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Home My WebLink AboutReel_0049D . . BASICS OF RISK MANAGEMENT risk management? Determination of loss exposures Eliminate or reduce the exposure Finance the exposures that remain Unavailability and cost of insurance coverage Increased public awareness of municipal liability Absence of governmenta~.immunity Improved level of service to clients Cost effective operations the basic elements of a risk management program? 1. Systemized method for identifying risks 2. Treatment of the identified risks through loss control 0 Avoid 0 Segregation Separation Combination 0 Transfer to non-insurer 0 Loss Control Prevention Reduction 0 Transfer to insurer 0 Retention 3. Procedures for handling incidents o Accidents o Worker injuries ...~.P . . ex::LL..-I l"- I"- l"- I"- N WO-l <D <D <D <0 en c... 0 <D I"- .--l <0 "" 00<: .--l .--l "" N N W=>- I- -<C c:l;.--la... ex::_ ::.::: L1'\ L1'\ 0 0 0 = -II-V) "" "" I"- "" "" = c:l;V)- "" 00 <0 "" 00 0 1-00<: O~ 00 00 .--l "" I"- 0 l- LL.. "" L1'\ ~ L1'\ 0 .--l - .... '" '>- ~~ W 0 0 0 = ~I 0 -I 0 = 0 0 = =V)O L1'\ c:> 0 0 "" c:C1-0 f' -V) L1'\ 0 = ()~ ex::00 .--l N Lr\ c:l;~L1'\ - .... ""' >- ..... ~ '-' ...... >- ~ t- OO ,,\. >- -' = u... .,-. -IV) 0 .--l 0 0 ~I 0 0 c:Q 1'\\ u..c:C:!::: = "" ~ 0 ~ <<( 01-_ .--l 0"': >- -' ~I--~ ~ I- ~ 0 - -' -I ~. <<( ci a: <..> ill = :z ,.... L1'\ L1'\ 0 0 0 0 I- c:C ill 0 "" "" I"- "" "" 0 V) '" !:lV)0 "" "" :<0 "" "" 0 0 WI-O ~ XV) 00 00 <0 "" "" 0 -00 .--l "" "" 0 u..~= .--l .--l - .... ..... '-' !:l 0 C> 0 0 0 0 u.J-I 0 0 0 0 = 0 ......1--1 0 = 0 0 = 0 c..osc> c> 0 0 c <::) 0 >-....0<: u.......>- L1'\ L1'\ <::> <::> 0 <::> f-c:( .--l N N <0 V)a... ..... .... u.J (/) '" I- 0: = 0 LLJ ::;:: ..... ill I- u ill U ex:: 0: :z u - c:l; 0 <<( UJ ..J c... >- :z 0: -' III LLJ ~ - 0 ::> <=l u... LL.. 0... a... . . 1.:XAMP(~}:;S Oi" CLMiS1J-3 1,'11<1-1 fU:COnlJt~ Resultant Raten. Premiums 1980 Adjusted Annual Additional Ann\141 Ind. InD. Ind. Ins. Ind.. Ins. premiwn Above Modification Base Rate Hate Premium BAse Rate Claims S .OB66 s.0650 Sl. 755 $ -5B3 13.5 S -0- 07500 $.OB66 $ .1120 S3,024 $ +6B6 13.5 S20,OOO 1.293B (1) ;10,000 1.5491 $.OB66 S .1342 $3.622 13.5 (2) 1. BBB9 $..OB66 $ .1636 $4,417 $+2,019 13.5 $ 5,000 (4) 2.2164 $.OB66 $ .1919 $5,lB2 $+2.844 13.5 2,000 (10) SALES REOIJIRl:D TO PAV FOR ACCIDENTS ACCIDENT If YOUII COHPANY PROf IT HAHIlI H IS: COi fa 11 ,! 