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C"f'o;:1[;'~E~"'" ;;l~.. p., ....IE"-!:; ~ d ,~; ~.,!;:.;-: - ;:~~o.::';,:occi Ie f . ~ " ~ . ~ 'tr. == F I "' E S = u r.:; = t.J e; U ~ 2 ~, E~t~..~ it:,: :::::"'::':E:;:.....-,:::;,,, ~~~h~~- ~"';:7~..105;'-io~..8 g;fc ~~ C: f, ~ c : ti~ j;=~ tc '" '" L r g 'ij~ ~ij"": :5 :::1 r:; f EJ' tI ~"Ig.~rl~J:";,::S:... .:I~J:-~~_~t?~ ..~_~ ! ' ;:" :; c a Qi;: ,:<l.... > eN'" .: "",:: c= r.: ,- Ii r' < c:j ~ <+ 4' '41:: ~ v, t; .". ~ .....,~. t.:> ,~ q'" - t2 " Co " c '" , ....0 "'0 . <r c ~,..... Nt"". en I~ ~, < ... c: C' r'" ~ ~ " r ~ (' -5 @ J~ ..-s fig o .:J 1!~ Hi .ft... u ~ 13t.: (,1 . ~; . . /"'; .......- CHANGE ENDORSEMENT r-ORM 199.A {Dec. 1%7) 09/24/73 II.r'rll(:tn:oTO ANCI f'tlR'-I1NG ""'''TQf' 52FS22U63 NAME OF INIIU"A,.,.:.:. C:O"'"",,,,I" HARTFORD FIRE INS CO JEFFERSON COUNTY COURT HOUSE o /22/73 EXPIRATION OF pOLle... 03/22/76 J '''"'0" CINSUlll;lj'lINAloIlCa "''''L-INQ ADORIlS", COMMENCEMENT 01" POLICY Location of Propertl' Covered (if nrhcr than llbo\'c) und Description EF03/~t2/73TH'S ENDORSEMENT Subject to Form Numb(:rs Specific Rllte PoI,L:C PREPAID COMPLETE FOR DEFERRED PREMIUM PAYMENT ONLY ORATE PAYMENT DUE AT EACH ANNIVERSARY CS) NE~:~~~TE OF OR (7) CASH EXCHANGE PERIl.. '" (6) DUE HEREWITH D. P. P. ~NGE{5'6) tl Due Company IINC;:l.UOINO c:,,,o,NIU:S I29 ANNUAL PREVIOUS Increase ......Nyl RATE o Reduction Que Insured 24 _33~. .296 78.00 3.920.' 3.894.00 26.00 26.00 EXTENDED xxxxxx 278. 265.00 23.00 23.00 COVERAGE .022 39.00 VANDAL.ISM AND XXXXXX MALICIOUS .009 -0- U9. U9.00 -0- -0- MISCHIEF TOTAL 22 .00 4 327. 4,278. 39.00 39.00 INCONSIDEHA'rION OF THE AUOVE SPECIFIED ADDITIONAL OR RETURN PREMIUM AND SUBJECT TO ALL OF THE TERMS AND CONDITIONS OF THE POI,ICY TO WHICH THIS ENDORSEMENT IS ATTACHED. THE t\:\[OUNT OF INSURANCE Ur-:DER THrS POLICY IS HEREny ADJUSTr~D FROM $ TO $ . AS FOI.I.OIVS, leem No, DESCRIPTION OF PROPERTY COVERED Form~r AmOunt Under thi. Item AMOUNT OF o INCRE:"S~ REDUCTION 0 UNDER THIS IT~M NEW AMOUNT 0,. INSU"''''NCE Now IN FORce U~'DIER THIS ITEM R,du,';on iu :UUo"uC. if uny. ".'d: SH 0 Flnl 0 . PR 0 'fl.,,,,,,,, fnr c.'''' "du<C;nn Further Pro\'i.iiOlu. if any: A. P. REFLECTS APP 0 PI#2 IS ATTACHED. REFERENCE TO 90% A/C AND NIL DEDUCTIBLE ON FACE OF POLICY IS DELETED TO RETIRE TAG H06525 .CtlIIWlllI1Y______________ IIl\Ur,,1 . NIlI trlluire-,J uulc'u I-n1icl' i. rc\lu(C',lnr rt"uril'lcl! hr thj\ t'ndnr\C'mt'nr, .C.lIu~h THE GROUND INSlDE''rJ-lE FOUNDAT[ON WAI,L.S OF THe: BUIL.DING; (4) P[LING. PII'.RS, PIPES, FI.UES AND DRAINS WHICH ARE UNDER- GROUr\D; (C) THOSE PORTIONS OF WAT,KS. ROADWAYS AND OTHER PAVED SURFACES WI-IlCH ARE OUTSIDE OF AND MORE THAN 25 FEET DISTANT FROM BCIL.DING(S) COVERED HEREUNDER; (D) INSURIW'S INTI\REST IN PERSONAL. PROPERTY IN WHICH PARTIES OTHER THAN THE INSURED AL.SO HAVE AN INSURABLE INTERI\ST. WHe:N THE INSURED'S INTEREST IN SAID PROPER1'Y IS OTHERWISE COVERED BY INSURANCE, (E) FOR LOSS CACSED BY OR RESCI.'I'IXG FH.O:..r POWER. l-IE:\'l't~n OR C()OLIX(~ FAlI.L"J{[~. C:\- r.ESS SCCI"l FAlr.trRERESUI:rs FRO:..I PHYSICAl. DA)'[AC,E '1'0' l'O\\'ER. HEATI~G OR COOLJ:-':(~ E(JCIP1lEXTSITCATI;:D O.\' Pl{E)'IIS[~S WIIERI': 1'HE PROPERTY COVEI{ED ]S l.neATl':!), CAl'SED BY THE PERII.(S) IXSL"RED AGAI:'\ST, '['IllS CO),[PAXY - SI"IALL - ~OT u~r.I,\BI.E,FORAN'Y L.OSSSPECIFICAI,L.Y EXCL.UDED Cl<IDER (a) ,Tl-LE RIOT PROVISIONS OF TI-!E EXTENDED COVER- AGE ,ENDORSEMENT. OR (h> THE \'ANDA[.IS~[ MiD MALICIOUS )HSCHIEF ENDORSF,ME;-;T, SECTION VI (A) Unoccupancy: This insurallce shall not be affected by tlO~ occupancy which is usual and incidental to the use of any building(s). (8) Control of Property: This insurance shall not be prcjudiced by any act or neglect of any person (other than the named Insured), when sllchact or neglect is not 'within the control of thc named Insured. (C) Di.vi~ible Contract Clause: If this jJoticy cO\.crs two or more ouildlllgs or the contents of two or morc buildings, the breach of allY policy condition applying to one or more of the build. il1g~ c,?vcrcd' (~r containing the property covered shall not pnlJucl!ce the right to.r,:cm'cr for loss occurring in any build. Illgs covered or cont;unmg the property covered, where at the time of loss a breach of condition docs not exist. NUCLEAR CLAUSE: TH2 WORD "FIRE" IN TI"IIS POLICY OR ENDORSEMENTS A'fTACHED HERE. TO IS NOT INTENDED TO AND DOES NOT E1\[. BRACE NUCLEAH RgACTION OR NUCLEAR RADrATION OR RADIOACTIVE. CONTAMINA- TION, AI,[, WHe:THER CONTROL.L.ED OR UNCON. TROLLI\D, AND LOSS BY NUCLEAR REACTION OR NUCI.EAR RAUlA'fION OR RADIOACTIVE CONTAMINATION IS NOT INTENDED TO OJ\ AND IS NOT INSURED AGAINS1' BY THIS POLICY OR SAID ENDORSI,MENTS, WHETHER SUCH L.OSS ~I[~J1I?[l~'6[?B~I\ ~ ~~llb'15!'OI~'?N'( IJt}};,I\Cc;.~t[D BY. CONTR[BUTED 1'0, OR AGGRAVATED' BY "FIRI':" OR ANY O'fHI!R PERIL.S INSURI\D tW~/rS~;T :lJ\JJVUOsllErl,g~~ %[DTfifDP,giiff: COING AND AI.I. PROVISIONS m' TH [S h)I ICY DIR,ECT l.OSS BY "FIRE" RESUL. T[NG I'IW~( NU: Cl,v,AR REACTION OR NUC[.EAR RADIATION OR RADIOACTIVE CONTAMINATION IS INSURED AGAINST BY '1'I-IIS I'OI.[CY. (E) Subrogation Clause: This ill~Ur:llICC shall not be invalidated should the Insurerl waive in writinA' prior to a loss any or all right of recovery ag-ainst any party {or loss occurring to the described [lroIlcrty. (~) ~X~J~,T~W.ttLA~MR~FtrA~L~UW6'n T1M~tg~s RESULTING FROM ANY EI,ECTRICAI. INJURY OR DISTURBANCE 'TO ELECTRICAL.' APPI.[ANCI':S DEVICES, FIXTURES', OR WIRING CAUSED BY ELECTRICAL. CURRENTS ARTIFIC[AI,LY GEN. ERATED UNLESS FIRE ENSUES AND IF FIRE DOES ENSUE, THIS COMPANY SHAL.L BE [,IABL.E ~~Is1lii'kJ1D/;'1};0~&lfrTION OF,[,OSS CAUSED (C) Loss Payable: Loss, if :lny"shall be adjusted with the'ln~ ~~f~' ~~J:tyable to the Insur,ed unless other payee is spccifi- (H) o10t1~i;;~~~~~ Anyloss hcrcumlcr shall not reduce the amount (I) Liberalization Clause: If, durinA' the period that insurance is ~~pfti~~~e (l:~t~.crtl~~:~~,lrl~~'I~~l~'at~;r ~~iSdaC(~I~l~:I~ry t~h~~~ ib~ adOPted, or [lied WIth an,d, allproved or accepted hy the insur- ance slIPt.;rvlsory authorltles, all in conformity with law, any chall~l's !l\ the form attache!1 to this policy by which this form of I\1S11r.l!lCC COllIe! he extended or broauened without mcreaM'd Ilfl.'tllIUllI charj.tc by endorsement or substitution of furm, then such extendell or bruadened insurance shall inure to ,thcb~l1cnt of the Insured hercunder" as though such CI1~ dorS~~lUent or substitu.tiol1 oeform had been made. ,SECTIONVII _ EXTENDED COVERAGE ENDORS];;MENT ,. .'