0 7.0 15.4 4,600 8.4 5.0 0.7 4.6 37,500 20.4 16.2 7.3 15.7 4,800 8.5 5.0 0.7 4.6 40,000 20.7 16.5 7.5 15.9 5,000 - 8.8 - 5.3 - 0.9 - 4.9 42,500 - 20.9 -16.7 - 7.7 -16.1 5,200 9.3 5.7 1.1 5.3 45,000 21.0 16.8 7.8 16.3 5,400 9.7 6.1 1.3 5.7 47,500 21.2 17.0 8.0 16.4 5,600 10.1 6.5 1.5 6.1 50,000 21.4 17.1 8.1 16.6 5,800 10.5 6.9 1.7 6.5 52,500 21.5 17.3 8.2 16.7 6,000 l0.9 7.2 1.9 6.8 55,000 21.6 17.4 8.3 16.8 (ContId) (C 1657-3-D) E`jDT. ^!0. 17 2040025794
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I ( P?: !~S iNi DISCOU2iT E?ZOP,S'T - VIRGINIA (Automobile Liability Insura^: e) ' It is agreed that the premium pertaining to Virginia for Automobile Liability and Medical Payments insurance is subject to discount in accordance with the following procedure: 1. Virginia Automobile Liability Standard Premii.m: Such premium pertair:.^g to Virginia coaputed in accordance with the provisions of the policies designated in paragraph 4 hereof, other than this endorsement and exclusive of the application ,:: a.,; rtLio- spective rating plan shall be known as the Virginia Automobile Liability Standard Premium. 2. Total Standard Premium For A11 States: The Automobile Liability and Medical Payments premium computed in accordance with the provisions of the policies designated in para- graph 4 hereof, other than this endorsement and exclnsive of the application of any retrospective rating plan, any Automatic Premium Adjustment Endorsement, any Premium Return Plan Endorsement, or other Premium Discount Endorsement, shall be known as the Total Standard Premium. 3. Premium Discount - Virginia: (a) The Virginia Automobile Liability Standard Premium shall be subject to the applicable discount percentages for the Total Standard Premium obtained from the current Table of "Virginia Premium Discounts" contained in the Con>paryts Manual. For Policy periods of more than one year, an average annual Total Standard Premium for the policies shall be determined by dividing the Total Standard Premium for the policy period by the term of said policies in years and fractions thereof and applied to said Table of "Virginia Premium Discounts" to determine the applicable discount percentage. (b) If retrospective rating is applicable to a part of tne premium, the amount of premium discount applicable to the Virginia automobile liability standard pre- mium exclusive of any Virginia automobile liability premium subject to retro- spective rating shall be the difference between (1) the discount determined by applying to the entire Virginia automobile liability standard premium, the Virginia premium discount percentaCe shown in the appropriate table for the Total Standard Premium, and (2) the discount determined by applying to that portion of the Virginia automobile liability standard premium which is subject to retrospec- tive rating, the Virginia premium discount percer.tase shown in the appropriate table for so much of the Total Standard Premium as is subject to retrospective rating. 4. Policy Numbers Estinated Standard Preniums I AL 1'321 aRRY TO AC D~T. This endorsement forms a part of the policy to which attached, effective from tts date of issue unless otherwise stated herein. (Ths information below is rrqaired only when this endorsement is is,wsd aubstqvent !o preporetion af tht policy) ~ . ............... Endorsement No. ..................1.8 ------- Endorsement eEfective .1---lPolicy •1io. 1AL.1........ .321 ~R.RY Named -....-~_------ - - •••••••~~•• -- .. :.amed Insured .........P.H.L.L.1.P.....'._G? B.LS.....L.P1.G. ........... .._........ _. _....... _. ._. ....._..._........................... _...... ....... ........... -_.................. The AEtna Cssualty and supety Company Hartford, Connecticut . «-i) .(12""'' Countersigned 2040025795
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r- -1- Pp:XIUb: DISCOUNT cNxHSu2•.~.vT - TEXAS (General Liability Insurance) It is agreed that the premium pertaining to Texas for General Liability and N:edieal Pay- ments insurance is subject to discount in accordance with the following procedure: 1. Texas Gereral Liability Standard Premium: Such premium pertaining to Texas computed in accordance with the provisions of the policies designated in paragraph 4 hereof, other than this endorsement and exclusive of the application of any retrospective rating plan, shall be known as the Texas General Liability Standard Premium. 2. Total Standard Premium For All States: The General Liability and Medical Payments pre mium computed in accordance 'with the provisions of the policies designated in paragrap 4 hereof, other than this endorsement and exclusive of the application of any retrospe, tive rating plan, any Automatic Premium Adjustment Endorsement, any Premium fteturn Plai Endorsement, or other Premium Discount Endorsement, shall be known as the Total Standa Premium. 3. Premium Discount - Texas (a) For policy periods of one year or less - The Texas General Liability Standard Premium, exclusive of any premium subject to any retrospective rating plan, shall be subject to the applicable discount percentages fo r the Total Standard Premium obtained from the Table of Texas Premium Discounts (General Liability). (b) For policy periods of more than one year - The Texas General Liability Standard Premium, exclusive of any premi.tua subject to any retroapective rating plan, shal]l be subject to the applicable discount percentages stated in said Table of Texas Premium Discounts (General Liability) opposite the total standard premium for the policies for each annual period or portion thereof during the policy period. (0) If retrospective rating is applicable to a part of the premium pertaining to Texas, the amount of premium discount applicable to the Texas General Liability Standard Premium, exclusive of any premium subject to any retrospective rating plan, shall be the difference between (1) the discount determined by applying to the Texas General Liability Standard Premium the applicable percentages stated in said Tabl* opposite the Total Standard Premium and (2) the discount determined by applying to that portion of the Texas General Liability Standard Premium which is subject to retrospective rating the applicable percenta,r,es stated in said Table opposite so much of the Total Standard Premium as is subject to retrospective rating. i.. Policy Numbers Estimated Standard Premium IALI32IQRRY TO eS OCT. Total EtdDT. ':0. .C-14041'$ (Continued) 2040025796
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- 2 - PMSUM DZSIX7Ui1P BNDORSEi•fdNT - TF..XAS (Continued) 5. Table of Texae'Premium Discount Percentages (General Liability) Colurm (1) - Total Standard Premium for A]1 States (2) - Preaium Discou-xt Percentaze Applicable to Texas for General Liabilit (2) 0.0% 0.6 1.0 1.3 1.6 (1) $3,500 3,600 3,700 3,800 3,900 1,250 1.9 4,000 1,300 2.1 4,200 1,350 2.3 4,400 1,400 2.6 4,600 1,450 2.8 4,800 , (2) 6.2% 6.2 6.3 6.4 6.4 6.5 6.6 6.7 6.8 6.8 1,500 3.0 5,000 7.1 1,550 3.1 5,200 7.4 1,600 3.3 5,400 7.7 1,650 3.5 5,600 8.0 1,700 3.6 5,eOO 8.3 1,750 3.8 6,000 8.6 1,800 3.9 " 6,200 8.8 1,850 4.0 6,400 9.1 1,900 4.1 6,600 9.3 1,950 4.2 6,800 9.5 2,000 4.4 7,000 • 9.7 2,100 ~.~. -4.6 7,200 9.9 2,200 4.8 . • 7,400 ; 10.1 2,300 4.9 7,600 ~ 10.2 2,400 ~ 5.1 7,800 - 10.4 2,500 2,600 2,700 2,800 •J. . 2,900 3,000 3,100 3,200 3,300 3,400 f 5.2 5.4 5.5 5.6 5.7 5.8 5.9 6.0 6.0 6.1 8,000 10.5 8,200 - 10.7 8,400 '.10.8 8,~800 11.1 9 000 9 :F; _ . 200 9,400 9,600 9,800 -r- (Continued) 2040025797