3% '11 <;1 . 1.IlOO S 100.000 50.000 33.000 $ 25.IlOO $ 20.000 $ 5.000 $ 50.000 250.000 $ 167.1100 $ 125.0op $ 100.000 $ 10.000 $ 1.000.000 500.000 $ 333.000 S 250.000 $ 200.000 $ 15.000 $ 2.500.000 U.25O.0lI0 833.000 $ 625.000 $ 500.000 noo.ooo UO.OOO.OOO $5.000.IlOO $3.333.000 $2.500.000 $2.000.000 TillS TARLE TELLS IftlV IT IS II1I'ORTAN' TO PllEVENT OH-TIIE-JOII ACCIOCIITS: AN ACCIDENT TIIAT fl.TS U.OlIO (NO' A VERV LARGE FIIiUIlE IN TODAV'S ECONll/1Y) IS NOT "PAID ron. UNTIL A CWNlY WITII A 1l1'llllF1T MRGIN SELLS SI00.000 IIORTII or GOOIlS. RISIC 'lANAC,ERS CAN POINT UP TIlE I/\PORTANCE OFSNETY 8V A1'I'LVINIi TillS TAIlLE TO TunR OlIN COIIPANIES. ,.. () ::; 0 Q, i i i .~ w 0 'B. c 1'- I J ,I :IE ,;, :IE 3 ? ~ ~ ~ ! ~ ... II ~ z m m ~ I I r1 (I) (I) (I) c:l ~ u c z~ Q~ !au irio cr... >!a u> ::i~; , 00 D.z ~c ;;;!~ '~~ ....a: ....::) Cu cru. !!i~,.. It f !?I gSL' . t ~ ~I ~ ~I dfhJelt:4 ~hhlhf ~H~~ D. .! ~ 0 i !11l~~J~:H- If Ii - sf Plol ~ I ~Ih!fhdms :rl1fifll.. iUil i fflj- dUUHi gisfhl!f' f!ld f I ff~JJli'jJl} JfliilJitf llllif Cl ~ f ~ t 'a ~ ~ ~ w > '" o u ~ ] j~_m ::; i ~ fHI ~lf{H ~I HI! 3: , *'~ = ~ ' ~' hill :C~;ct'5 l!?hU fi~ a; 8.!~ o~-Hfe -ih~~i j ~~ if B - -B~h;~~ I *,!m!!~!J,! g ~ ~ S ~ i [~ SUii1'dI !l!1 go;; a; ~ ~ ~~ U SSe ... IV-45 . it J~s;i~ f .I?:sjot=~5 _lIS ~i~8'J.'lld 2~ !i..a;{j~ ~~ 1m ii8;;;~m~B . ~ !l1l~HT~1 h mt!!S~~,8.~, p j~h~:hl d JI!~::~,~~~8o .,- ;.djiHH H~ BUdllliU 1iiS~ j~~ H~ s;~~ tu. ,E~~ In sUf' 1__ ~'" G jf ill ..; .. . " t c ~~ ~ 11iB f ~a a;w >!!! u> ~~ .0.. a ~~ ;;J!i ~ mw Z ~i ..J::) <u ffi~ ~~ _ ~ i ~~ ! ~ 3: ILl! ~ t ~ l! :.! )i I ! sir S ~I! II jJ ~. .t i5 H j ill B wi l!I i i i i i I J J I :. ~ ~ ~ ~ ~ = = :I :I j! ! ! .!l i,~n~lil !:hj h ll.: ffi~ ,r1lli!ufii Ui~!i~~.!lt,iiih~J ~ U~if dU,'mU mUlUm tWIll ~ HII! JIHf.~jf!i il'HHffUlflUU!r{, Hi!l lilllHthij Wljfl'If!1 milnl ~~J2j ~~:!Ij~~ll!~ ~~.!l~~I)si!s~~E~i~~~ !l H J, ~L ii, iiU Hn~ .llJ ~Isj f!i~1 ~h ii)t f: f~! iii II-Ii HI fiU I fIn f II I , 1; I '" ...: '" IV-46 ,-- . . ._~~- ~ ~ l i ~ i l- :i .. II 3 !' ~ ~ ~ !A! I I J J ~ 1.oJ ~~ ~ I~' 1 C zll: .. Iii olZ s.! h2~ ~!llfiq Ii Ci50 ~ ~~ .. ~':l ~li1;'!PR~<H CCW ~ -~~ -,~ ~! ,'U gl~ >!!! .. I;, iillj~(~'~ 0> a: i ~ :J~ a: dHI '; e~ ii-' ~Cl ~ ~2H p~li! ;~ 8h, ~~ P'! ' ;:!lZ ~ 1!