. (Perils 'of 'Windstorm, Hail, Explosion, 'Riot. Riot Attending a ,Strike, ,Civil:.Conllllotion, .', _,:, > ~, Aircraft, Vehic1es;Smoke, except as hereinafter provided) In considerntlc;n'of the premium for this coverage,and subject to the prm'ision's herein and inthepolicy to which this endorsement is ,attached including- endorsements thereon," this policy is extended to insure against direct: loss by windstorm. hail,€!,xplosi,on. riot, riot attending a"strike, civil commotion, aircraft. vehicles. and smoke. EXCEPT AS HEREINAFTER:PR<;>VII?ED. ,"-,' ," LOSS DEDUCTIBLE CLAUSE; THE LOSS DEDUCTIBLI': OPERATED BY AN INS'umiD OR BY ANY TENANT OF CLAUSE SET, FORTH IN SECTION IV APPL.IES TO THE THE DESCRlBED PRE)llSES: (h) BY ANYVEH1CI.E PERII.S INSURED AGAINST BY THIS ENDORSEMENT, TO FENCES, DRIVEWAYS, ,OR WALKS ; (c) 'TO ANY PROVISIONS APPLICABLE ONLY TO WINDSTORM AND AIRCRAFT OR VEHlCI.E INCLUDING CONTENTS HAIL: THIS COMPANY SHAI.L. NOT BE LIABI,E FOR THER\,OF O~HER THAN STOCKS OF AIRCRAFT OR b~sMLW~~gSW~fT5~ ?~kl~g+~tE1t~L~J ~~Sff. XKt~CL.ES IN PROCESS OF MANUFACTURE OR FOR ~~9r\V OR SLEET, WHETHER DRIVEN BY WIND OR ~~~~l~:J>,~JK~!:'PfJC~~;.~ I~N~II~OEJ~g:SEiMHJ*' THIS COMPANY SHAL.1. NO'1'BE LIAB[,E FOR MEANS ONLY SMOKE DUE T'O A SUDDEN. UNUSUAl. h~Sf~I ~al.igpnL.f\.1~6~~k~~ 9r~[l~liJ~~~J~g(&~ 2~8Kr.~"c?VJ;T?~IWN\$~E~F StJ~J Jk1'iTl~~00N~ RAIN SNOW SAND OR DUST WHETHER DRIVEN BY NEC'1'ED TO A CHIMNEY BY ASMOKE PIPE OR VENT W[ND 'OR NOT, UNLEssniE BU[L.DING(S) COVERED PII'E, AND WHIL.E lN.oR ONTHE DESCRIBED PREM- ~M-i?~,[~~;.,W?;R'I~c~cz.Egnl,tgrl.i-~E~01:W5:< !(rfi;..EUlP~~~Kf\?s~E FROM F[REPL.ACES OR INDUS. ~NVN~P:'i T~IJ,S.l~~'i.:T l~x1L~N F'b~ \y,~s~ Wb r~A~k ~~c~f;tI:t~LJ'~b~~H&ilS 3~ %~%y~~~.f\%C~W: INTERIOR OF TIlE BUlI.DING(SI OR THE PROPI':RTY TAMINATION, Al.L WHETHER CONTROLLED OR UN- COVEHED THEREIN AS ~IAY BE CAUSED BY RAIN, CON'1'ROl.L.ED OR DUETO ANY ACT OR CONDITION SNOW, SAND OR OUST EN'rER1NG TI'IE BUII.DING(Sl INCIDENT 1'11' \NY OF THE FOREGOING IS NOT IN- THROUGH OPENINGS INTJli.ROOFOR WAI,I.S MADE SURED AGA,I 'BY TIUSEXTENDED'COVERAGE BY r>IREC'r ACTION OF \_) OR HAlL; OR (I!) BY E;<;DORSEME, WHETHER SUCH LOSS BE DIRECT )Y.l~ TJ;'I~ I ~~mk !(J~'[~~~J'~uciPii6r;,;Wi1JN~Ro~ ~7~~ ?JiI b7~ I1gir)'N P~~*!r~l~ns~~~r~\I~b31TO~BV+m INn BE n..\).rAl~I~D .'\5 A DIRECT RESUI/I' OF WIND TO o'r~. AGC,RAVATF.D BY \VINDSTORM HAll,; EX- OR HAll.; OR (c) TO CR,AINIiIAY, STRAW OR OTHER 1'[ aSION RI~{]OT A'f'rENDINC A STRIKE C[ViI, CHOI'S OUTSIDE OF I1U[[,1 1S, , Cri~iMO'1"ION~~CRAFT,VI':HlCI,ES OR SMOKE; ,\ND f.,~y,~,\~i~ii~,~r~~~:b:;'~~i~" t~r~rn 11~~o~~p\~~,\~,~Y o'n~~;:~~, ~~:~\ ~~ g\g.tb'T fv\ c6 ~~ ,~\\\#}l1W61;~ R IttD IMj~.rH~~ .:as('s or'1II1conSUIIlCd fuL'lwithin the ,lirebox:(or comhustion CONTROL.I..ED OR UNc;ONTROI,l.ED, ISN~T "EX~l.O~ c1lOlmhcr) of allY fired \'essel or within the Aues or passages which SION" OR "SMOKE." , conduct the A":I$CS Qfcolllht1~tiol\ therefrom, WAR RISK EXCLUSION: THIS COMPANYSHAT.t,,'NOT nlI~ CO~IPANY SHAT.I. NOT BE I.IAIlI.1\ FOR LOSS !lI': [,IAIlI.E FOR LOSS CAUSI':D DIRECn.Y OR INDI. BY EXPLOSION OF Sn,AM 110ILERS, STEAM PIPES, RI\C'I'I,Y BY (n) HOSTlI,E OR WARI.IKE ACTION IN STEA~I 'rL'HIlINES OR Sn\A~IENGINES, IF OWNED l'IMI\ OF PIlACE OR WAR.. INCLUDING ACTION IN !lY. LEASED BY OR Ol'l\RNrED UNDI,\R THE CON- HINr>ERING, COMBATING OR DEFENDING AGAINST TROl. OF 'I'Im I~SURED" AN AC'1'U,\L, IMPENDING OR EXPECTED ATTACK, nm FOl.l;mVrNG AR'I': NOT EXPI,OSIOXS WITHIN Wl\I%R\~hRG%~E~,~J{.8jT o7i'B\PX~~I':Wl:brg;tif~ TIlE I;o.:TI\NT OR MI\AN[:-lG OF THI\SE PROVISIONS: MAiNTAINING OR USING ),m.ITAkv,)!>r,{VAI/ORiAlR (n) SHOCK WAVF,S C,\U~ED BY AmCRAFT. GEN. FOHCI(S; OR (2) BY MII.ITARY. NAVAl. OR AIR ERM,I.Y K;<;OWl<I AS "~ONIC BOOM." FORCES; OR (3) BY AN AGv:NT OF ANY SUCH GOV. (h) EI,1\CTRIC ARCIl<IC, 1\l',NMENT, POWER, AUTI'lORl'rYOR FORCF.S, I'1'BElNG (.ol RUI'Tl!I<!-: OI~ \lCI{STING Of'. ROTAT,lN,G O~ g~IV:l;1},~6~9.~J~NA~6W gJW~~Rrf~fptcf';iN~W~ Mpy[;o.:G PAR rs <,\1' MA,CIilXhRY ~AUSI,D m CI,EAR FI~SlON OR FUSION SHAI,I,BE CONCI,USIVE' CI,,~'1'I~IFlIG/\l, I,ORCI', OR MI'.CHANICAl. I.Y PHESUMED 1'0111\ SUCH A HOSTlI.EOR WARl.IKE IIRhAKIlO\\N, ACTIO~ BY ~UCH GOVI.;R~MI':NT, POW 1m, Au'rHOR- (,I) WAT[\I~ HA~IMlm. ITY OR FOI<CE~; (h) INSURRECTION. REBI\I.LION. (0) IWPTUIH:' OR Bl.'RSTIN<l OF WATER PIPES. RIWOI.vno~, CIVIL WAR, USU~PI':D POWI\R. OR (I) [H!I'TUI{I\ OR BURSTING DUI': 1'0 EXPANSION ACTION TA,KF.N BY GOVERNMENTAl. ~1:~1I0RITY OH SWI,[,I.INC'. OF TIlE CONTI':NTS OF M~Y IN I11,NDI.~ING, COMAAT,INC': OR DF.FENDINC Bllll.r>I~C OR STRUCTVI'I':. C,\USED III' OR ,\GAlNST SUCH AN OCCURRENCE, I,I,SVI.TINC\ FROM WATE!', WATER EXCLUSION; TillS COMPANY SIIM,I. NOT BE (0) IU;PTURE IlIIRSTI~C OR OPFHATION 01' 1.1,\IlI.I': FOR LOSS CAUSI\D BY. RI(SUI.TING FROM. PRI\SSl'Rr\ REI.li!F DI(VIC1\S,' . f.g~[:8~SI\(r}~~) '1'0 OR AGGRA VAnD BY ANY OI'THE ~[:i~is~~::o':f~~~bI14~1~~nl~~ \~~o~.IOrli~I~':t~t'~:I\;l~d~~~t~i~t~r~~c c~~~ (n) Fl.0QD, SURFACR \VATF.~. \V^Vl~~. TIDAl;, ~t:~n::::;~~~:,ihi~,~;:::;~':':' ~l;;;;~'.l~'~r::~:;I:~il:\;~~;~~;;'~i',\'r'~'~~;;:;;I:':: ~Yr},l[f.\I,J) ~R 1W~ kR \~A ~ l}\s Oci;J'~J~fI~~, gk by,Jald "tril.:inR (mllloyt'c~ 3ml ~hlllll\hl) include tJln~t't Ion from ('Ill- SI,lRA Y Y'.ROM ANY OF TIH... FOREGOING, ^I~I.. la~e IImllllOliml (J('turrlnIt1IurirlR" and at the imm~dinle'place of 3 \\ lIETllhR DRIV('.N DV.\VIND OR Nl;)T'i ,',- g:~i.;:,!al~l~rJ~~~~I~rifm'~lM?!:'1i'iW~lo~Iill~~~~~ir,tn: (h) ~R'hW~~~lJ!CH BACKS UP THROUCH SEWERS ~g~ IW/,}~!lI.~"I~~~Jf!f\MFtw:!irm 1;~\~~ll7~1~\i (r' ~VATF,f{ ll1(I,OW TIIF.SURFAC~:OF THE PROP"RTY DtlF. Tn CllANGH IN T[,MPI.;RATUllE Of, C,R<')U1'lr> INCI,UDING TllAT WHICH F.XF.RTS HllMIf)lTI' OR ,l;o.:'rl(I{]lUPTIO~ 01' OPI(RATIO;<;~ PH[',S~UllF. ON pR FI,OWS. SEr:P~ OIlI"I\AKS WlmTHr-:T, OR NOT ~UCll 1.0SS IS COV[m"r> Ill' THIS Tll)<Ol!fo)I ~mhWAL.KS. I?Rl,vI',WAYS. l'OUt!- 1'01.1~':A~~Q~TII,I'~~ 1'''lms[i.,;:'fiH ,.", J .f. ~~~b~~~~I~~A~~RHf;{t7~~rl~'J~~WR\~3xf~~ PROVISIONS APPLICABLE ONLY TO LOSS Ill' AIR. nHIVI,\\',WS. FOU~r>ATION~, wAI,r,s OR CRAFT AND Vf:IltCI,f:S: TilE '['ER~1 ",\lnCRAFT:' ,\~ F1.00R~; ~gl/ I'W,,:WI~'l:wr'~~lin:~I1~~;r,'sr.I~~I;L:n [\w.nn:: [1N!.F,SS 1.0SS IIY "XI'1.M[ON AS [N~llIU-:n AC'.AINS'1' TI;li~i "VFliIC'r!'S'" \',; 'l;~I;Ii IS 'fIllS liNnimSF' l,lI\IH:u;<;nr;1< ENsU"S Mm TlmN TII[~ COMPANY MI~;o.:'T ,m:'A:O;S \i'Ii!IICi,[\s' r{UN:';IN'\ 'liN i:A;<;II 'oii. SllAI.I, [1[<: 1.1,\B1,.H FOIl ()~I.y SUCll I\N~lllNG I,OS~, THt\c~~nLll'" SOT ^IHCR^Pl',I.O~~' n" AIIH!IV\fI'f ,Other PtQvh(onll:" '\}-";'j' ,I '>lP:'V;' . n~ II\' 'V1~II1CI.;1!:~ Sll,\14'~' 1~('J~t'UI': O:-\I.Y' f)lIH~CT, Acbhn flir:1o'1)~ by "riy perlf Illll\lrl',I'Aj{ahlU hy \hi\ rnllor"l!4 1.0~~ HF.gL:l:rl~(, Fun~I..