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f -3- PR:MM-1 OISCOUNT END]RSFr`0:T - Ti•KAS (Continued) .: ro (1) ,"r10,000 10,500 11,000 .•.11,500 '• 12,000 12,500 13,000 13,500 14,000 14,~°D, 15 000 1. , i sjFs0Ur16,000 e:,: 13.5 ... 07. zo77co „c. 17,000 18,000 19,000 . ~d L• 13.7 13.8 14.0 20,000 14.1 21, 000 .... : ? 14.2 22,000' 14.3_ ~ . 23,000 . . .-~ 14.4 24,000 14.5 - :'IIll Q :-CY.~e 7P , . .. : 25, 000 :. _: . 14. 6 ' 27,500 14.7 30,000 15.2 32,500 15.9 '35,000 16.4 '97, 500' 16.9 ,40,000• 17.4 42,500 17.8 1c5,000 18.1 47,500 18.4 50,000 18.7 '52,500 19.0 55,000 19.2 57,500 19.4 60,000 19.6 v,rxvsu rna :_ , ,(C-1904-2-A) (Continued) (2) , 11.8 12.0 12.2 12.3 12.5 i evtraer;anl 12.7 12.8 12.9 13.1 (1)' ;:LB j`sLa ~.,$62, 500 ° 65,000', ~ . 67,500 ' 70,000 72,500 r 75,000 80,000 85,000 90;000 95,000 100,000 105,000 110,000 115,000 120,000 i 125,000 130,000 135,000 140,000 145,000 -150,000 162,500 175,000 187,500 200,000 212,500 225,000 237,500 250,000 262,500 275,000 287,500 300,000 312,500 325,000 •. 3r . i: • . J .. (2) 19.8- 19.9 20.1 20.2 20.4 20.6 20.8 21.0 21.2 21.3 21.5 21.6 21.7 21.8 21.9 22.0 22.1 22.2 22.2 22.3. 22.4 22.5 22.6 22.7 22.8 22.9 23.0 23.0 23.1 23.2 23.2 23.2 23.3 23.3 23.3 ..: ~- rl . 2040025798
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-4- _P`•iF.^:IUi•1 CIS:OUYdT EP~xP.SrtV,4T - TEXAS (Continued) (1) (2) (1) (2) $337,500 23.4 $462,500 23.6. 350,000 23.4 475,000 23.6 362,500 23.4 487,500 23.6. 375,000 23.5 500,000 23.6 ' 387,500 23.5 and • over *.." 400,000 z3.5 , 412,500 23.5 425,000 23.5 _ .. . 437,500 ?3.b , ~ 450,000 23.6 If the Total Standard Premium is between two of the amounts shown in colum . (1), the premium discount percentage applicable is that shown for the lower of such amounts. *If the Total Standard Premium is $500,000 or over., the discount percentage applicable shall be determined as the weighted average of 23.6% for the first $500,000 and 24.2% for the portion over 4500,0c0. For attachm6nt to and forming'part of Policy No. IqLI32I.90 Y Issued to . Qy.1 L JP .•.J MORR f^i USCORPORATED J . : 7 ' .. : .. . - ~ ' . .. ,~, .. ~ •..~ • =H D T. i 10 * E 9' ~ Hartfo 3d, Connecticut . '3 9 DI2COf111L :r1D7ES2c .^[iL - : "' (iouF•TUncQ) -3- -e -5'a THE FTNA CASUALTY AND SURSTY WMPANY 2040025799
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P.IIUH CISCOuh: V? In-n^r.A " (General Liability Insurance) It is agreed that the premium pertaining to Virginia for ;,eneral Liability and ?!edical Ps7_ents insurance is subject to discount :.r: accordance with the following procedure: 1. Virginia General Liability Standard Premium: Suchh premium pertaining to Virginia computed in accordance with the provisions of the policies deeignated in paragraph 4 hereof, other than this endorsement and exclusive of the application of any retrospective rating plan, shall be Imown,as the Virginia General Liability Standard Premium. 2. Total Standard Premium For All Statess The General Liability and Medical Payments premium computed in accordance with the provisions of the policies designated in paragraph 4 hereof, other than this endorsement and exclusive of the application of any retrospective rating plan, any Automatic Premium Adjustment Endorsement, any Premium Return Plan Endorsement, or other Premium Discount Endorsement, shall be lmown as the Total Standard Premium. 3. Premium Discount - Virginias (a) For policy periods of one year or less - The Virginia General Liability Standard Premium, exclusive of any premium subject to any retrospective rating plan, shall be subject to the applicable discount percentages for the Total Standard Premium obtained from the Table of "Virginia Premium Discounts"..., (b) For policy periods of more than one year - The Virginia General Liability Standard Premi- um, exclusive of any premium subject to any retrospective rating plan, shall be subject to the applicable discount percentages stated in said Table of "Virginia Premium Dis- counts" opposite the total standard premium for the policies for each annual period or portion thereof during the policy period, (c) If retrospective rating is applicable to a part of the premium pertaining to Virginia, the amount of premium discount applicable to the Virginia General Liability Standard Premium, exclusive of any premium subject to any retrospective rating plan, shall be the difference between (1) the discount determined by applying to the Virginia General Liability Standard Premium the applicable percentages stated in said Table opposite the Total Standard Premium and (2) the discount d etermined by applying to that portion of the Virginia General Liability Standard Premium which is subject to retrospective rating the applicable percentages stated in said. Table opposite so much of the Total Standard Premium as is subject to retrospective rating. 4. Policy Numbers Estimated Standard Premium IALI32IQRRY TO eE DET. Total 5. Table - Virginia Premium Discount Percentage Applicable Premium, to Virginia General Liability Standard Column (1) - Total Standard Premium for A11 States (2) - Discount Percentage for General Liabi lit4 W•r (1)J . (2) (1) (2) $1,000 or less 0.0%' $1,500 3.6% $2,000 5.4A 1,050 0.7 1,550 3.8 2,100 5.6 1,100 • 1.2. 1,600 4.0 2,200 5.8 1,150 1.6 1,650 4.2 2,300 6.0 1, 200, 1.9 : 1,700 ,, 4.4 2,400 6.2 1,250:~~~ 2.3 : 1,750 4.6 ..2,5W 6.4 , 2.6.' 1,30p 1,800:A" 4.7 2,600 6.5 , 1,350 2•9.~ 1,850., ` • T, .4.9 2,700 6.7 1, 400 3.1 1,900 " • • 5.0 2,800 . 6.8 1,450; ,irc. 3.4 : 1,,950~_ •, 5.2 2,9,00 ( 6.9 ENDT. Rjp~;o 20 (C-19-59 'i)_ . . ~ (Continued)'` 2040025800 ., ..R....• .............. .... ' _i~.i.._ • ..._..• . ~ 1••
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-2- P?SNSUM DISCOL'2.T E.NDrPSE1L'".:.NT - VI?GIhIA (CoaLinued) (1) (2) (1) (2) (1) (2) $3,000 7.1% f10,000 . ].5.1% $100,000 22.7% 3,100 7.2 10,500 15.4 105,000 23.0 3,200 - 7.3 11,000 15.7 110,000 23.3 3,300 7.4 11,500 15.9 115,000 23.5 3,400 7.5 -12,000 16.2. 12o,00Q 23.7 - 3,500 7.5 12,500 16.4 125,000 23.9 ,` 3,600 7.6 23,000 16.6 130,0M 24.0 ' 3,700 7.7 13,500 16.7 135,000 24.2 3,800 7.8 14,000 16.9 140,000 24.4 3,900 7.8 14,500 17.1. 145,000, 24.5. _ 4,000 7.9 15,000 17.3 150,0U0' 21..7 ,~ 4,200 8.2 16,oG0 17.5 162,500 25.0. 4,400 8.2 17,000 17.8 175,000 25.2 4,600 8.3 18,000 18.0 187,500 25.5 4,800 8.4 19,000 18.1. 200,000 25.6 ~ 5,000 8.7 20,000 18.3 212,500 25.8 5,200 9.1 21,000 18.5 225,000 25.9 5,400 9.6 22,000 18.6 237,500 26.1 5,600 10.0 23,000 18.7 250,000 26.2 5,800 10.4 24,000 18.8 262,500 26.3 6,000 10.8 25,000 19.0 275,000 26.4 6,200 11.1 27,500 19.2 287,500 .._. .._265.- 6,400 11.4 30,000 19.5 300,000 26.6 6,600 11.7 32,500 •- --19.8 312,500 26.E- ~ __ 6,800 12.0 35,000 20.1 325,000 26.7 ' 7,000 12.3 37,500 20.4 26-.8 337,500 7,200 12.5 40,000 2o.6 350,000 ,.-., ---. 26.8 - 7,400 12.8 42,500 20.8 362,500 26.9 7,600 13.0 • 45,000 . 21.0 375,000 27.0 7,800 13.2 47,500 21.1 ~ 387,5Q0,. 27.0 .c. 8,000 13.4 50,000 21.3 400,000- 27:0` 8, 2D0 13.6 52,500 71.4 412,500 27.1 8,400 13.8 55,000 21.5 425,000 27:1 8,600 14.0 57,500 21.6 437,500 27.2 8,800 14.1 60,000 21.7 450,000 .27.2 9,000 14.3 62,500 21.8 462,500' ..27:2-t 9,200 14.5 65,000 21.9 475,000 27.3 9,400 14.6 67,500 22.0 487,500 27.3 9,600 14.7 70,000 22.0 500,000 f 9,B00 14.9 72,500 22.1 and 75,000 22.2 over •- - - , : .. :SL.' 80,000 22.3 85,000 22.4 90,000 22.5 2040025801 95,000 22.6 If the Total Standard Premium is between tao of the amounts shown in coluam (1), the premiu discount percentage applicable is that shown for the lower of such amounts. *If the Total Standard Premium is $500,000 or over, the discount pereentage applicable shall determined as the weighted average of 27.3% for the first $500,000 and 28.5% for the portio; over E500,000. This endorsement forms a part of the policy to which attached effective from its date of is unless otherxise stated herein. (THE INfVRHATION S=W IS RFX2UIRED ONL2 WHEN THIS FNLUR4EMENT IS ISSUED SUBSEQUENT TO FRE- PARATION 0F THE POLIC2.) Endorsement effeetive . Policy No. Endorsement No. Named Insured THE LTNA CASUALTY AND SURET7 C02TAN7 Hartford, Connecticut .. ,~.: n..~:..