=,11 "01-11 "0111- i!i~ mw !t! nnU~liU!ii <II: ~Hi ::ill: ..J=> <u ffilS f I ~g ~ ,~~ zz .. I1lg _ ~ a ~~ ~tB~~g~;iii~flii- 0- ii !!1 ~ 21 . liiiil!tif!lirflii1ifll!. . ~ ~ i U I a: illi!lflfilliililiii1jf!1 I g ~ ! I liiliifJillliltllflflfili I ~ ::l J l5 II :z: w J m > .. g 8 IV-47 . . ,.. CJ ~ i i i i f!: c 'e I :1 :i 2 .;, 2 ~ 3 ~ :I ~ ~ A ~ ... :I :I :I :I z ! ! I ! en en In ... u C zll: o~ !as iiio a:w :>-!!! Qftj 6~ l1.z ~c ~~ a1w ~I ....J:J ~ 8 r->.G~~i h . h ,.. !!,;2'!! 1'8..2~ ~~!! ~'Ii ~ j~~ HB .gl!~ ':il~~:p.~ 2 ",ill 1:;;1:1 ,5~... Sill ~'2i! - , . ill .~== . J! ii'il "g III '" l!....j:!. 1ii UJ . g ~ 9 i~CDIon ~ii1t5.~ a. ~ tJ ,!i i .li"UI" fii ~!i~ ... -~' - ~ ell ~ - S - g ;x '8.~~ - :2 ~ UJ I~tl !iti ii~~Hg, ~ h1;{~I: .Ji~~i ~H2 lt5!rrUl :I ." ~ ,; ~ [- !R.I" '" - ~ ~i .. ii & Ei . . .. 2-s f! ~. i 4) ~ ~ ~ , ~..: l!flI IfIll iell~l II~il~jl { sp i ~ i g Ji 5t hU l I P~tliliLJ I .G ~Hoj lt~Hi .G I 1-)~riHI {, -ill il~Jl, !l I. ~!f-.i i II II 13 Ii Jhtlflli hi i Ii i ) I !:! !:i ~ IV-48 t jJ i fh I B ~ ~ -~~ ll=l .. i!sjil~ u r 0 ~ ill Ea:~i $f _'5 i.!i~!;i i '0 . {!i i ~ o II Q~ r"-~ llHji c 'I i f~ ~ i I :i ~ .;, ';'5.h~,,!j :II ~~ i = ;riEa:j ~ , i~' .!,! ' , I~i~d~ ' p U"PLli ! ~ ~ iU-) ill !,! ::; ~ ~8p ~ .. Ii i={~ I l~f ~ { J tn.!t...QQ. I '" r; n ~ ,!j c 51 ~'a [i5~ ~ 'ii...: U .!! ti H' !sill' ~ t!! ~, Fi <no ;h~ -u ~i liE [;c ill if i~'5i a:w ~ >!! ... il~ !i 8.l~ Qjt '" it Hi!i '" ;!~ ....= ::> lrc u j'" ~~ ~ II ~ H:.tA ;!i ~ L I ~;~: :In ... h t~!H lOw z .. ~ Sa: U Ha ~ hu~E ....= "'; ....= <u a: I&. wo fllPP If ffi~ ~ B o _ ~ 'S;~H o ii: i! . ~ ! Fi~ , ,a i~] r !Q c - . Do c!l ; "flrli H ~ ~ ... Ef r lji ili ff~ll J i ~QiBH . Ii iu a ,a ~ 1Jli'Cl!d I~I ' iH~ Q . iH! I I .g.. BFi It It I s r IjjHlh In I Ii h !c g j J i~ iJj f :: II w Ii C) A c a:: w > :!! ~ ~ ~ 8 IV-49 . . ' I" ~4"'lI''IJltIalllll!ll //8 _' Jhls .ndarsement, effective on 8-20-80 :'" J afth. 1NDIANA INSURANCE COMPANY' I;sued t"JEFFERSON COUNTY Agency.l HOMER SMITH //80081 @ PORT TOWNSEND, CHANGE fN DECURATIDNSUDDRSEMENT " 0171!OOO-7 at 12:01 A.M. sta.hdard time. forms a p.:..I poliCY No. : . . --;;r./ WA ................. .............t:~,d.iiepre~ti';;'.