-\C"l'-\I. 1'1-1 ":"IC:\I. C()~4 tIl("tlt _hall nol!1l' h;Hrl:'"d ht'l":tu((" of l.'h:tnKl' Ilf ;)('C'"lIl1ancy, nnr he. T..\CT OF ,\S AlI~C({I\F1' OH..\ \'EII1CI.H. \\'11'11 TilE r:ttl't'Or\";lr;ln(,YM\11l0f{~UI':tIlCY, PIWI'F.Rn' 1:0\'1\11[(1) llEI<El:;o.:DF.I, OIl Wl'rIl 'I'llI', lItJll,IJI~G(S) CO;<;1',\I;o.:INI1 TI1I( I'IWI'I\RTY COV- gl~d?T II ~~ah1r.K'~j,ki~~1~:';.l)S~1 ~(\:r (:i:;~,~TI~\, ,\'i.\~: ISI1 TI1I',nEFIW~1. TIllS C()~II'''N\' SI",I,[" NOT [11'.' 1,1,\1\[,1,1'01< I.OSS; (n) IIY ,\NI' VF.I1ICI,I('n\\'~E[) nIl Tltls E"()nnSE~IF,NT nOE~ NOT INCRI(ASl\ TIm A~'rn;~T(S). OF INsunANCI': I'HOVIDI\f) IN THI~ I'm,lCY, \\'hC"l thi. rn,lllur.l1lrnl :tPlllir" tn twn nr lllnn." IIrll1(, tllr Tlftl4 \'l(i"n( of Illh rllll"nrll1C'1I1 ~11..1,1-~fifllr ,In C'ndl !trnl "('Il:\r:tlrly. ~. e :':"'.'iW,1;'}1;l'k'~~1C;titi_"i.':!.~li'O:o;.,,:," . P.l. Fo[m No.1 Edilinlll)~l.. ItJl,/{ ... PUBLIC AND INSTITUTIONAL PROPERTY FORM IFOR USE ONLY WITH RATING PLAN FOR COVERING PUBLIC PROPERTY OR EDUCATIONAL INSTITUTIONS, CHURCHES AND HOSPITALSI AMENDED , EFFECTEDs2~~~!r73' (A) '$.....,.......J.,?J?.~.1..~~2.':!.Q.Q...................OIl all property of every tlcscriptiun (EXCEPT AS OTHER\VISE LIMITED OR EXCI...UDED) owned by the lnsurcd, and ,all personal property of others for \\'hich the Insured assumed liability prior to loss. and on the Insured's, liability impqsed by law for loss to Jlersonal property of others, nnd on the Insured's interest in personal property belonging in whole or in Imrt to othc~s, alt wl~i1c situated AT LOCATION AS SHOWN ON THE LATEST STATEMENT OF VALUE FILED BY THE INSURED WITH THE WASHINGTON SURVEYING AND RATING BUREAU. KS 09/24/73 HOMER S SMITH AGENCY 8~0143 (D). This polic:ycovers: (1) Bullion and manuscripts; (2) Personal property; EXCEPT WHILE \VATER- BORNE. (a) in the open on the described prcmi:-;cs or within 100 fectof building(s) on the described prl'miscs, or (b). in or on railway cars or other vehicles in the open on the described. premises or within 100 fcc~ of build- '". i~g(s)'on thed~scrib~d ~_~~mi~~s. ',' . ;, \' (3), TheI~'surcd's use interest in Improvements and .B~ttcr- ments. The' tcrm':lmprovcments and Betterments" is defined as fixtures~ :altcrations. ;installations. or ,additions comprising a parr of the described building(s) ,not owned .: '~~s~hr~~ n:~:I~siv~d or~~~~~~dq~~~fl:tI ~~~:ed~eb~~~fhl~~ are not legally-subject to removal by the Insured. The' word "Lease" '- \\'herevcr' used in' this policy shall mean, the, lease orrentat agreement.' whether written or oral, in effect a~ of thetime,of loss. In the event Improv~01ents and Betterments are damaged ~'or destroyed during the, term of this policy by the perils ~AN~'sfi~Lt fi~t€i~~lrlJ~D OIs 19I18&-~~ (a)-If repaired or replaced :ltthe expense of the Insured within a reasonable time after such loss. the actual '~a;j B~~~:r~:~~~_ama.ged, ~r destroyed Improvements (b) IF NOT REPAIRED OR REPI,ACED WITH- IN A REASONABLE TIME AFTER SUCH LOSS. THAT PROPORTION OF THE ORIC- ,INAI. COST AT T[ME OF INSTALLATION OF THE DAMAGED OR DESTROYED IM- PROVEMENTS AND BETTERMENTS WHICH THE UNF.XPIREDTERM OF THE LEASE AT THE TIME OF LOSS BEARS TO THE PERIOD(SI FROM THE DATI\(SJ StiCH IMPROVEMENTS AND BETTER~ MENTS WERE MADE TO THE EXPIRA- TION DATE OF THI\ LEASE, (e) IF REPAIRED ,A, EPLACED AT THE EX- PENSE OF onllll!"5 FOR THE USE OF THE INSURED. THERE SHAl.L BE NO LIABIL- ITY HEREUNDER. (4) Expenses incurred in eemOVtllo{ all debris of the prolH:rty covcred hcrCl ' which' may, be_ occasioncd by IOS5Cn.~lscd h{ :my' of th~ pt'rils insured a"ainst in this .' u~'6i:mH~id~v Fgi.I~~1 EFOTROht~H L\~~<;IJ.I f6 PROPERTY AND REMOVAL OF DEBRIS SHALl, NOT EXCEED THE A~IOUNT OF INSURANCE APpI,YING U:\'DER nlls POI.ICY TO THE PROPERTY DAMAGED OR DESTROYED, UNI.ESS I.IADII,ITY IS OTHI;RWISE SPECIFl- CM.1.Y, ASSUMED IlY ENDORSEMENT AT- TACHED HERETO. 1'1-IIS COMPANY SHALl. NOT B1\ I.IAlll,EFOR DEBRIS REMOVAL EX- PENSr; OCCASIONEIlIW THE ENFORCI,MENT OF ANY STA'rr;:. OR~rUNICIPAI. I.AW on OHD[NANCE WHlCIl NECESSITATES THE DI';MOl,ITION OF ANY PORTION OF A BUll.D- ING COVERED HEREUNDI\R WHICH HAS OR HAS NOT SUFFERIW DAMAGE BY ANY OF ,THE PERILS INSURIW AGAINST, . 'Debris ~c:n~oval'c:<IJen!le' ,hall not lle ctln~idercd in the dC'tcrminatinn" of the actual cash 'valu~ as set (orth in Sc~tion, I r'Sub~S(",!=tiol~.: (A'). Thili policy also co\'erli iUllroportlol1 of: (1)' Additional in,nrance, NOT TO I~XCEED 1% OF 'rlJF. WIlOl.E AMOUNT 01' FIRE INSURANCE OR $5.000,00, WIIICHIWER IS THE I.I,SSER J\~IOU~T. on Ih.'r~nn:ll prul'crty. llS covrred hy'llth policy, while' temporarily 10<7atcd t'hrwherc in the State 111 which thi!! Iltllir)' cnvers; . (2) Additiol'alilHur:l.lll:~'. ~OT TO EXCEED I'll OF "f-II-: 1I'1l01:E ,\~IOlJNT 01' l'I1H; INSUR,\;';C[\ OR $5.000,00. 11'1,1 ICIl E\'!,R IS '1'1-11, 1.I\SSI,n ~~~;;9~l~c~lao:~~~:t r~:t~~~c~L~r()r)t~~~~~~~~'~i~,:~~c~~: drnwinj.:,.cardlndcx ~>'titcm!\ or uther rcrordll, im'hlllin~ nllll.1:tllt'.dbc. dnnu. cdlnncl (lther 11llHtndic record in/.( or ~loraRC media lor electronic d:ltrl IIrt>Ct'),illl{ on which cO"rrllR:~ Is limited t1lldt"r Section I SlIh-Seclioll (D). (1) and (2): (J) l\dditional innlranCt. NOT -TO gXCI~gO. 11'0 OF' , TH~: WHOI.I; AMOUNT OF FIRI'; INSUIlANCE OR $5,000,00, WIlICmW!;R IS TIm 1.I,SSI\1l ^~IOU~T. on t'111111oyt'c'i' llcr,on.1ll'roptrty, not cnv~red hy (}ther imur:lIlcr. while runt.1lncd In bulldmK(s) 011 the t1c~crih(,II.rrl1lilil"ll nnil I.IM 17~D TO NOT EXeRr.n. IS'O ~OO.OO Or\' PUOPJo:RTY o\v~r.:n nY AN\' 0;';1; EMI'I,OYI\I\; (-.I) i\llllitillll:.1 ill'llranCt', NOT TO EXCgf~() 5'1" OF TIm \\,1101,1'; .UIOUN'r OF FIR!; INSlJI1ANCF, OR SIl'O,fI(l),liO, WIIICIIJ.:\,gR 15 TilE I.I':S~ER 1\~IOlJt-:',.. nn prUI't'rty. a\ ('lIv,'rr,1 hy 1hl\ 1lu1iry, :It-'luirl'''ll hy thl:' II1!oUf('.1 whil,'llt any utlll'r ].ll'lIlil'tll wilhlll !t.lln~XL illl~'~bll~,~I~~cl~,1i~~ ('T:i'~i'llltt~S 1~\llJ~\ I'EltlOn OF 180 DAYS ItlHlM l'III'~ lJ/\TE OF ~~g\!lt~~~Lli~I,;!'A~~~MD IlOf(S NOT COVIUl (D) TillS POI,ICY I.I~IITS COVERA<:I,: (11 ON !lOOKS ni' Accoe;';T, AIlSTI1,\CTS, O'~:\\\'l~r,~, CAnl) I~IH':X ~iYST,.:~t~ ,\SO O'rIIEH RI\COIWS (EXC!;I'T FII,M, 1',\1'1\. DI~C, DlnlM. CI\I,I. ANU nTIIEl1 MAns 1\1'1(' HI~COI~D1N(j OR 5'fOI~(\C'tE ~II\IJI,\ FOR HI.EC. TIlO;.;IC D,\T.\ I'RnCI';SSll>nl. TO ;.;OT F,X, CI\l~DI:-:(i Till': COST OF IlJ.i\NK IH)OKS. CARns Oil O'l'IIEH 1H.1\i'K ~1/\1'F.ru/\1. Pl.l:S 1'111\ COST OF 1,,\1I01l ISCI.