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2S. PREMIUM DISCOUNT ENDORSEMF.NT-TEXAS AUTOMOBfLE LIABILiTY INSURANCE r ......... Thts enacrsere.^•: :c:ms a parn ct =oitcy tia I..aL I.. 3?.I~a~Y.... :ssued to ....PH.LL.1P.... ".~^ =3 t.S... . l::_CRP.vt.:• -~, y:he . ,F-T..-NA-CASUAL.TY AilD....SV.RETY. Co.."9PANY .. .... ...... .... ...... .... ................... _. .. .._.... .. a• .•s :,cc (Name of Insarance Company) -~' located (cttY and s:ale) t?ARTFDRD CONNe I - 5 .•....... .... : ................ ........... _- and rs effecr:ve !rcm ..,.... "~ ......,_ . . .. ... l._.Z l A. M. S:c nc (Tlse ialormation abo.e is required only when Ihis endoraemenl is issued subsequent to pnparation of the polir.7•) It is aoreed that the premium pertmntng to Texas tcr Auxrmobile Liability and Medical Payments insurance is subiect to discount in arordc with the followtnq procedure: l. Texas Automobile Liability Standard Premium. Such premrum pertaimnq to Texas computed in accordance wnh the provtsrans of the po:r poroqrapn 4 hereof. cther than thrs endocsement and exclusive ot the application of any re!rospecuve rounq plane aha11 aestqncned in known as the Texas Automobtle Liability Standard Premium. 2. Total Standard Premium for All States. The Automobile Liability and Medical Payments Premium computed in acccrdar•ce ••vith :he pr stans cf the policies designated in paragraph 4 hereof• other than this endorsement and exclusive of the application of any retrespec• rating plan• any Autcmauc Premium Adtustment Endorsement• any Premium Return Plan Endorsement. or cther Premium Discount Endcr ment, shall be known as the Total Standard Premium. • 3. Premlum Discount-Texas (a) For policy periods of ane year or less-The Texas Automobile Liability Standard Premium shall be sublect to the apphcmble disco percentaqes fcr the Total S:ondard Premium obtained from the "Table of Texas Premium Discount Percentaqes (Automcoue Ltabtitt set out cn me reverse side hereof. • (b) For policf Periods of aore th® one y.ar-Th. Texas Automobile Liability Standard Premium fcr each annual period or portion ther during the policy period shall be subject lo the applicable discount percentages stated tn said "Table of Texas Premium Discount F , cemoqes (Autcmobrle Ltabthry)'• opposite the Total Standard Premrum for the policies for each such period ot portion thereof during •.poltcy period. (c) If retrospective rating ts applicable to a part of the premium pertatnrng to Texas. the amount of premium discount applicable to "° Texas Automobile Liability Standard Premium, exclusive of any premium subwct to any Retrospective Rannq Plan. shall be the ddlerer buween (l) the discount determined by applying to the Texas Automobile Liability Standard Premium the applicable percentaqes stated said Table opposite the Total Standard Premrum• and (2) the discount determined by applying to that portion of the Texas AWomob Lrabtbty Standard Premium which rs subtect to retrospective rating the appbcable percentaqe stated tn said Table opposite so much the Totai Standard Premium as ts subject to retrospectrve rating. 4. Polic7 Numbers F&timated Stoadard Premlum i ~ t i.~2. ~..9R_RY.._.... ................ T.Q....B.F...n.Er,.... Total Appltcaate premium percentoges based on total esttmated advance standard premrum: Taxicabs. L•very, Buses and Long Haul Truckmen Garage Liability All other. tncludtng School Buses SEE REVERSE SIDE FOR FURTHER VISIONS ENDT•. i!o< 21 ° ........ . X (Duly Authortzed Representative) FORM 25.-PREMIUM DISCOUNT ENDORSEMENT-TEXAS Texas Standard Automobile Endorsem.nt Re.ised Novernber 1. 1959 By 2040025802
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E08SZ0040Z TEXAS i:.EMIUM DISCOUNTS-AUTOMOBILE LIABII.ITY INSURANCE Tazr Tan• Tasi• ctal Standnri Prem:um See ~ Note (l) caba. Livery. Buses and Long Haul Tntck~ men All Other )n• cludtnq School Garages Buses otal Standard Premtum See Note (1) cvbs, Livery, Buses and Long Haul Truck- men All Other In• cludmq School Garages Buses otal Standard Premium See Note (I) cabs• Ltvery, Buses All and Other Long In. Haul cludtnq Truck, School men Garaqes Buses (L) (2) (3) (4) (1) (2) (3) (4) (1) (2) (3) (4) $1•000 00% 0.0: 00* 56400 23% 5 7 : 5 2 : $60.000 877: 129% 122% 1.050 1 .4 3 6,600 2.5 5 8 5 3 62.500 8.8 13,0 12.3 1,100 .1 6 .6 6,800 2.6 5.9 5 4 65,000 8.9 131 12.5 1.150 •1 8 7 7.000 28 6 1 5 5 67•500 90 133 12.6 1.200 .2 1 0 9 7,200 2•9 6 2 5.6 70.000 9 l 13,4 127 1.250 2 1,2 1.1 7,400 3.0 6 3 5 7 72.500 9.1 135 12,8 1,300 2 1•3 12 7.600 3.1 6.4 5 8 75,000 92 136 130 1,350 3 1.5 1.4 7.800 3.3 6 5 5,8 80.000 9.3 138 13,2 1,400 .3 1.6 1.5 8.000 3.4 65 5 9 85.000 9.4 140 13,3 1,450 .3 1.8 1 6 8200 3.5 6.6 6.0 90.000 9.5 14 1 13.5 1.500 .3 1 9 1,7 8,400 3 6 6.7 61 95,000 9,6 142 136 1,550 4 2.0 1.8 8.600 36 6 8 6.1 100.000 96 143 137 1,600 4 2.1 1 9 8.800 3.7 6 9 6.2 105,000 9.7 14 4 138 1,650 .4 2.2 2.0 9.000 3,8 6.9 6.3 110,000 9.8 145 139 1,700 4 2.3 21 . 9.200 3.9 7.0 6 3 115.000 98 146 140 1,750 •4 2.4 22 9•400 4.0 7.1 6.4 120,000 9 9 14 7 14.1 1.800 5 2.5 2 3 9.600 4.0 7 1 6 4 125.000 99 148 142 1.850 .5 2.6 2 3 9,800 4.1 7.2 6.5 130.000 10.0 14 8 14 2 1.900 .5 2.6 2 4 10.000 4.2 73 6 6 135.000 10.0 14 9 14 3 1.950. 5 2.7 2 5 10.500 4 4 7 4 6.7 140,000 100 149 144 2.000 5 2 8 2 6 11,000 4 5 75 68 145.000 10,1 150 144 2.100 5 2.9 27 . 11.500 46 75 69 150.000 101 151 145 2•200 6 3 1 2 8 12.000 4 8 77 70 162.500 102 152 146 2.300 6 32 29 12.500 49 7 8 7 0 175•000 10.2 (53 14 7 2.40C 6 3 3 3 0 13,000 5.0 7 9 7 1 187,500 103 153 148 2 5C^_ .6 3 3 3.0 13,500 5 1 8 0 7.2 • 200,000 10,3 15 4 14,9 2.600 .6 34 3.1 14.000 ' 5•1 8 0 7•2 212.500 104 155 14.9 2.700 .6 3 5 3.2 14,500 5.2 8.1 7 3 225.000 104 155 150 2.800 6 3.6 3 2 15.000 5.3 8.2 7.4 237.500 10,4 156 150 2,900 .7 3•6 3.3 16.000 5.5 8.3 7 5 250.000 10.5 15.6 151 3.000 7 37 3.4 17,000 56 8.4 7 6 262•500 105 157 15.1 3.100 .7 3 8 3 4 18.000 5 7 8.5 7 6 275.000 105 1S7 152 3,200 ,7 3 8 3 5 19.000 5.8 8.6 7.7 287.500 10.5 15.7 15.2 3.300 .7 3.9 3 5 20.000 5•9 8 6 7 8 300,000 105 158 152 3 400 .7 3 9 3_6 21.000 5 9 8.7 7.8 312,500 10,6 158 153 3,500 .7 4.0 3 6 22,000 6.0 8.8 7.9 325.000 10.6 158 15.3 3.6=0 .7 40. 3.6 23,000 6.1 8 8 7 9 337.500 10.6 159 153 3•700 .7 4 0 3.7 ' 24,000 6.1 8.9 8.0 350,000 106 159 15,3 3 800 ,7 4.1 „ 3,7 25.000 . 