~......,..............."......... A648 lEd. 1-BOI ....It is agreed that the policy is amended as Indicated by the following items designated by an "X": D The.lnsured's name and/or address as shown In ITEM ONEaf the policy Declarations is changed as follows: INEW TOTAL POLICY PREMIUM Is ::~..,h..', o hown ,opposite .the Coverage(s) In-SCHEDUlE- A below, and JOf/.whlch 'a",~lddltional.or return.,premlum IsJndlcated,.replac8s(replace) "the, l.lmillsl, shown Covgag.e~)!n;~~~:lut~el::~:O:e:::::::: Is (~;e:h:::;;e~I~~~~";ri:,;:<5"~'?" .... . ....... ....:. ,:?;%~~.' SCHEDU!jf.~~a~~~f~;;:~il~)a;'~b~~:~ag~:I~~:fH~~=~I~;~~~~!;Cla1:~Corer ~~PII" (apply) to the o 'the' e ~~~~r~I~~ are hereb~i;ciuded u'nderih(~IIf.~.~e;'~~lilifndl~;~d,I~_;SCiimiE:~~~e!~1\ . .....! premium charie l(!] IbIlH".SCHEDULe,jl.balaw ore hereby eliminated from coveroge..nder:thepollcy eoveragel,Hndlcated In:SCHEDULE A'b\i'l!ietum'premium. . 0 o. (s) Indicated by:areturn premium In SCHEDULE A below Is (are) hereby terminated for Covered AIIt,o(s) No'.(sL.....~..:.- ,,;~.~:;;:::~;';'.:~:';;:.~::';;....,......_....., .......,...... , ;,,,,,..;.,. "3-12-81 sI/dg' ....... SCHEDUlE)"''''?'i'' I "'I~~~~~~,~~J.O'~I", LIMIT symbols from ITEM THREE THE MOST WE Will PAY FOR ANY ONE s"o:~v~~~~haX:~ Ire ACCIDENT OR LOSS 8 PREMIU M LIABILITY INSURANCE PERSONAL INJURY PROTECTiON (P.I,P.) (or equivalent No-fault coverage) ADDED P.I.P.{Ot equivalenlldded No-faull COY.) PROPERTY PROTECTION INSURANCE (P.P.I.) (Michigan only) AUTO MEDiCAL PAYMENTS INSURANCE UNINSURED MOTORISTS INSURANCE $ SEPARATELY STATED IN EACH P.I.P, ENDORSEMENT MINUS S Deductible SEPARATELY STATED IN EACH ADDED P.I.P. ENOORSEMENT SEPARATELY STATED IN THE P.P.1. ENDORSEMENT MINUS $ Deductible FOR EACH ACCIDENT $ $ ACTUAL 1$ Deducllble FOR EACII COVERED AUTO FOR ALL ~~s~oWgf LOSS EXCEPT FIRE OR LIGHTNING REPAI\ $25 Deductible FOR EACH COVERED AUTO FOR LOSS wr~c~~~ R CAUSED BY MISCHIEF OR VANDALISM . MiNUS $ Deductible FOR EACH COVERED AUTO S25 for each disablement of a private passenger ..to TOTA PURCHASED I Orlain.1 COil NllWl ~g:ta~ ~iro IrJ) Additional $ Return $ 0"0 COVERAGES ~ '" COMPREHENSIVE COVERAGE !