~I!I!F,D Ill' TilE I;';SeIlED FOI! TI!ANSCllllHxn nil C()I'YI;.;n SUCIl HECORIJS; (2) OK F(D!. TAPE, DISC, DRUM. CELL AND OTI-IER'~[:\(~XETIC RECORDI:-.:e OR STORAGE 11E.DIA FOR 1;:LECTRO;.JIC DATA I'ROCESS- lNG, 'TO !\:OT EXCEEf)I~G 'fl-IE CO~T or- SUCH MEDfA IX e!\:EXPOSI~D OR HLA:\'K FOR:\l: EXCEPT AS PROVIDED IN SUBSECTION (Cl (2) ABOVE, (E) Alterations:and' Repairs: Permission granted to make addi- tions, alterations' and, n;:pair,s ,a,nd, this policy, insofar as it covers building, or' structure, is extended to cover additions, alterations and repairs, ,,,'hen not otherwise covered by insur~ ance" .including temporary: ,structurcs..mater:ials.equipment and supplies therefor on the ,described premises or, Wltllln 100 feet thereof; and. insofar as it covers ,contents; is extended to cover in such additions. \Vhen an item of this policy covers on or in'two or more buildings; the term "additions"shall indude new buildings on the premises, described ~tlsuch item; SECTION, II, (A) ~~k~i~~'~~~M:T}5i:r ~<?,T A~Vi~~k.EO~<t~: RING AFTER THE INCEPTION DATE OFTI,IIS POLICY AND PRIOR TO ""...,,,,,,,,,,,,,,.....03/22,174,,,,,,..:,,,,,...,,,,..,,;......,,,,.,,,,,,,....,..,,,,.. 11!:ltPlRATION g....T~ 0.. THIS CI.AUSIrI 1'1-~ANTHEAMOUNT, OF i~3Ylf5\.~CSt.5~~8ER THIS POLICY BEARS TO $"...""""".."",..""....,,,,,..,,,,,...,,.... (B) IF 1'HE EXPIRATION DATE SET FORTH IN THE u.nIEDfATEI.Y. PRECEDINGl'ARACRAPH. (A) IS NOT EXTENDED BY ENDORSEMENT, THEN IN THE EVENT 01', LOSS OCCURRING THEREAFTER. THIS COMPANY SHALL NOT, BE LIABLE FOR A GREATER PROPORTION ,OF SUCH LOSS THAN THE AMOUNT OF INSURANCE UNDER THIS POI.ICY BEARS TO 90% OF THE ACTUAL CASH VALUE OF THE PROPERTY DESCRLBb:D HEREIN ATTHETIMEOFLOSS, , , " ' (C) Waiver ofa...ntorY4nd Appraisement: In the' event that the aR:grcg~aim for any loss to the described tlroperty is less than Z% of'the total amount of fire insurance upon the property described herein at the time such loss occurs,. it shall not be nl'c.CS":lry for the Tnsured to make a special inventory or appra. nt of the undal1laA'cd property; _ BUT NOTHIN ,REIN CONTAINED SHALL OPERATE TO WAIVJo. THE APPI,ICATION OF THE IMMEDI- ATELY PRECEDING PARAGRAPHS (A) OR (B). (D) If this policy 'covers t\\'O or 'more' itcm~. the immediately. pr~- ~~~~~~.Pfovisions (0) and (C) ,shall apply to each item sep- SECTION III (A) IF THERE IS OTHER INSURANCE WHITTEN UNDER FIRE INSlJRANCE pOI.ICY(IES). THIS COMPANY SHAI.1. NOT BE I.IABLI; FOR A GREATER PROPORTION OF ANY I,OSS FROM ANY PERIl,(S) INSURED AGAINST UNDER THIS 1'01,ICY, OR ENDORSIi,MENTS ATTACHED THl,IlETO. 'rlIAN THE AMOUN'r OF INSURANCE UNDlm THIS POLICY BEARS TO TIm WHOLE AMOUNT OF INSURANCE WRITTEN UNDER FIRE II{SURANCE POI.ICTES COVERING THE, PIlOp. ER'rY. OR WHICH \YOUI.D HAVE COVERED THE ~~I?nm;RX~~~~rVI\~.~H~li~d'i~!~Ul'iii.~ g~ NOT. AI>D WHETHER OR NOT SUCH OTHER FIRE INSURANCE IS EXTENDED TO COVER THE ADDI. TIONAI. Plmll,(S) INS'URI;D AGAINST HERE. UNDER ' (B) IF THERE IS INSURANCIi. OTHER THAN INSUR, ANCI,; WRITTI\N UNDER FIRE INSURANCE 1'01.ICY(lES), COVERINn I,OS~ TO 'rIm prlOP- ERT\' I'IWM ANY pl\IIII,(SI INSURI';D AGAINs'r UNDER THIS POI,ICY, THI:,; COMPANY SHAI.I. NOT BE I.IABLE UNDER 1."HIS POI.IC\', UNTil. SUCIl onmll INSURANCE HASiHmN, EX.' HAUSTED. SECTION IV LOSS DEDUCTIBLE CLAU'SE" THE SUM 01' $100,00 SIIAI.I. 11I\ m\DUCTED FROM 1'1,11-: AMOUNT OF 1.0SS IN ,\NY ONF. OCCUIlRENCE RI';SUI.TING FROM ANY OF 'I'llI'. PERILS INSURI\ll AGAINST, OTHER THAN FIRI\ OIl I.IGIITNING, THIS D[WUCTIB1.E SHAI.I. AP- PI,\' SI,PAR,\TIU,Y 1'0 EACII !lUII.DlNG OR STRUC. TURI'; (iNCl,UDlNG ITS CONTI;NTSI ,\ND SI\I',\RA'rE, I.Y TO I'lmSONAI. PROPI;RTY INTHE OPEN. ,BUT IX NO 'EVI,NT SII,\I.I. TIm AnGRF,GATI'; AMOUNT IlJWUCTED I'ROM I.OSS IN AN\' ONE OCCllI1RI\NCI'; EXCEI\Il ~I,IKKI,OO, TillS CmII'ANI' SHA!.I. 1m I.IAnl.E 0:\1,," JrOf{ IT~ PfHJI'OR'rrnN 01"-' I.OgS. IN E:':CESS 0': '1'111,; DlmUCTIIII.I':. II> ,\CCORDANC[\ WITII 1'111\ AI'. l'nRTlnN~IENT PI10VIS[OXS 01' THIS I'OI,ICY, SECTION V EXCI,USIONS: IN ..\DDITION TO OTIII.;Jl pIlOPlm'l'Y oJ< INTEln:ST~ j';XCI.UDHII IIY '1'111-: CONDITIONS OF 'I'IIE I'ell.le\' 'ro WllIC11 'I'1I1~ I:OH~I IB A1'T/\ClmD. 1'111:-; POI.ICY llOES NoT ('OVEH: (A) I.AND VAI.LlI\S,I.AWNS, TIU,I;S. SlIllUIlS, PI.ANTS. GROWING CIlOI'S. MOTOIlIIOATS, SAil. g\!f~tl~b "VI81~~t}s 'WlrO~\~~Il.i~~\SSI,!M;!W.r ~}~:~'(61~1 ~!mll~1(~\;,t:; ~lIi m;Gf{i~X d i~~ I~NNi~\llJ I !;m~ ATI\[) I'RINCI!'AI.I.\' ON '1'111; I'IU,MISI\S 01' Till( INSUlum: (III f\mJn~ (131 J-:~fil'i'K'Tk~l,~)~',,(2lJl21\:i?~~~I\!~~ FOUNIlATdlNS INCI.VIJING FOLJNIJATIONS OF MAX:HlNERY. IlolI,I':IlS AND [,NnlNl\S. WIIICII All!; Imr,ow Tim UNIlI\IlSUIlFACI\ 01' Till; I.OW, I,;ST FI,OOR, 011 WIII;RI': '1'lImn: IS NO IIASI';, MI\N'r. Wlllell Aim IIlil.OW Till! SLlH[IACI, 01' .oj _~ L. ..... 1_..._...1 ","I.L l.......~...... ......,.......1.,10... ",.1 I.,... 1\"" hu, in.hl'l',lnlu hl'r \'I'nr or 11ll' dt'H'rilwli prulll'rh' Ilmtlr 77'".. ' , .. c;,:,." · .' ',:"".'" i'>.',' , , , " ,,', '.' , ",' ' ..:".., ".' .. " ',"" ' , ,,',' ',' '.,.. -,' ..., Ii ,:' ',: ",,, , ' , ,,', :,., ".' '.. ~. ; : y,"'" "..::. ' , " '."" ,,',' " ",..: " " ....:,.,.. ,> ,i'..-. , ;" ",...,'",:,;, ". '::':'.' ;,,'. ; . ,,:':. ' : ::. :.'..',,' ,...,. ',,', ,:.,'..:. : . .', ", ,....' , ,,;.. ..",,' ,;, :: :" '".. "... ". " " ' 'C,' ", ",,,,.,,,' ,,':' .. " " '", ".:- '.', " ;" :.., ,:, '., ' "',", ,.,"".:,, :."",; " , . .":, :,; : ,,,. "." ..; ';', ," .,' , ....,. . ,no~ ~~ " ",' ','.,' "'.' '", ,',',," :. ,> 'J,,', . "",,:, ,,:'::' .,..;:.:.' ,:':'- ,:,,:' :",:.-" ' , ", ' . , :' " '... :, ',' ': '.' , , ' "", "..' .' ",', . ".,:' :' ."" "., 'c,.; ';'" ,_; ':, ,': ';.:', .... :', ' ,,' ,'.' ,,': ':,,', .,'," ,'-::': "''', ;,';. t>~;,.:, ~~~",,:"i:,:'<: .'"',,.' ::':":,':": ..' ,...S"r. _ ,,:::,,":V"!.~" ,.'.",' ;,:. , ,:..:.. '.:.;' ,'~V'''"" : :?:'"..~,:,;.:',.. ,,', ,rJ 'add" " ",", ' ',', .; "..';: ',' ,"/;::" ,'. ..,,, " > n..:.;:' '~CE66i . " ,." ,.' , "" i,:J,:: " ':";: ,',:" ,':, ,.;:c o,",'lln_ CCE66 "', :>:,,::' '", : ,\: ' ',l'lo. TI<-: "', ii';: --~ ,.,' .,_ '> ';' .,.~/>,:.." :',..;), J''''; '.. ,'.' " ' , " , .: :":":,",'; ',', ..,., ,,: --- ;Co,> " :, " ,.; ":' .:': ."'.;",,, ',,;,.', .... .' "':...'..'><(..,':: , :', '" ',,' ' ' ,,'EdWirA; BeQkor,"- , ,,' :;:..: :.,.'" " .,' " ': or:, ' .'. " '., ',', '<;'. ",;, ' .. "'" ".':,~D :,,',,: , . .. """.,'..., ::-..( ';':;': .:;, ': " " " ,...';.,:: ' ' ~, I ,'" ",' ,".::: ,. I :<>, ' " , '" "': ,: " :<, :".".'