6.2 8.9 8.0 362.500 10.6 159 15.4 3,901 •7 4.1 3,7 27•000 6.3 9.0 8 1 375.000 10.6 159 154 4.00C .8 4.2 3.8 30,000 6.6 94 8.5 387.500 106 159 154 4.200 .8 4.2 3.8 • 32,500 6.9 9.9 9.0 400,000 10.7 16.0 15.4 4,400 .8 4.3 3.9 35.000 7•2 10.3 9 5 412,500 10.7 16.0 15.4 4.600 .8 4•3 3.9 37,500 74 10.7 9.9 425,000 10.7 16.0 155 4.K,' .8 4.4 4.0 40,000 7•6 11.1 103 437.500 107 160 15 5 5 3^' .9 4 5 4•1 42.500 7.8 11.4 10.5 450.000 10.7 160 i55 `_.:.Z3 1.2 4 7 4.3 45.000 8.0 11.7 , 10.9 462.500 10.7 160 155 5.40J ! 4 4 9 4 5 47.500 ' 8.2 11.9 111 475,000 107 !60 155 5,6Z:' 1.6 51 4.6 50.000 8.3 12.1 1 L.4 • 487,500 10.7 160 15 5 5 932 1 8 5 3 4 8 52•500 8 4 12.4 116 50c:r0 See Note !21 6 C:7 2 0 5 4 4 9 t, 55,000 • 8 5 12.5 118 and over c--- 2.2 56 5 0 57,500 8,6 127 120 ° ':: :r.s 7o:c1 Stecdera Pre:r.:u^ ts betwee,^„two o( the amounts shown ::: coiuma (1). the pre-.:u^ d:scac;: -^a•^=-•^a^ ___,•cc_ie :s :::c: s:aw,~-:or :he iower o'su^a a^:aunts - - - --... -.. ..-_.a: S:an:ad -rrem,at:: is S500000 0: ever. the premtum dtscocr:• Fercenta9e ep;.::cac ~:x ee_c scbe:•:s.c~ oi '- -^^ t:=:::ry tns.:rc: ce 1hal: be determ:ned as- tne we:y^^te:i = e o( :he percer::oge shcxn in ^ .e .'..•-: S:ar,=cr= rce^tu:- and the pe:centcye sr•wc :n ~'c r• icr the Pe.^.•cr. c. Tota: S:ar.~ar~ Fre-:::r.. F:rst r::o- c 55 u 2:C 55:1 (b) I0; , .=:
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..~ .. .. ~-_.~ ~ ,_.,.E~. ._.. t. . . ~r. _ FINANCIaL Rr.'S ?ONSTiILITX S rU~CH:tRG1-, AS RESPECTS CARL H. YATES, IG23 JANIE AVE., NASHVILLE, TENN.(6--f It is agreed that such insurance as is afforded by tho policy for Bodi]y Injury Liability and for Property Doraaoo Liability applies in accordance with the Financia2 Responsibility Illws of th4 $tat3 of TENNESSEE and that the Cor.puny has filed a Financial Responsibility Certificate as requirod by such Law: Additional Proaiuns: 3•39 Badily Injury ;; 2,50 n _ 6 / Property Daaagc , .89 This endorsement forms a part of the policy to which attached, effectift from its date of issue u ted herein. (The information below is required only when this endorsement is ianud .tubrequtnt t preparation of the policy.) Endorsement effective ......•.t-.--:.J.'vQ _....................... Policy No. _1A...1..,~2.1.9RRY.._.......... orsement No. Named Insured ......... ...... -.1. Issued by one or more of The LEtna Casualty and Suraty.Company The Standard Fire Insurance Co any {' ~ . ...,._..... d, Connecticut ~.!!.. .... .. . .. ~..A~ .................... _.. Authorized Agent. Countersigned . ........ . ....r... . .....:•~:.. .~~,.'~-~. V(:LLY (ti351-Gi 2040025804
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, CoDE E-670 USE OF OTHER ~'C:-._ - ! -Cvfi'.- (E) TO ANY AUTOMOBILE MHILE USED IN A BUSINESS OR OCCUPATION OF NAMED {NDIVlDUAL OR SPOUSEp UNLESS OPERATED OR OCCUPIED BY SUCH INDIVIDUAL-s SPOUSE, PRIVATE CHAUFFEUR OR DOMESTIC SERVANT; THE N A M E D (F) TO ANY ACCIDENT ARISING OUT OF THE OPERATION OF AN AUTOMOBILE SALES AGENCY, REPAIR SHOP, SERVICE STATION, STORAGE GARAGE OR PUBLIC.PARKING PLACE ~ (G) WITH RESPECT TO DIVISlON I OF AUTOMOBILE MEDICAL PAYMENTS, UNLESS THE INJURY RESULTS FROM THE OPERATION OF SUCH OTHER AUTOMOBILE BY SUCH NAMED INDIVIDUAL OR SPOUSE OR ON BEHALF OF EITHER BY SUCH PRIVATE CHAUFF OR DOMESTIC SERVANT OR FROM THE OCCUPANCY OF SAID AUTOMOBILE BY SUCH NAMED INDIVIDUAL OR SPOUSE OR WHILE THE AUTOMOBILE IS USED AS A PUBLIC 0 LIVERY CONVEYANCE. 3. OTHER INSURANCE. THIS INSURANCE SHALL BE EXCESS INSURANCE OVER ANY OTHER VALID AND COLLECTIBLE INSURANCE FOR BODILY INJURY LIABILITY, FOR PROPERTY DAMAGE LIABILITY AND FOR AUTOMOBILE MEDICAL PAYMENTS. 4. THE INSURANCE AFFORDED BECAUSE OF NAMING HEREIN ANY PERSON IS ONLY WITH RESPECT TO SUCH AND SO MANY OF THE FOLLOWING COVERAGES AS ARE INDICATED BY SPECIFIC PREMIUM CHARGE OR CHARGES FOR SUCH PERSON. PREMIUM NAME OF INDIVIDUAL BODILY -PROPERTY INJURY DAMAGE THOMAS F. BURKE ~ TOTAL PREMIUM AUTOMOBILE MEDICAL PAYMENTS $42 • 43 ~ ,M.. - Th' endorsemmt fornts a rt of the policy to~:hich attac ed, ective from its of issue unless otherwi stated,herein. aration ot 't •' (Tha inJornwtion below~ '+ req><ired only when tbiu tndorrrement is ittued sub.reqonst to prep nt Effective I- ~ -"0 Policy No. ( A(„ I32 ( 9RRY C~' d E orseme n Namedlruured PHILIP MORRIS INC. PREMIUM : Additional j Return $ The 1Etna Casualty and Surety Company Countersigned ..__._....._. _ ....._.__..___._....._.._....~_._ .._..___ .......... Authorized Agent Hartford, Connecticut Jr. Kind Terneary Code (Suro £ Coumy or Cnr) Pohq Ye>r Tcrm E.p~ry Form Cl>ss :\c<ount. xprnenc~ t90455) Ed 3'co 37•a3 5•40 2040025805
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CODE E-670 , USE OF OTHER AUTOMOBILES - BROAD FORP, ~,~. 7` " ~ ~ IT IS AGREED THAT SUCH INSURNACE AS IS AFFORDED BY TH POLIC9 faR BODILY INJURY LIABILITY, FOR PROPERTY DAMAGE LIABILITY AND FOR AUTOM081LE MEDICAL PAYMENTS WITH RESPECT TO ANY OWNED AUTOMO c APPLIES WITH RESPECT TO ANY OTHER AUTOMOBILE, SUBJECT TO THE FOLLOWING PROVISIONSI I. DEFINITtON OF INSURED. WITH RESPECT TO THE INSURANCE FOR BODILY INJURY LIABILITY AND FOR PROPERTY DAMAGE LIABILITY THE UNQUALIFIED WORD ttINSUREDn INCLUDES (A) EACH INDIVIDUAL NAMED BELOW AND THE SPOUSE OF SUCH INDIVIDUAL IF A RESIDENT OF THE SAME HOUSEHOLD, AND (B) ANY OTHER PERSON OR ORGANIZATION LEGALLY RESPONSIBLE FOR THE USE BY SUCH NAMED INDIVIDUAL OR SPOUSE OF AN AUTOMOBILE NOT OWNED OR HIRED BY SUCH OTHER PERSON OR ORGANIZATION. INSURING AGREEMENT III, DEFINITION OF INSURED, DOES NOT APPLY TO THIS INSURANCE. 2. EXCLUSIONS. THIS ENDORSEMENT DOES NOT APPLY: (A) TO ANY EMPLOYEE WITH RESPECT TO INJURY TO OR SICKNESSsrDISEASE OR DEATH OF ANOTHER EMPLOYEE OF THE SAME EMPLOYER INJURED IN THE COURSE OF SUCH EMPLOYMENT IN AN ACCIDENT ARISING OUT OF THE MAINTENANCE OR USE OF THE AUTOMOBILE IN THE BUSINESS OF SUCH EMPLOYER; (8) IF THE INDIVIDUAL NAP7ED BELOW IS AN EMPLOYEE, TO THE EMPLOYER OF SUCH INDIVIDUAL; (C) IF THE INDIVIDUAL NAMED BELOW IS A PARTNER, TO THE PARTNERSHIP OF WHICH SUCH INDIVIDUAL IS A MEMBER; (D) TO ANY AUTOMOBILE OWNED BY SUCH NAMED INDIVIDUAL OR A MEMBER OF THE SAME HOUSEHOLD OTHER THAN A PRIVATE CHAUFFEUR OR DOMESTIC SERVANT OF THE NAMED INDIVIDUAL OR SPOUSE; " This endorsement forms a part of the policy to which attached, efret.~i~eTftbat its date of issue unless otherwise stated herein. (The information below ir required only when this cndorsc>neat is issued subsequent to preparation of the policy.) Endorsement Effective t- 4-6o Poticy No. t AL l 7j2 t 9RRY Endorsement No. 23 NamedInsured PHILIP MORRIS INC. PREMIUM: Additiotnl; Return $ KT MM The /Etna Casualty and Surety Company Hartford, Connecticut (I) Cauntersignad ..._...-._,1. . ~ J J~ w. :., Authorized Agent le President. T tnrr Code Premtum Jr. Kind I (5tue & Countr or Gcy) PoGcr 1'ur Term E.p,ry Purm Clau Accounu Exiunenc e f901S5) FA ? to