~ 5~ SPECIFIEO PERILS COVERAGE ~l!S COLLISION COVERAGE Q.. TOWING AND lABOR I.,NOci~=:'- SCHEDULE B . Cavertdl 'i::~ r Serial Hu~e:~r M~~ I AS PER 01-54 AT. l SCHEDULE C $ $ $ $ $ $ $ $ $ a $ $ 24. $ $ ION me: Body Type Number fVINI $ $ $ $ RETURN PREMIUM $ $ -ljU:>. TERRITORY; Tawn & State Where the Covered Auto will be principally garaged I I Cove/tel . '.<.. ..k 'i::~ :X;,~-.,.... DESCRIPTION r. Serial "U~~~~~'~.~~~.'::~t~g~ ~~P,:ber 'VINI . PUR HAS ,OtillAa' eolt Naw t;~.~ SJ~ l(~)l TERRITORY; Town & Stala Where Ihe Covered Auto will be principally i.raied i: '~!'.' . c~ ClJ;;;~ 'ltcIlUi"ot-' l~=-U... Sll:,C~::,! ~. NO. ='). ~:=':n1 SellinlClp.eJty GrOllI' Ptl""ty aatlnl rector Secondary R.Unl Flelor '.' . ;'EXCEPT FOR Tawlnr.U physical d.mag. ....1. payable'a yOu end the lass Cod. . . ", payee named .below as interests' may appear at the "lime of the 1011 ". " "n", CDVERAGES- PREMIUMS, LIMITS ANO DEOUCTlBLES l:r~'';~~~I~~~ui:i~~. aD;~T~:.l~:~ I~f ~~~ 'i>'~~~n a~~~:. Tn'J::dt)hal the limit or deductible entry In Ihe corresponding lIA81L1TY P,I.P A'pP~~ ~~~h.~~?yll' AUTO. Mlo. PAY. ~~lrJ~l~\~ COMPR[HU4SIVE s~r(~r~~D COLLISION T~~~~~& CA:::'" limit :;::::~: llnut- limIt- luM limit limlt-- llm"-- l~~""u-: US per No T~~~. P",.,iulll ~~' :I':~ Pr,mlum ~~, :1';;" T~~nu' :::m T~I:u. :t~~ ~~, :If~ P"mium dltdhu:~I~11 Pllmlum D~:~~ "ltdl) o.lG" b,lo. "ndt' IIndl) bfIro. bllo. Premium Totll Addl Premium ~ ~ LVIIIIIUIId WI NCIl .~lC'Il""" . Addtd P,I,", 0' P,PI (11"0'''''''1"1 ~ ~ '*~" Llft\lt ,"lid II'l III I ."U 01 1111 PollC, o.clIF.llonl ~~ .':' . CHANGE IN DECLARATIONS ENDORSEMENT A648 J" 712 lEd. 1-801 lhlsendorsement, .ffectiveon 8-19-80 ',,} at 12,01 A.M. standard time, form.. PO: - poll~ d _ 1-000-784 o(the iNDIANA INSURANCE COMPANY ~ Issued to, JEFFERSON COUNTY Agencyal HOMER SMITH 1/80081 @ PORT TOWNSEND, WA .... .. ........ ..... .....~......::-. .. . ..... .... ............................... Authorized RepresentatlvlI /17 It Is agreed that the polley is amended as Indicated by the following items designated by an "X": o The Insured's name and/or address as shown in ITEM ONE of the policy Declarations is changed as follows: NEW TOTAL POLICY PREMIUM I 10 I ~(..::.:.~:,,~...., '. . , ' ' . ," -' ,-,~,~",P'" .-:,' ,,\'...-.,......:.,._"_ ' :::._ ,.:vr.J;.; o Th8::Jjmit(s)..sbowD~oppos.lte, the Coverage(s), In .SCHEDULE" A below, - Ind. for.~.wblc:h"".n'li:Idltlonal ori,elurn. .prt~"un'~ia.-indieated.'