\' I.:, " "',, ' :",'... ,'.' I".." , " " 'j.' ADDRE.' .". :.,i ';',..,;,:.~" ,.\:-..h;,'.<.: 2~F.H ~8,l' r1J\1&i~~~joN~.!fOI':i~'!.;.~~i~5\i'l."'&'r'r,'~.\'rlgt.tc :~~~~ ~~: ~ ?M$g~~1~f&'.!'l.5'.lWtr.ENT .aENCT W"E." SF ",oao Inltv. n.711 \?) l. 8, . S.F. FORM "~" \I.li #1 ENDORSEMENT DATIl:D ATTACIHl:l:;ITO 12-28-72 FG:IT~:~/'~:"'INO 53-196-06 GFNF.RAL ACCIDENT #402-853 JEFFERSON COUNI'Y PORT TOWNSEND, WASHINGTON ,- tt:tI T EFFECTIVE 0 .E OF 1-3-73 1-3-76 18,000. FIW: p.e.: 10.00 IT IS HJ,;RJ,;BY UNDJ,;RSTOOD AND AGRJ,;J,;D THAT THJ,; ~a:.? ....&' '.$ll::: ./ ~O:b"'~ ~o~ :.;::.o<:'~~ ,0" ~~e ~ S- i~~'o~ ~~:;;.~ J- .'l1'$....::;- ~~.....(. +Q.~~ ,$ o~ 4.:-~:" i4..'o.<;.,,,,~ k4i~ ~~~~ .....(;:>c;,-Q':- ,," .,. ,- <i'a-~o'" oQ:"~ ~ ,/'a. do 4-0 S- "':;".....~ 4,.<;) '" <1; 0 0 0 0 0 0 0 0 0 0 0 IS CORRJ,;CTJ,;O OR CHANGJ,;D TO RJ,;AD AS FOLLOWS PREMIUM A\1ENDED AS SHOWN. FIRE $289.00 E.C. 18.00 AJ'lNUAL TOTAL $ 307 . 00 3YR. D.P.P. TOTAL $921.00 .#06 ec~~ rI /; ~t 'li~<<J TO RETIRE TAG # G08556' 'Const'nl 'Con!'>l.'"t by., "' ........ ~i ~~'l~ ~.~~~. .;;~. "i'~ ~~.;. .. -Not rL'(lllin'c! unless policy i!l reduced or rc~triclcd hy this endorsement. STANDARD Foih'fS nDREAU FORM i99.A <.19(7) .t 0{ CHANGE ENDORSEMENT 11/30/72 JEFFERSON COUNTY MIA: PORT TOI-.'NSEND, WASHINGTON ATT.....HCP TO AND P"O">-tING F 996823 SAFECO INSURANCE COMPANY OF AMERICA 1 ,,,".,.. lIN&UA&D'.N"''''I:6 M"'I..INOAODRC.., MARCH 22 1972 MARCH 22 1973 NOVEMBER 24 ltlcati,m of Propert)' Covered (if nther than abovt') and Descriptioll Subject w Form Numbers Sped fie Rate P:t!-:c PROTo I'> PERIL. NEW AMOUNT OF INSURANCE CINCL.Ul:lINO CH4NOIi:& JO Adc!ltlonal ',....NV) 0 Return 203 000. VRS. 198. xxxxxx .080 18. xxxxxx .036 8. (5) NEW (2X3) D ::;{,~,~i~~ FPD #1 7 580, 582 & 58 COMPLETE FOR DEFERRED PREMIUM PAYMENT ONLY .323 P R PAYMENT DUE AT EACH ANNIVERSARY (8) CAStt EXCHANGE (6) (7) DUEHEREWlTH CHANGE (5.6) 8. OueCompa', PREVIOUS 0 Increase o Reduction Due Insured 224.00 IN CONSIDEIlATION OF THE ABOVE SPI-:CIFIED ADDITIONAr. Oil RETURN PREMIUM AND SUBJECT TO AI.I. OF THE TI':R1IS AND CONDITIONS OF THE POI.ICY 1'0 WHICH THIS ENDORSI,1mNT IS ATTACHED. nJE; A1lOUNT OF INSURANCl, UNDlm THIS POl.ICY IS HERlWY ADJUSTED FROM $ 134.000. TO ~ ?n3, nn , AS FOI.I.OWS: TOTAL AA~NUCNRTI:;>:f: NI!:W AMOUNT 01" Forme'r Amount INSURANCE NOW Under thil Item REOUCTION 0 IN FORCE UNDER UNOER THIS ITC'" THIS ITEM $ 75 000. $ 10 000. $ 85 000. NIL $ 27 500. $ 27 500. NIL $ 15 000. $ 15 000. NIL $ 16 500. $ 16 500. Rc-duction in amourlt, if ,my. cOlllputed: SR 0 Flat 0 .PR 0 .Reason (ur pro rat;t rcdllctiol'1 I:nrther Provislol1'i, IC :lny: LOCATION: ITEMS 5 & 6 RATED AS "B", 90 FEET EAST OF A - LINE 582 ITEM 7 RATED AS "C", 70 FEET SOUlH OF A - LINE 584 ITEM 3 RATED AS "A" - LINE 580 "OmJr1uby In"UN . Nol rC'lluit('1.' unlt'H r(lliq-' is rC'.lu(C't! lit rtr.trklcJ hr Ihis rn,luncllwllI. ~ / z ~ H Z ~ ex: H ~ ex: H "" E' H H :<: ex: ... H ~ ... ex: 0 ~ ... Q 0 ...:l Z Q ...:l -:: ...:l Z ~ ...:l -:: ...:l ~ t>l t>l ...:l Q t>l t>l t>l H IE Q W Ul H Ul !E Q Q t>l t>l Q Q ~ ~ t>l t>l ~ I ~ ~ ~ ~ Q Q Q ~ ~\ ~ ~ ~ .~~ 0 rUJ d I-U UJ z- !: ::JII. ui I~ ... III 0 >t > - 011. w CD 1-<00 III U) uO (.) w .. , :;: ..... 3= \Z! z g ~~~ N N - Zlll , &.8 III ro Q) . UI < D~i~~ CD ....OJ.<: 00: a: .(1)0(1) -IJ .,.. 1Il1::1 ::I ;;;:2 ~ r-:f8 ;; ~'O~Dl 0 (.!J U) ~: ::>>-c15;t -;; ::> O:Z !: ~~~ ~~~ C = U = UI c:c U1- o III 0.0-1 II.(!) :c ~~ 8 ~li .... 1-<'0 II.Z I- III P, I-< 0:: U1W :iE c > I-COCl) ....OJ III '") ~ ::Ia~ Ch..lIlDl .~ OJ I-< III OJ I- cC Q.c ~.;; 3=1-< "'a: ::E ~fl '" = a III P,'o-I'o-I = 0 III 0 :c .<:1-<.....0-1 ....Ou.... .0-1..... III 3= I-< OJ 0::>::>' '0 r- 0 0'.... OJ " >t .... III .... >t '" 0\0.... = 0 r""'t~n:sns 0(1)-'<: '" r =........ ~ III OJ 0 al III ::> al P,'<: .olllO OJ .....<:::>> <Xl ~ S al ~'g, \0 E-< .<: ~p:..... OJ M Z 0 <Xl ~ ...'" Hill en CD III = fj 'alOJ OJ .B r-.<: Dl ..... ~ !'i E-< N....Ill=P, >t .... E-< ;:,=~.~. .... OJ f<l S ..; .<: III .0-1'0....'0 III ..... OOJ ..../"..,:.....~~~::;~.~~~::-:. 0 = :;: 0.0-1 >t Ill.... ~~:S u Q)Q) la H ~""""''o '" '" ~ = a 0 I-<.lIl = >; $1 = ::l = '0-1 III .0-1 Q) OJ.o-Illl 003= I-< Ill..... >t.o-I III E-< L ....., {j. /:, . . 824-888 . - RECORD FACTS ABOUT YOUR VEHICLE .. J:.,"~mplete all information concerning your "...Jcle. DRIVER'S NAME t1 AGE ~ ADDRESSI'..box'3~:J t2.~/''....J M/JO,?F314L. :7.(..,--~t/.1Y "::"^/~ /. )- MAKE & YEAR OF VEHICLE >"'0..4 00 / B d. SS/_< t. ICENSE Noftc,ft/").-j1"'....'SO,!. TRUCK OR TRACTOR NO. ':l / TRAILER NO. NATURE OF DAMAGV-:C" /'&> /J /' /-5 VI ,.;-, /J .e /" do.L".,. "'./ (... L.e:f;I / . S-dc Vii"! I!/~ ;>A-''''Gc 4. OBTAIN FACTS ABOUT OTHER VEHICLE(S) '1U 77Z-,c, g..m',/,<'/?"/ It is important to obtain name, address, vehicle registration, and driver's license num. ber of other driver(s) involved. NAME TEL. ADDRESS MAKE & YEAR OF VEHICLE LICENSE NO. REGISTRATION NO. INS. CO. NATURE OF DAMAGE NAME TEL. ADDRESS MAKE & YEAR OF VEHICLE LICENSe NO. REGISTRATION NO. INS. CO. NATURE OF DAMAGE S. OBTAIN FACTS ABOUT INJURED PERSONIS) It is important to obtain nome, age, address, and nature of injury of anyone injured. NAME " ADDRESS INJURED WAS: AGE_ TEL. D IN POLlCYHOLDER'S VEHICLE D IN OTHER VEHICLE D PEDESTRIAN NATURE OF INJURY N^ME ADDRESS AGc_ TEL. INJURED W^S: 0 IN POLICYHOl.DER'S VEHICl.E 0 IN OTHER VEHICLE 0 PEDESTRI^N N^TURE OF INJURY 6. RECORD FACTS ABOUT OTHER PROPERTY DAMAGED INON-VEHICLES) Complete all information concerning domage to other property. OWNER TEL. ADDRESS OBJECT DAMAGED NATURE OF DAMAGE 7. GET WITNESSES Get the name and address of at leost two people who saw the accident NAME ADDRESS TEL. N^ME ADDR ESS TEL. . ,""'"''''~''''''' i ~ 1'\ \') ~\ ~ \. '\ \ ~ ~ ~ w ~ \ " I I ~ '\i 'i , r 0 (, ~. I , ~ , i " '\ >\.. "< .\: \ ! f ;. ,\ ~ '\ " '\ '.' , " .\\.. i-'; \. \\ \. \, , \. '\ I. I \' r \. ,\, \ ' , f " >- I ,\ .\.; ,.. ~' ,~ '-' \ '- '\. \': ,\. \. l '\ ~'.~ \. t \~ ,\ I ~ I I "" ~. , :' \~ \. I I ~~ " \.' \" '. ~ ~ ~ f "- ,\) " ,-.; \. \:; ..'< I. ~~ ~ .~ \ '~ \' '~ '~ ,~\ ! ,\l o ~ ___.."._-....~;,.~'".....~'" '"It. ~..,.,o;.,......;>,l.....,...;. ..", _-".'<.......--...-...__..._.........................._...... ~ [ i i r f ! i d Ii Il Ii H ._,.., _..__J! -r~ ~. I~ I.l; I'- I~ ~. ~ ~ I~l ..! 1 ~ '., \) 0 ~, ~; ~ I~""I .~" ~ I' f' '" .... ~ ~"~,,i; U \s- f ~ g !' i,,~; . ~Ie' !-b< 8i ~ ~ ~~'~ : IJ~~ :~ I \f \r ~ ~ ~ ~ u 1,.-.. -\ ..-- t ~ 15~1 ~ ~ I\::> ~~. \I:~C'i '~ ~.... c( ~I\,,"I~'~ I~P' -I" r~ -~~fl ~ iI~ 111 U ~ , !:t I~~ ;~ I;. ~ .~ J . ,( I,' ..'t ....