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~ ~• . . i AL,TOMOBILE EtiDORSEMENT EM 399 - FINANCI.4L PMPONSIEILITY S«?"N" ~_ ~ r~ •y~.~~ As RESPECTS THOtdAS F, BURKE, 26 E. SPRING ST., WINOOSKI, VERMOYT It is agreed that such insurance as is afforded by tho policy for Bodily Injury Liabi'lity and for Property Damago Liatility applies in accordance with the Financial Responsibility Laws Of th0 State OYERMONT ` and that the Co)vpbriy has filed a Financial Rosponsibi - lity Certificate as requirod by such Law: .1-.r..~ , et[1LL11riVitGi CiVILLL4YW ~ Bodily InjuTq ' 'u¢ PropertY Daaago 0 i.-r29 E This endorsement forms a part of the policy to which attached, effective from its date of issue unless otherwise stated herein. (The in/ormation below u re~u ired only when thir endortemetst is ir.nad subsequent to 1-1-b0 / 1 AL I j219RRY / N Policyo. ... Endorsement effective ......... _..._........._...... .... . Y.._. Named Insured ...PH.IL.1.?....1`1QRR.1.S..._.l.N.C.Ql?P..QRArFII.__._.._.._ __.._..~ KT MM f Issued by one or more o The fEtna Casuatty and SuFcEy Company The Standard Ftra Insuran Corrpan Connecti ~i -~ a d , Pf ~~ ~ T' ~ Countersigned ..._..._........ t L' _......._.._...~~~...__ ..................._.... Authorized Agent. p to.u•c1 2040025807
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I ^•EV/sED 57 THE PUBLIC LITILII7ES COMMISSION OF THE STATE OF COLOrZiDO UNIFORM PUBLIC LIABILITY AND PROPERTY DAMAGE EIvDORSEL4EtiT The policy to which this endorsement is attached is written in pursuance of, and is to be con• strued in accordance witly any one or more of the following laws of the State of Colorado: C. R. S. 1953 -- C-TEa 115-9 As AMENDED C. R. S. 1953 -- CHapTER 115-11 As AMENDED C. R. s. 1953 -- Ct<.PtcR 115-10 and the rules and regulations of the Public Utilities Commission of Colorado adopted thereunder and applicable to the Insured. In consideration of the premium stated in the policy to which this endorse- ment is attached. the Insurer hereby waives a description of the motor vehicle or motor vehicles to be insured thereunder, and agrees to pay any final judgment within the limits set forth in the policy or endorsements attached thereto, for injury to, and/or death of persons (with the exception of any employee of the Assured) and damage to property (excluding property of the Assured or property which is rented or leased by the Assured or property other than the baggage of passengers in the custody of the Assured or carried in or upon any automobile of the Assured) resulting from the own- ership, maintenance or use of any and all motor vehicles and/or trailers, pursuant to a Certificate of Public Convenience and Necessity or a permit issued by the Public_ Utilities Commission of Colo- rado, and further agrees that upon the failure of the Insurer to pay any such final judgment, such judgment creditor may maintain an action in any court of competent jurisdiction to compel such pay- ment. It is understood and agreed by and between the Insurer and the Assured that the right of any person to recover hereunder shall not be affected by any act or omission of the Assured or of any employee of the Assured with regard to any condition or requirement of said policy, but all the terms and conditions of the policy shall remain in full force and be binding as between the Insurer and the Asstued: and the Insurer shall be reimbursed by the Assured for any loss, costs or expenses paid or incurred by the Insurer which the Insurer would not be obligated to pay under the provisions of the policy independently of this endorsement. MINIMUM SCHEDULE 'On each motor vehicle used for the transportation of persons and/or property: Passenger Not to Exceed for Dcath or Injury to Capauty Any One Person All Persons Property Damage 12 or less .................................•........ $25.000 $ 50,000 $5.000 13 to 18, inclusive ..........................- 25,000 70,000 5,000 19 to 24, inclusive ............................ 25,000 90,000 5,000 More than 24 .................................... 25,000 100.000 5,000 "On vehicles used for the transportation of property: For death or injury to any one person. $25,000; all persons.$50.000t property damage. $5,000. All conditions and provisions of this policy, and any statements or agreements contained therein or endorsed thereon in conflict with this endorsement are, by agreement of all parties hereto, held null and void insofar as they are in conflict herewith. The policy to which this endorsement is attached shall not be cancelled until after ten days' notice in writing shall have first been given to the Public Utilities Commission of Colorado, at its office at Denver, Colorado, said ten days' notice to commence to run from the date notice is actually received at the office of the Commission. Attached to and forming a part of Policy No............ j.AW.32.j.a.°.•.1>! ........................issued by the .iT.dA CASUALTY ; $URETY CO• ...._ .................... _...................................................... ........ .,............................... Insurance Company to ................................. ............................................ •Ellminate reference to tranaportatlon of puxarera when endoraement b attached to policy Iwued to a property carrier only. ••Eltminate reference to trnasportatlon of property when endorsement Is attached to policy Ipued to a paasenter rurrter only. Full schedule applies to carrfer of both pusenjers and property. Thls form of Endoraement m reQutred to be attached to the pohcy of Publ[c Liabllity t Property Damasa Insuraau but not to the Certificate of Insurance. hrC 2133 D 2040025808