~ -.:...;'!F ~;;" 'c' ,;.; " ;:: ,Ii.. r.... ,,,. :. 'i':\c "t,iJ,. ".i" .!.i .. ll. ~i ~ .~~ 1::' '::i1~' ";;l.". ,: ....;, ~ .~ j ~:..i .... . t.' . "~ t~\j ....'~ ; -". ,.I., I. o ........ ":i! :1' ~.o"J ~.' )-, r!i''i;( r~ lJ\:. ." I.,,"". ." a :~ .,.. ..,.". .r;~ .:t:I' :T~~::' g . to;: f"~ ;~~~ _ ;~ ;''',~; 11, 't:; (gd :;;, r\7~ i.;;':," , ~ ~,~ ~ ~ ~ ~ ~~ ' ll. ~t~ I~ '}~I 'r .~,~ .,' i, -- 5 I-~- - -I- -r,." .,If ~ ~.. ~~ ~ ~~~ ~ ~~ ~ I' = ~ c; ::! >< ~.... ~ a ~ g :l :I El '" :;j ~ is !!!N '>'0 'oj I- ; ~ l;!' . . < is < :y:t;'> :\:::\ ~.:::': ,it.. 5~ ~~ ~o i E~;!l~t :~~EJ.5"'.',~.,; h,L~ :.\w i 1~~~~Jl~:' 'it!:.: h ~ ..l ~~e:g~ 'I: .';: ~'~ ~ g .g _0_.5 0 ..J'. 00 [ UI I"- Jl [;;::;1 ~ ~ g 51~=!~ S () ~%a ~51i~ 1'\ i\Q @ .:;g~l<s~ ~ I-: :~,.':;;:::g...5!CJ L Q W ~ ~~l"aj~i N ~ i= g <II'OC~:P'~ co ~ 2i Ul ~ j5-;':iSg.8 " i= ~ 111 =-- ..~~...~ l ill i"- !l:~~;n ~ fil '~~~.!!2i5a ,.... ~ hi~hj ~ ll! . iiai~i ly i :i~~:~i~ i > . c w . ~ w . ~~ ~. r ~ 1 .:. ~ . I:' ,~I_ '~f.' 11 -~:, . tl ~.. ~ I-:-- ." ~. .J.iIU ~ : 1"",,; 'I" :; UI, 1;;' ''I' ": :w ' ,/J" ~ ';; .' ... .;.}ll~~ e-,;J " ~ 1(J.~+'l . "" ,'" ;: ;:;, ','r,! ~" . ~;~ .:., ; ::""" ..",',' ".. ':;~ . :'1. '::;~ ;:",r ; f';J ;fl .4 t I i 1 rI Ij Ii · '-- ~......, .., . ,..",) '\II. fUOClItl_ "'1I.IltI'Wloot.II~'t'GI""''''~lf U.II "",...,..~ tKt~~.f4 . . ";AM INSU",NC~ December 1, 1987 State Farm Insurance Companies Board of County Commissioners City of Port Townsend Jefferson County Port Townsend, WA [R{[E~[E~W[E[ID nEe - 41987 JEFFERSON COUNTY BOARD OF COMMISSIONERS State Farm Insurance ClaIm Ofllce 15320 N.c. 40th Street Redmond, Washington 96052.5322 Our Insured Claim Number Date of Loss Location Amount of Loss: Type of Damage: K:f.esel, Michael 47-F585-223 3/25/87 210 West Valley Road, Chimacum, WA 9B325 $696.39 Falling tree c >- IU ~~ W 'M;).U, > ,..... (oj IJ. = 60 ~ lI.lk2 "" .".(JJ 0:;] U 0 Ultu w frj2 U1l CJ Ld'J ~ lli2. ...,!.lJ We are ~iting to you with reference to damage to property which we insure. Our investigation indicates that you are responsible for this damage. The law entitles us to reimbursement from the responsible party. If you have insurance to protect you against such liability, please refer this letter, to your insurance company and advise us of your insurance company's nameandaddress,snd your policy number. If you do not have insurance to protect your liability in this matter, please forward your remittance for the above amount. Please respond to this request within fifteen days from the date of this letter. If you cannot arrange paymnent in full as requested, please contact me to discuss payment terms. Please use the self-addressed envelope when replying. If',you have any questions I please contact me. Very truly yours, FIRE AND CASUALTY COMPANY ...J-Ic-I:-U- -..J..J,).'~"I-S Jackie Jenkins Subrogation Unit 882-5567 JJ:mac Enclosure t4 . . A. G. Brown, County Commissioner 2. repairs to the roadway and Survey Monumen~, and a claim for damage to my vehicle. Estimated costs for repairs the damage to .the vehicle are as follows: Wheel assembly $60.80 Dunlop Tire 57.31 Wheel Trim Ring 24..94 Sub Total $143.05 4. Washington State Sales Tax 11. 30 To~a1 Estima~ed Costs $154..35 and present danger exists to bo~h pedestrians and the mo~oristin this matter. May I recommend immediate repairs to. the roadway and Survey Monumen~in .order ~o prevent any further incident.s of. this nature. I .have enclosed pho"tocopies of certain photographs taken. on Sunday af~ernoon, Augus~ 10, 1986, which illustrate ~he problem at hand. Two of the photographs illustrate a Survey Monument tha~has been properly se~ in~o the roadway. Thank you for your attention ~o this matter, and please feel free to/call if ~here are any questions. v~er~ytr~y yours ~ l.0. l'/1'if ~". /\....:-- . Lennox Jr. Enclosures. P. O. Box No. 19475 Seat~le, Washington 98109 Telephone: Port Ludlow 437-2955 Seattle 324-9499 (~ ~~ ~ / z ~ H Z ~ C<: H ~ C<: H ~ E< H H ::;: C<: ... H t>< ... 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'" . : . .~~ ,~~:~:,,:'--:-:':...~'" --""!"",!;;.,',," . .~ m_ 'II) :'H~__ .-:::::",<"'''~".., ';i / >, .1.1 ___----.-.0-- . -I" .-c~ .. ,: /,' "'",;;.", , ,,',,, '.:.:: ,:. .: :."', , ';"'''''' '::',., ,", . :" ".":','':;,. .' ;,:":.,, ", '., ',' . """"..,, "'.," ':....' ,." ".. ,',:, '. .' ; ':, ',"':'::';"" ;1, '>"..' ,'i, ",,'.' '......:,,:, ,'" " "" '. '.:,';""'. ", " ':",., " .' " ',':' ..'; :. ::,: ,'" ";., ..' '. .'. ' ;'<>':, ':", . :': . '"' , ',,', ' :. ".' " 'i. ' ',..., " ': ',: '.> '. :" . :.' ..:': ':,;:"" " ',' :;:", ,. .' " , .,.. .' :'. ','. <;:" ,.': . "",,': " :". ,:' , ':, , " :' >', ',," . ,""':' ': : , , ", '.: " " ," , ,<': ", ", ,:' " " 'h,' '. ,,,,', ',' (, \:' '::"',' ',,:',. :..:/ ," :','.',:, ,,> .' '!!,~ :,: '." , . '; ,'" " ,-- - . - ' ~ . . 824-888 DRIVER'S N^ME ^GE ~ ^DDRESS h e, .:) X 3 .:;:> "'- a'~/----r , tV". ?$3J~l, . 7C <<;"'- ~ '/.2 Y M^KE & YE^R OF VEHICLE S"Ch ;;',6""7' f7 ,'^- S"S k C)ICENSE No/t.c~trJ/l?'S3o.c TRUCK OR TRACTOR NO. 71 . . TR^;LER NO. N^TURE OF D^M^Ge..UP /l /" A to<. "l1 P'L- /' d'-..("'~ vi -/".... L.ef.'7 / ' '" S~d. 4. OBTAIN FACTS ABOUT OTHER VEHICLElS) V",e.j U/7?-" )A<'>,q"e e.. -ru 772--". ff"-,,,,-e:-;e/ It is important to obtain nome, address, vehicle registration, and driver's license num- ber of other driver(s) involved. NAME TEl, ADDRESS MAKE & YEAR OF VEHICLE LICENSE NO. REGISTRATION NO. INS, CO. NATURE OF DAMAGE. NAME TEL, ADDRESS MAKE & YEAR OF VEHICLE LICENSE NO. REGISTRATION NO. INS. CO. NATURE OF DAMAGE 5. OBTAIN FACTS ABOUT INJURED PERSON(S) It is important to obtain name, age, address, and nature of injury of anyone injured. NAME _ MDRESS INJURED WAS: AGE_ TEL. o IN POliCYHOLDER'S VEHICLE 0 IN OTHER VEHICLE 0 PEDESTRI^N NATURE OF INJURY NAME ^DDRESS ^GE_ TEl. INJURED WAS: 0 IN POLICYHOLDER'S VEHICLE 0 IN OTHER VEHICU 0 PEDESTRIAN NATURE OF INJURY 6. RECORD FACTS ABOUT OTHER PROPERTY DAMAGED (NON.VEHICLES) Complete all Information concerning damage to other property. OWNER ^DDRESS OBJECT D^"'^GED NATURE OF M"'^GE TEl. 7. GET WITNESSES Get the name and address of at leas' two poople who saw ,he accident N^"'E ^DDRESS TEl. N^~E ^DDRtSS TEL, , (""'' ::E ::E I" <( a: I~ I~f'- I~ g~1 I~ ~ k~ ~~ ~r~9 'h~ 5: . ..~ t\-;:, ~ ~ - ~ I' I I ~ I I' i I 1"'; ! i .. [J ~ '" ClJ.;:: ~ i~ ~"" ~ ~~ ffi ~ ~ \. ~ g ~,~ ~1 ~\ ,_, \'& :; ~ I ~, " \1"". j;. ~ r= ,...~ ...., ';...~ ~ ~~ " I ~ ~ ,,<l. ~ ' ~ ~~ ~ ~ 5 .... \.J: ..')~ 'if ~L ~ ~-~ U\ ~ ~IR V' '.'