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W~ ,/_ ~O~ '_,=EiA Ti C,S _xCLURE^ IT IS AGREED THAT SUCH INSURANCE AS IS AFFORDED BY THE POLICY DOEB NOT APPLY TO OPERATIONS OF THE FOLLOWING 8UB81DIARIES AND DIVISIONS OF PHILIP MORRIS INCORPORATED: A.S.R. PRODUCTS COMPAkY ANTOINE DE PARIS, INC. ANTOINE DE PARIS (CANADA) LTD. CONTINENTAL BLADE CORPORATION LAWRENCE DISTRIBUTING CORP. EVER-READY RAZOR PRODUCTS, LTD. PAL BLADE CORPORATION, LIMITED BAM PRODUCTS CORP. SUPREME PRODUCTS CORPORATION THE LIGHTFOOT COMPANY INC. COM-AtR PRODUCTS U.S. RELAY-ELECTRONICS PERSONNA BLADE C0. OF CANADA LTD. i r . . ~ 11; ,r .A1't E This endorsement forms a part of the policy to which attached, effective from its date of issue unless otherwise stated herein. (The iwJorsiation below it requirtd only when t6it endortement is vaved subsequent to prtporation oJ the policy.) ' Endorsement Effective +A-2'j-60 Policy No• IAL 13219RRY Endorsement No. 25 Named Insured QH tLIP MORRIS INCORPORATED PRENfIUM: Additional $ Return $ The I€tna Casualty and Surety Company /% Hartford, Connecticut Countersigned ........... _........ ._........_ __..._,_._..._. _..._..._...._. _.........l......__... ..... FD OK JR ML G-24-GO Authorized Agent T tory Cod< remmm P Jr. Kind (State & County or Oq), Po6cy Year ~ I I Term Expvy I Form Clau EaYnenc Account. (90155) Ed. 2/59 Prerident. e 2040025809
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r Ad-"tio:Y,1 Iasured - Lessor rt ia agrLl-'i th-!~t such Insurcnce as is afforded by the PcZicy .°or Bodily Ir.ju.y Lialri~.l.ty and f'.n' r'~'operty AmuGe IQnbiLty applies, subject to the fcL'osri:,g prwiAionB: 1. The unYtnlified word '71'istsedt` also includes the Additionol Insured desiCnated below but only with respect to the of.-{ership, maintenance or use oP that part of the premises occupied by the lvaaed Insured which is desi~.*scsted opposite the naae of such Additional Insured, and operations necessaty or incidental thereto, and to the oWershipf aaintenance or use of only those elevators) if any designated beloft, 2. The Insurance does not apply (a) after the Ntused Insured ceases to be a tenant in said prers.ises; (b) to structural alterations,, nev oanstruction or dssalition operations performed by or for said Additional Insured; (c) to liability assuaed by said Additional Insured under any coatrart or ac;reenent 3. The Insurance afforded by this endorsenent is on],y»srit,h respect to such and so maily of the following hazards and Coverages, as are indicated by a specific preni.ua charge or chnrges sho5m belov. Schedule Desi ==tion of Preaises Narae of Additional B~ ~~ il.Y In3ur}r PropertY DmmmSo Part occu ied b Naaed Insured I,iabilit~ L•SabiLtt Insured and Elevators ~ LEASING OF COLISEUM AT THE KENTUCKY STATE ~ KENTUCKY FAIR & EXPOSITION FAIR BOARD, CENTER. LCUISVILLE 17,KY.FOR LOUISVILLE,KY. INCLUDEC IN COMPOSITE RATE PRESENTATION OF A COUNTRY MUSIC SHOW IN CONNECTION WITH THE DERBY FESTIVAL TO BE HEtD ON 5/3/61 This endorsement forms a part of the policy to which attached, effective from its date of issue unless otherwise stated herein. / (The in(or.aattion below tis requirtd only when this endorsement is issyed srbsequent to ¢reparatioe of the policy.) Endorsement Effective 5/3/6l ~ Policy No. t AL! 321 9MY ' Endorsement No. ,'Z'r Named Insured PHILIP MORRIS 1NCORPQZATE~ PREMIUM: Additional $ Return $ The /Etna Casualty and Surety Company FD PC !a/~/61 TV Hartford, Connecticut ............... ..»...._..... _.._... • ....1.»:.._.._._._.:..... ... Countersigned ............ ..._. Authorized Agent J., xtnd Terntory Code (Stste & Gwnty or Ctty) Patul yeu Te+ Ezptrr Foren Clau Prcm um Accounu E:penene Y(o -, 2 46- -2526-A (90455) Ed. _•59 President. e .r,-a .. U.s A.. 2040025810
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Lu•>(5~~, Q G.- ~ =~.•",I+ :.L-"..:IItI`I'Y S~HED.TI+r. AM'.*r:fYv =:lsr.ded as £o11o(rs; It is a-zreedt that the General Idabil+_ty Schedule attac;ted to this Description o£ Hazards 1/1/62 TO i/i 63 ~ THiRD YEAR BILLING FLAT CHARGES SPECIAL COVERAGE INCREASED LIMITS BASIC CHARGE Tn2rz3um Bases 2.90 5.48 , A i . 6~..A- .~( .u , 9 This endorsement forms a part of the policy to which attached, effective from its date of issue unless otherwise stated herein. (The information below is reqtdred only when thu endorsement it issued subsequent to preparation of tGe policy.) / Endorsement Effective f/( f62 Policy No. I AL 132 I 9 RRY Endorsement No. 211 Named Insured PHILIP MORRIS INC. PREMIUM: Additiona(,= 43-64 Return $ ~~' 0120 Th! /Etn%Caauatty and Surety Company 0 Countersigned _ ......... ------- KT KT AL Authorized Agent Territory Code Premmm jr, I Kind (State & Coonty or City) Potiq Year Term E:piry Form Ctass Accounts Espenenc~ ( _rZ) 46-tg•-1518 B ~ 2040025811
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} Tfiird Tssr Mnircrss:9 EL:L'Lia~ &adors.eaat kasnd.d It ia agretd that the Third 7armiTSrstry gi12tl!IC Eadcrssent in the State of Virginia to r+cdt It ia twrthet s.gr..d that the sehs*r of vehicles for the Third Anniarss.rT 8illina ia amend.d to l.#olnds 10 additiional vehi¢les in the State of [.ntmelpr and to rsLd a0 follont 669 ' D.I, r.D, H.I, (P) 60.82 31.45 4P) 39,411.36 (E) 2.75 (Z) 1;782. (S8) 21.74 (IDZ) 14,087,52 P.D. L11 ); )L0 eQS ~ ~ /, / '54' 6a, f-./- a/ a !~~ I' AWI-°r` ' ~77 ~ ~.~, ~G ~ 7~ ~ y ~ ~G,~ . >- ~~ .u ~ .~.. ~. . ~r y r ~_ C~~T1d This endorsement forms a part of the poliq t which attached, effective from its date of issue unless otherwise stated herein. (Tlu inJorw+atia~n rrq~ired nly w6rn this orrrn~ptnyt is isr.ed rvbtrquent to prrparatio» oJ thr policy.) Yolity o.Z 1Lj+ 13219W Endorsement No. 29 Endorsemeast Effective N Named Insured PhMp NOMiS ~~ 2'ateQ PREMIUM: Additiotul $ 11L1.60 Return lW-62 - 1/1163 Ai:(horized Agent Hartford, Connecticut Jr. {{{ Rind ~ Terrrtury Code (State & Couney or City)) Policr Y<ar 'L'Lrm EaPiry Form Class Premmm Acceunta Espenena (9-5) Ed. 2/59 t rrinf.d in U.S-A. 2040025812
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THE !c'TNA CASUALTY AND SURETY COMP Hattford, Connecticut -- - - - - -- - - - - _ cec' ~n tng_Dw,s,cn(s) of this endorsement designated by PHIIIP "RIS INC. Efiecnve Date of Change IGcncy Nc. 1/1/62 IAL13219RRY I Dwwons 1. O ELIMINATE CAR(S)-Fhe insurance terminates cn the automobile descr bed in the policy, or if more thon one automobile is descr,oed therein, tnsurance terminates on Car(s) Number 2. ~ ADD CAR(S}-The ,nsurance apolies on the following described outomobile(s): uR CAR Class Year of Model Entry Number Trade Name-Body Type Identificatton No. Model 3. F1 ENCUMBRANCE DATA-Complete information below if automobile is encumbered. Down Payment 4. 0 Due Date of Final Payment OTHER AMENDMENTS Loss Payee Symbol Actual Cost SCfaEPULE OF AUTOMOE I LES AMENDEI' AS FOLLe4l5 s/ Add'ress of•NSmdB llfsulSd'fs &ang&i tE RStiRp 19asfl626tiah 1I rJrarW td` " Other changes: 5. Q COVERAGE and LIMITS CHANGES MAaS,-19 VEHICLES INSTEAD OF 21 VA.,UMC:TQ,READ 42.. Purchased Mo. & Yt. N or PREMIUM A s n d cated by "X", a coverope is Indu ded or Excluded or is Amended as to its limit of.liabiliy. Addi tional or Ret urn Premium under Th e li mit of the Company i liability for an y surJt coverage shall be as stated below. Divisions 1 , 2, 4 or ~, " Ca r I - Ca r 4 1 E A COVERAGES LIMITS OF LIABILITY Add'I Return Add'I Return " thousand dollars each person $ $ $ $ Bodily In)ury Liability thousand dollars each f°Cr",d`M~ (CA AeTdL Fw.) ~~~ S f S , f Property Da nape L abiliy thousand dollars each °C a,,,""=~o;', j. F„~) 62.90 S S ' S S Med ml Paymenh dollars each person thousand dollars each persan S $ S S Family Prot.pioe thousond dollars each accident 61. (1) Comprehensiv.' ~A Form) S Actual Cash Value unless otherwise stated . S S S S •(4) Personal EKeesl S 100 Comprehensve(G,JS.erAl.F-) S Actual Cash Valueunlessotherwisestated Fire, L ghtnsng ti Transponation S Actssal Cash Value unless otherwise stated - S S S S Theft $ Actual Cash Value unlass otherwtse stated S S S S Actuo a us ess S S $ S Collision S Cof 1dedvctible S f S f S f S S Towing and Labor Costs 45 per disablement TERM s I I 62 TO ! I 63 ~ADDITIONAL~ RRURN This endorsement is itsued For attachment to and Forms a part of the ENDORSEMENT PREMIUM I S I f ~25.90 above. above numbered pohcy effective on the date indicated , ENDORSEMENT NUMBEIEND.29 "' Countersrgned by (t3sas.B) 2040025813
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bT85Z00bOZ • • .•,.-. :-t I LOSS PAYABLE CLAUSE (NAUA ~o!L.31 aed S1a) Loss or damage, it any, under the pobq sholl be oayable as mterast may appear to the person or orqonizatton named in the declarations (or tn the automobile schedule) as loss poyee and this insurance as to the snterest of such Botiment Lessor, £ondstional Vendor or Mortgagee or Assignee of Badment Lessor, Conditional Vendor or Mortgogee (herein called the lienholder) shall not be irswlsdsted by any act or neglect of the Lessee, Mortgagor or Owner of the within desvibed automobile nor by any change in the tstle or ownership of the property, provided, however, that the.converston, embezzlement or secretion by the Lessee, Mortgagor or Purchaser in passession of the property insured under -b bailment lease, cond ttonal sale, mortgage or other encumbrance ii nbt covered under surit policy, unless specihcally insured aga nst and premium paid therefor, and provided, also, that in case the Lessee, Mortgagor or Owner shall neglect to pay any premium due under such policy the L enholder shalf, on demand, pay the some. prov,ded also, that the Lienholder shall nonfy th. Company of any change of ownership or increase of hazard which shall come to the knowledge of sa d Ltenholder and, unless permitted by such policy, it shall be noted thereon and the Lienholder shall, on demand, pay the premium for such increased hazard for the term of the use thereof; otherwtse such policy shall be null and void. ~ The Company reserves the right to cancel such poliCy at any time as provided by its terms, but in such case Il e Company shall notify the Lienholder when not less than ten days thereafter such cancelaoon shall be effective as to the interest of said Lienholder therein ana the Company shall have the right, on like notice, to cancel this agreement. If the Insured fatls to render proof of loss within the time granted in the policy cond tsons, such Ltenholder shall do so w th n sixty days thereafter, in form ond manner as prov,ded by the policy, and, further, shall be subject to the provis ons of the policy relating to appn7tsal and t me of payment and of bringing suit. Whenever the Company shall pay the Lienholder any sum for loss or damage under such policy and shall claim that, as to the Lessee, Mortgagor or Owner, no, liab ltty therefor axtsted, the Com ny shall to the extent of such payment be thereupon Iegally subrogated to atl the rtghts of the party to whom such pQyment shall be made, under cll securities held as collateral to the debt, or may at its option, pay, h l h h to t e L en o der t e w ole princpa I due or to grow due on the mortgage wtth interest, and shall thereupon receive a fUII assignment orqdttransfer oLthe elostgagj p~d.o{•all such other secur ties; but no subrogation shall impair the r ght of the Lienho(¢q~p;•(ecover the full cSmount of its claim. Whenever a payment of any nature becomes due under the policy, separate payment may be inad® Fo-®d"ch party at interest pro4ided-"-- the Company proteca the equity of all ponies. Nothing herein conta ned shall be held to vary, alter, waive or extend ogy of the terms, conditions, agreements or limitations of such' poliry, other than as above stated. 1'. I I c... It.- I.i•,1:;": / ~ v_ ~ v CtrC tN- -1 SYtt,
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EXPIR. CARD AUTOMOBTI;.E ENDORSEMENT © XWX 399 POLICY REG. SEC. FILE FINI~.NCIAL RESPONSIBILTfiY SURCSARGB BILL PASSED 61 AS RESPECTS JOSEPH J. MC CARTHY JR., 99 N. KENSICO AVE., MITE PLAINS, NY ~ It is c.Greed that such insuranec as is afforded by the policy for Bodily Injury Liability and for Property Damage Liability applics in accordnace vith the Financial Responsibility Latrs of the State of CONNECTICUT and that the Coapany has filed a FYnancial Responsibility Certificate as required by such Iav: :>.dditioael Premiums: 4.37 / Bodily Injury $ 3.13 Property DamaBe ~ 1.24 L ~ ~• - This endorsement forms a part of the policy to which attached, effective from its date of issue unle otherwise statEd erein.' (Tht in/ormatiou below is required on when this eadorsetneat is itsued srbseqreet to eparalion of tht policy.) ~ Endorsement effective ........._...4I T~.bZ PHI L 1 . Poliey No. Endorsement No. _~......_._3fl_. P hF0 Rft(5 _....~...._. _. „---~ ._.. _~ . 1 NC. ....._ iCf..AI. Issued by one or more of The Mtnat Casualq and Surety C pany The Standard Fire insuranc pany Pretidcnt. Hartford, Connecticut ~ Countersigned _...~ ~ _.~.._.._.._......................... _..._... Authorized Agent' , ctiss..ct 4l-Mq-l5^ciF A - 2040025815