$~l ~ ~ 0 0: ~1 :i <.. .vl~ ~ H \}[~~l ~ I"'~~ ~ .tl, \r ~\.f"' It""' j, .... ~ ~ 6 j ~ C! \::J f1'~ ~~ 0,;:.. .~ .::l~~ :~ ,~iy. ~ k 1:"\ 1\...:::;. ..:: ~k'::'; !: --I-I-- --- -1--1-- w ~ -----1--- i ~ -'--1-- - 1--1-- --I-. ill ~ ~ I 1-.'"<: ~- -. - ----I-- I qlt-::" ~ '. : ~ _~ dt!l.. .~". ~ .' ~ ~ ~ ! ~ .~ ~.~ ~ <: ~ ~ .~,~ - ~ ~ t;:3 ..' C r ~ < i~ g ... a: :;:! ~ L [J, ~ I? ~ ~ U " 1)9 ~ '" ~ l n ~ ~~ ~~~ ~ m ~ ~ m w~ ~~L f\..::. ~ ~ .... ~ ~ a: ~ . ffai~i IV ~ r. ~ ~~;j~~~g~ if ~ ~ ~.~ / l~ t;-< 2- ~ ~ ~ ..\ !~~ ~ \\.. ~ ~ .j .j ~D i ':". LII,,- I >.~~.c ,J;: 'o::,cn:;~ ~,'.5~~ wi!!o~ !'l> ~-z:g Zi3 ;,~fZu;: /. . g:!E "::J:~..r ........... ~g .2a\~l:> ,.". 0;:) oll~<i. "'i=:;i-;;~~ Iii!;dli€ ~~ci12 '8jri: " . z w ~ ~ ~ ~ .' z 6~l ~ I,: > . c . < .!!- ~ ~ .. ,~... . '-::1; ! I i ~ :I ..c;- l; II "; ~! ; e j s:. ~ IS E ~ ~ 8 i ~ .; ~ ~ I o I lit ,- '8 -;l- ~ j t I ~ I ~. i 5 j J . i t ~ it. -' ;! ~ ~ ~ I * ~~. Ia .. $ /,.". ",~y .".,;1' ".:;-v"/,,'" '~!I~ ;~: ',,'''I' I ........'.' "'~'~tN III I,.t-~. 111~ll ~l I~~........() IJ llll~ ''''f1'''''''~ 10"" . . BUDGETARY FUND EACH MEMBER. WILL l1AKE AN ANNUAL BUDGETARY CONTRIBUTION NECESSARY TO FUN~ THE FOLLOWING EXPENSES: ANY DEFICIE~IES IN THE CtMULATIVE RESERVE FUND ACMINISTRATIVE EXPENSES CURRENT YEARS' CLAIMS REINSORAN:E COST ctl1ULATIVE RESERVE FUND A PERCENI'AGE OF THEIR ANNUAL CONTRIBUTION IS THE POOL'S BANK, A CUSHION TO FALL SJI.cK ON IE' ACTUAL PAID ?ROJECTE;:l CL.\DiS. THIS PERCEm'AGE DEX:REASES OVER A SIX Y"'..AR TL~E PERIOD AS FOLLOWS: 1ST YEAR 11<10% 2ND YEAR 75% 3RD YEAR 5g% 4TH YEAR 3g% 5TH YEAR 25% 6TH YEAR 20% TOTAL 3"10% . . 4. In the event that the Budgetary Fund is e:<hauste::l during any Pool fiscal year, any funds required to fulfill the purpose of the BUdgetary Fund shall be wi thdrawn from the Cumulative Reserve Fund. '!he sun so withdrawn shall constitute a deficiency in the CUmulative Reserve Fund. .'\RTICLE X - EST.\8LISHMENT CF Cti'lOLATlVE RESERVE FUND In addition to the Annual Budgetary Cont~ibutions made into the Budgetary ,Fund pursuant to Article IX, .\!embers shall make annual contributions for the establishment of a CUmulative Reserve Fund. SUch contributions shall be based on each Member's Basis Rate in accordance wi th the following schedule: Initial COntribution 100% of Basis Rate First Anniversary 75% of Basis Rate Second Anni',ersary 50% of Bas is Rate Third Anniversary 30'% of Basis Rate Fourth Anniversary 25% of Basis Rate Fifth Anniversary 20% of Basis Rate Thereafter, no Cumulative Reserve Fund COntribution shall bernacle unless the Board shall require further CUmulative Reserve Fund COntributions for the purpose of maintaining the CUmulative Reserve Fund at a level equal to 300% of the total cm:rent Basis Rates of all ~bers or to canply with the requirements of any applicable regulatory authority having jurisdiction over the Pool. XI - MEMBER' 5 WITHDRAWAL,CAN::EUATION, CR TERMINATION 1. Members agree to continue membership for a period of not less than one full Pool fiscal year. At the conclusion of such period, or effective at the end of any subsequent Pool fiscal year, a Member ~o has given sixty (613) days prior written notice to the Pool may withdraw. 'Within 120 days following withdrawal, the 1'001 will refund to the withdrawing Member that percentage of those Cumulative Reserve Fund contributions made to the Pool by said wi thdrawing Member according to the fOllowing schedule, less the Annual BUdgetary 9ontribution~ich the wi thd rawi ng Member wo uld have made for the fiscal year following wi thdrawal: of ~mber's First E'u:l fool Fiscal Yei:lr s,n of !'ember's Secord Full Fool Fiscal Year 60% of !'ember's Third Fu" 1 Pool Fiscal Year 70% of !'ember's Fourth Full Pool Fiscal Year 80% of Member's Fi fth Full Pool Fiscal Year 90% of !'ember's Sixth Full Pool Fiscal Year ard thereafter 100% Effective12:{Jl a.:n. on the date of withdrawal and' notwith- standing anything containe:-d to tho contrary within this Agreement or attadrnents hereto or the RiSk Sharing Certificate issued pursuant to this Agreement, payments for all claims and clatms expense shall therea:ter become the sole responsib il ity oi tile wi thdrawing Member wi thout regard to ':'r;~::} ;:; .-'" -, Road DCDartmen1. Number. or Units Remainder' of County Operations Graders 6 N/A 4 N/A 3 N/A 2 N/A 0 N/A 5 N/A Front End Loaders Back Hoee Bulldozers Cranes Mowers Miscet1aneous (describe) Shovels N/A N/A L NfA and mobile construction equipment Track Loader Rollers ToteI' value of 'Vehicles operated' by: .. Couoty (excludi~ hh:bway department} N / A b. Road Depanment $241,220. "'aximum ,'alue of vehicles and mobile construction equipment earaReda' one location:. _ Value Address .. CountY (exclUdinj1 Road Dept.) b. Road Deponment S173.208. 371 Chimacum Road HadloCk, WA. 98339 Does Count,)" operate Or .nili.te with or linancia1Jy support an). vansit district, transit authority or dial-a-rlde proc-ram (includin2 elderly and handicapped syeteme)? If yoe. deccrlbe: N/A N/A N/A E. HISTORICAL EXPOSURE INFORMATION Summarize the County's historical exposure information On the chart below '(exclude' information for , hospitals, nursin~ bomes, sheriff's department and.. Ro~~ ))epartmen~).. County General Operatin2 FUnd Bud"et Budl!et Eodi~ General Fund ~ CountY Payroll Total Vehicle. Counts 1952 3,479,758 335,240 1953 3,407,873 83,551 3,357,766 632,058 3,491,195 568,770 3,724,347 499,388 610,121 5,328,925 3,693,754 Not avaliable yet. 195~ 1957 Surr4narizetheRoad Department's l1istorical exposure inCormation on. 'the MileBe-c. of Mileaj1e or State Roadc Total Operatina- CountY-Owned l!aintained VehieIe Budl!et Payroll R2.!!!.! by County Counts N/A N/A N/A N/A N/A 1953 N/A N/A N/A Nf,A N/A 1984 -.!!.LL N/A N/A N/A N/A 1985 3.168.100 N/A N/A N/A N/A 1986 3.562,700 757.629 408.2 N/A N/A 1987 3.171.100 824.316 418.37 N/A N/A 1:5 exposure infonna- Number. of Jail Vehicle Payroll Offic::ers Capacity (Beds) Counts 782.740 26 -11- 16 109.012 25 -11- 16 706.523 23 ---1l.- 14 788.983 23 ---1l.- 14 739.662 22 ---1l.- 15 732.405 12 -11- 16 LIABILITY LOSS HISTORY Calendar. Year of Accident No. of Claims Paid to Date,!1 } Amount of Case Reserves!11 AmOUDt Total Amount Incurred Ceneral Liability (excIudin2 hospit8i';/nursi~ homec and Road Depanment) 1982 0 0 -L- 0 1983 0 0 -L- 0 '1984 0 0 -L 0 1985 0 0 -L 0 1986 0 0 0 0 0 0 ---L- 0 valued. as Df: 12-87 LiabiJjt~ (cxcludin2 Road Department) o 1987 o ---1L- Unknown o 112.00 1113.00 o o 1986 o o ---L- Losses valued as or: Unknown 12-87 Liability - Road Deoanment 3 3 15;478.00 2569.00 ---1L- 15 ,'478. 00 ---L- 2569.00 0 457.00 .--0.-. 304.00 0 353,00 -ll..- ~Rl ,no J965 -2- --1.ll&0 --1Q.4...Q.o 1986 353.0p 1987 ~ Louoe valued as of: 12-87 Liability - Road DeDBTbnent 9 2773.00 0 '7 1 5.6.9 . 00 0 5 758.00 0 5 537.00 0 '3 547.00 0 2 548.00 0 valued a.. of: Officiale Enol's and Omiscions Liabitit.v (3) o o o o o o o o o o Unknown Unknown ? n o o Losses valued a.. of: Pollee Proreuional Liability (3) 2773.00 1569.00 758.00 537.00 547.00 548.00 o o o o o o 1982 n n 1983 n 0 ,1984 n 0 Ilf.!S, n 0 198& ---'L- R172.0Q Unknown Unknown Un~nown Losslta valued as of: :\"t~s: J. ~:'1ctude attome).'. feee and other case-specific expenaec oLhcr. than adjustor feea. 2. Cheek cne: The claim count Includes .11 cl.lms The cl.lm count exciudec ctalme ctosed with no pe)o.ment 0 0 ~~j u; 0 il 0 0 ]1 0 0 0 0 N en 0 ~ ! 0 N ~ CO ...., .M ~ en ... '" LO N '" ,... II 0 ~~1~ 0 0 0 .0 0 0 0 0 0 0 lit; '" LO 0 0 ~ ..... N '" '" 0 ,., 0 0 r ~j 0 l'i ~I ~ ~I ~ ~ 00 0 I 0 00 0 ~ 00 ~ ",u-j 9 t9 .J: .<: ..... 3 ..... e e tJ3 ~ Vl ~ ~ Vl ... ... is. CIl CIl e S e 0 0 :x: u :x: I t co i ..... ~ I ~kl ..... 0 ..... co ,... ,... ~il ..... 0 .....I~ co ..J: en en co en ..... L() ;e~ ... ,... '" ..... '" 0...., ...., ... ..... '" ..... 0- ..... LO 0 0 co '" '-" 0- 0"'" ...., '-" LO '" '" ~ '" ';;; ..... c: " CIl '" ..... c: " " k ..... ::E " .. CIl CIl :l c: ::E ..... :l ~ iil 0 c: II '" c '-' >, '" c: -0 ... III ..... c: ... III c: CIl CIl CIl CIl ..... cC '" ..... > c: c: 0 :z: .., '" 0 0 0 u ..... I- In '-' :z: :z: I- In .. , OFFIC'E: NW'- '- ,ATnE.... ,.. . () V# 02 QUOTATION WORKSHEET DATE 03/07/83 " PAGE a**************** POLICY ISSUANCE SCREEN INFORMATION ENTERED ******************' GENERAL POLICY INFORMATION EFF:032283 ENTY:O SCRN#:1 B.KIND:A ISSUANCE SCREEN INFORMATION ENTERED *************~ a****************** POLICY MASTER SCREEN INFORMATION ENTERED ******************, GENERAk QUOTATION INFORMATION A.SYM:GPp POl-ID:D06l9204AR-DT:032283 SCRN.:I B,CO:INA P-CO:INA FO:NNS PROD:246162 PIIC:9259 C;DSCl:JEFFERSONCOUNTY D.DSC2: E.DSC3:425 JEFFERSON STREET F. DSC4: PORT TO~INSEND SECTION I- f'IULTIPLE LOCATIotJ .PERL:CO .PERL:CO CMOD:lO >75:010 SECTION II L.SGL:YBOCUR$:lOO BAGGR$:100 .EXT:N BLANKET-REPORTING INFORMATION AMTS PCT LOCI ITErll LOC2 90 1 I 22 23 1 MANAGEMENT ORIENTED DATA T.ORG-CD:S TERM:l PAY:A WTR:A PPOL#:D0619204A PKIND:A EPOL$: DCC:E WA 98368 D/R:W AUD:A ADV: ARC: RATItlG ItjFOR~IATImJ ITEM2 COVI COV2 AR REP ADJ DEPY. 1 A 0 B , a*************** END OF POLICY MASTER SCREEN INFORMATION ENTERED **************1 a*************** SECTION I PROPERTY SCREEN INFORMATION ENTERED ****************i LOCATION A.LOC-P:I ITEM:l LC:WA1105l6 ZIP:98368 SCRNI:I n.Cl-CD:070l PROT:6 CONST:A D.DSC:COURT HOUSEPT TOWNSEND WA PGI7 LN680 ,COVERME A E.INS$:3798500 R-ID:I G.FR:0.058 EC:O.027 VMM:0.008 COVERAGE B J ,ItJS$: 296800 R-IDIl L,FR:0.160 EC:0.027 VMM:O.OOo EIID OF SECTION PROPERTY SCREEII ~ OI.<{o,03 PIl-6 : jJ.JS, / e.iSl::: /iii /VG-VVI r ' (::; 110 v-.t-i) e, 6. ) ~6'~r/i~rz..",..,. . . ':,~'f' ';; /,~':;.:.,.','.;; r;.\';'f:'j~fS~,\I~(~\;;:'W~\:\':j:":i;:.iJt!..,l.:,,~~. ItIFORI1A'notJ ENTERED ************1 COY A $3,798,500 PERL BASE-RT RT-ADJ DU-COFA PK-COFA PKG-F MAII-RT P'REMIUM DlT/RPT FIRE ,058 .850 .049 11,873 1 EC .027 .850 .023 072 VMM .008 .850 .007 258 . AUTOMATIC INCREASE (FACTOR .050) .850 .004 15V TOTAL .083 3,l5 PK~822!i SERVICE OFFICE: NW~ &,'hTlE'.',' '" . () 0; D0619204A VII 02 QUOTATIONWORI<SHEET DATE 03/07/83 PAGE c***OEOUCTIBLES*** 'STATE: l'IA LOC OED FROM / TO NUM DEDUCTIBLE ALL 1 1,000 STATE TOTAL POLICY TOTAL POLICY AVG OED CR ***EXPERIENCE*** NU/1 ANNUAL YRS PREMIUM 3 33,087 DATE 061581 110181 010182 120581 011082 LOSS LIMIT 6,700 PREMIUM OED OED CR PREM AF SUBJECT CREDIT AMOUNT DEDCRE 18,548 .890 2,040 16,5 18,548 2,040 16,5 18,548 2,040 16,5 .110 LOSS LOSS lIMIT AMT 243 6,700 1,000 6,700 1,000' 6,700 1,500 6,700 1,500 6,700 TOTAL AMT LTD LOSSES DIVIDED BY NUM YEARS AI/NUAL LOSSES D1VIDED BY ANNUAL PREMIUM ANNUAL LOSS RATIO CURRENT EXPER FTR PRIOR EXPER FTR DIFFERENCE TIMES AMTOF CHANGE NET CHANGE PLUS PRIOR EXPER FTR REVISED EXPER FTR PREM SUBJ TIMES REVISED EXPER FTR PREMSUBJ AFTER EXPER *lI*RISK PECULIARITIES*** TOTAL PREMIUM BEFORE PREMIUH SUBJECT FACTOR PREHIUHADJUSTHENT TOTAL PREMIUM AFTER SECTION I ~1I TH OED .810 .850 -.040 1.000 -.040 .850 .810 16,508 .810 13.371 SECTION I 16,801 ]6,80] .600 -6,720 ]0,081 S ECTI atl I H/O OED .810 .850 -.040 1.000 -.040 .850 .810 4,234 .810 3,430 ~. '7,1 C'> 0 L LTD LOSS 243 1,000 1,000 1,500 1,500 5,243 3 1,747 33,087 0.052 SECTION II .810 .850 -.040 1.000 -.040 .850 .810 12,345 .810 9,999 SECTION II 9,999 9,999 .750 -2,500 Y 4-L'-'r>rJ;. OTHER 21,786 ~j/A II/A OTHER 21,7( .oc 1 21,7E t!.f"'" :;;: ... ,.., on '" on c ... c c Q. W W W '" .., '" '" '" ~ '" II< :::> :::> :::> .... u N U U C> '" '" ;!:; C> ;!:; ;!:; ~ ... '" ~ '" N ... N "! .., 00 .; .; ~ '" '" on ... C> .., ~ N '" W W W ~ .... C> '" .., N ~ '" '" '" N '" '" :: c c ... ... W W W > > >- II< '" 0< ~ W W '" '" W W W '" '" 0< 0< ;!:; ;!:; ;!:; 0'" .... ... .... 0 '" r= 0 :Z:O >: >: >: ... .... 0... << << << :::> :::> :::> M << << << ....u. :z: z: :z: ::;0 ;; << << << O<Z: Q :z: ;: :z: ~~ "" '" .., ~ ... ... n.. M '" M W.... << << <( '" '" '" "'<( .. ~ .. n.. W W W U '" '" '" '" :z: :z: ;: ....M .... ::; ::; ::; .... N .... .... .... ... :z:u. g :z: :z: :z: 0 0 '" WM 5 5 5 :::> :::> :::> "'u> 0 0 C M'" ... ... ... ... >: >: :EO u<< << ... 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REQUESTED BY 52 LCD PACIFIC NORTHWEST( ~ATTLE) POL. NO 52 CLN SP5368 TERM 03/22/86 TO 03/22/87 SEEKTERM 2 PREV POL NO 99 999 999999 wEFFERSON COUNTY / / HRI 0 POL CLM CNT. TO / / ACCT NO PORT TOWNSEND WA ALL 815201 PUBLIC ENTITIES NATIONAL COMPA LOSSES OVER CLM IDENT LOSS DATE CLMT/DRVR/DESC OF PROP/CLMT OCCUPATION 932 L 99050 04/24/86 KELLY ERVINH CERT.NO CSI 0 TYPE INw V7 HRI 0 lZ PORT TOHNSENDWAFALL FROM 932 LP 99191 07/23/86 wOHNSTON MAXINE CERT.NO CSI0 TYPEINw HRI0 03 PORT TOHNSENDWADAMAGE BY TOTAL CLAIM VALUES FOR TYPE/SEEI: TERM REQUESTED PAID O/S RECOV IND EXP 7500 4000 IND EXP REINSURED ALLEGED DEFECTIVE JAIL e'ED IND 251 EXP NOT REINSURED FALLING OBwECT PAJ;D O/S RECOV 251 7500 0 0 4000 0 . . . . '" . . ": , , . . ~ :;:. .. ~ ... .. l~ ... ... '" , " " i; '" ... ~ ~ is '" ... , '" .... :: , ~ ~ . s .. I '" . z ~ . '" '" .. . .~ ~ ....:oz. ,. :: ... -'I .. .. .. ~.:.J. r:: :: .. e:= z ~ :CIon .. " " " .. ...' .. ~ .. " .. ... z !;; ~ .. .. .. ~ . '" ~ '" Q !:! ~~~ ~ ... 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