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AUTOMOBILE ENDORSEMEF4T Due Date of Final Payment It is agreed that rh-s policy is amended as indicoted in the D vision(s) of this endqrsement designcted by "X", tronea ;nsured -_ iT,Fecnve Date of Change I Poucy tio, PHILIP MORRIS INC. ~ ( 5-15-62 ~ I IAL13219RRY ~ I _ - Divisions 1. F1 ELIMINATE CAR(S)-The insurance terminates on rhe automobile described in the ool cy, or lf more than one automobile is describea there,n, msuronce terminates an Car(s) Number_ 2.7 ADD CAR(S)-The insurance applies on the follow np described outomobile(s). Year of Gass Model Trade Name-Body Type Identification No. CAR CAR OTHER AMENDMENTS 3. a ENCUMBRANCE DATA-Complete information below if automobile is encumbered. Down Payment 4. 0 5. 0 Other changes: Loss Payee Symbol f THE lFTNA CASLlALTY AND SURETY COMP. Ha nord, Connecticut Model Purchased Actual Cost Mo. a Yr. I N or ~ ctampss•L+ttvmrtsCyrmm~~fstfRlnDettfe) P.De RATE PER CAR TO READ 31 .l~5 (P) ~ Rating classif,mtion is changed to . 2.62 ( E) COVERAGE and LIMITS CHANGES As indicated by "X", a coverage is Included or Excluded or is Amended as to its limit of liabil y. The limit of the Company's liability for any such coveraqe shall be as stated below. I E A COVERAGES LIMITS OF LIABILITY I thousand dollars each person Bodily Injury L abiliry thousand doflats each {o«cvrr.~,c. (FA For.) occMMr (CA. JS cr AL ron.) I X Property Damage Liability .01 100 thousand dollars each {°tt dC~js o""nl F, u I Modiml Payments dollars each petson thousand dollars eadt person ( Family Protection thousand dollars each accident 1 { ' (1) Comprshonsrv.1 ~A Form) $ - Acn+al•Cash Volue unless otherwise stated ~ I (2) Personal Effectsl S 1oo 1 Comprehensive (CA,JS,'or.+.i.vor. S Actual Cash Value unless otherwise stated - { { Fire, Lightning & Transportation S Actual Cosh Value unless otherwise stated Theft S Actual Gash•Volue-6nfess otherwise stated Actual C:ask Valuedess - ' . i j Collision s C&rr Q dedudibfe I l Towing and Labor Costs S 45 per disablement This endorsement is issued for ottach Counters gned by itJte2•x) PREMIUM Additional or Return Promium Divisions 1, 2, 4 or 5 Car 1 under Car 2 Add'I Returrt Add'I Return S S S S (E) ~ S © S S S S S S 1 S S S S S S S S S S S 1 S S S S S S S S S S S S S ADDIt1ONAl sto8g.67 numbered policy, effect ve on the date indicated obove. 2040025816
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LLBSZOOtiOZ . - 3S LOSS PAYABLE CLAUSE _ (NAUA Nos. 51 and Sta) Loss or damaqe, if any, under t4 o policy shall be payable as interest may appear to the person or orqanization scaed in the declarations (or m the automobile schedule) as loss payee and this insurance as to the interest of such Bailment Lessor, Conditional Vendor or Mortgagee or Assignee of f3atlment Lessor, Conditional Vendor or Mortgagee (heretn called the Ltenholder) shall nor bo invaltdated by any act or neglect of the Lessee, Mortgagor or Owner of the within described automobile nor by any change in the title or ownership of the properry, provided, however, that the conversion, embezzlement or seuetion by the Lessee, Mortgagor or Purchaser in possess'on of the property insured under a bailment leose, conditional sale, mortgage or other encumbrance is not covered under sudr pol cy, unless spectfscolly insured against and premium paid therefor, and provided, also, that in case the Lessee, Mortgagor or Owner shall neglect to pay any premium due under such poLcy the Lienholder shall, on demand, pay the some. Provided also, that the Ltenholder shall notify the Company of any change of ownership or increase of hazard which shall come to the knowledge of said L enholder and, unless permitted by such policy, it shall be noted thereon and the Lienholder sholl, on demand, pay the prem um for such increased hazard for the tenn of the use thereofy otherwise such policy shall be null and.rosd. ; 1 ^r I The Company reserves the right to ca'ncel such policy at any time as provided by its terms, b5t.in such ctiS e the Company shall notify the L enholder when not less than ten days thereafter such cancelatton shall be effecttve as to the interest of said L enholder there n and the Company shall have the right, on like notice, to cancel this agreement. If the Insured fals to render proof of loss within the time granted in the policy cond tions, such Lienholder shaff do so within s xry days thereafter, in form and manner as provided by the policy, and, further, shall be subiect to the provisions of the policy relating to appraisal and time of payment and of bring,ng suit. Whenever the Company shall pay the Lienholder any sum for loss or damage under such policy and shall claim that, as to the Lessee, Mortgagor or Owner, no liability therefor extsted, the Company shall, to the extent of such payment, be thereupon legaffy subrogoted to ail the rights of the porty to whom such payment shall be made, under all securities held as collateral to the debt, or may at its option, pay X to the Lienholder the whola pnnctpoI due or to grow due on the mortgage with interest, and shall thereupon receive a fulf assignment and transfer of the mortgage and of all such other secuntses; but no subrogation shall impair the right of the Lienholder to recover the full _ amount of its claim. Whenever a payment of any nature becomes due under the policy, separate payment may be made to each party at interest provided the Company protects the equtty of all parties. Nothing herein conto ned shall be held to vary, alter, watve or extend any of the terms, conditions, agreements or limitations of such pohcy, other than as above stated. ' A ot(I .. .. _ ; .. . .- . ,,;.a v tya -Io _.:12 1 :1C Ib~IJJIo-~1,, ; t,a~C' • COt•i4Ct' • sc __Y, C'r2.Y~ :..^p - ac_~ C3' f`JsIA 3

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