!'eplaces{replaCe)'.th~, ,timitCs) shown fO~~~!~;~..Cov~rli~(S)I~ IT~.~..Of the policy Oeclaratlo~s.' ,",::. ~_-i..:-" ".";,:"~,.',:,:;:~~~'::~;":,~~;'~~A~~.<~~~t:.~,,.Ff.O~::':',:: '"S. .~'~,::::~~;_'. B Tht~,~..geis} lndidatedbY8 rttUhi~remlum in SCHEOUlEA below Is Carel .her~.byten .' :~~::.:;?i' . ~~"...;;.::~~~,~:~"\':/~~ ';, The:.eover.._ aWs.. ...:1., indicate.. d ~n:SCHED.. ULE.A. bel.ow .for WhiC.h. an. additiOnal.pre..m.' . <are).. '. . . ...UC..h.1~.Cov...!L e~.. ...~..~Plles (sp. ply) to the ~-.~ ,.ut"il!dic~.bythe eovered,Auto"DeSlgnation symbof(S)from.Declarati~ns '" , , ,.In-~~EiN?''!~t-~... ',' o Th~.,.j;sc;ib;dtnSCHri1ui.'i;,c:b~I;W. are hereby .Included under.:ti,'::pd~eo.eta~(SI'lndlcat.iCr,llr';;5CHmuLE~;belowbY'I;.jOddI!i;~~1 premium charge [jJ ~~~~;~r~d ~:p~~~~u~;.~r::I~~'are hereby .!iminatad from co;erag~~nd;r;hi ;';Ii~'C~~e;;g;(~i~d~aled"'j~'sCHEo;IlE A6f~riiilf~p;emlum. o Th,~.~riiefs) indicated by a return premium In SCHEDULE A below is (are) hereby te'rmln~ted for Covered AatO<l1 NO.b)....,...:,::.:.....:..... ..~.;.~:..~.::...:....:~~~............................... &,,.,.,,,...., ~_1 ?_'" ~T"'"". SCHEDULE A '-<""'~.'~~" (Ent~~~~~;~r~~~e~the LIMIT PREMIUM symbols 'ro~ ITEM THREE THE MOST WE Will PAY FOR ANY ONE ShO~~v:~~h.~~:f 1Ire ACCIDENT OR LOSS COVERAGES DESCRIPTION h.r Model; Trlde Name; Boefy Type Strial Number S . Vehicle IdenliflCltlon Number (VIN) $ SEPARATELY STATED IN EACH P.I.P. ENDORSEMENT MINUS $ Deductible SEPARATELY STATEO IN EACH ADOED P.I.P. ENDORSEMENT SEPARATELY STATED IN THE P.P.1. ENDORSEMENT MINUS $ Oeductible FOR EACH ACCIDENT $ $ ACTUAL 1$ Deductible FOR EACH COVERED AUTO FOR ALL g'lt~oWgf LOSS EXCEPT FIRE OR LIGHTNING REPAIRe S25 Deduclible FOR EACH COVEREO AUTO FOR LOSS W~~CL1~~ R CAUSEO BY MISCHIEF OR VANDALISM MINUS $ Deductibl. FOR EACH COVERED AUTO $25 for each disablement of a private passenger lulo TOTA PURCHASEO Actu.1 NEW (N) COil & USED (UI Additional $ Return $ !.At. . . LIABILITY INSURANCE PERSONAL INJURY PROTECTION (P.I.P.) (Dr equivalent No-fault coverage) ADDED P.l.P. (or equlv.lent .dded No.f~uft cov.) PROPERTY PROTECTION INSURANCE (P.P.!.) (Michigan only) AUTO MEDICAL PAYMENTS INSURANCE UNiNSURED MOTORISTS INSURANCE ~ COMPREHENSIVE COVERAGE ~~ ~ I SPECIFIED PERILS COVERAGE ~ Z COLliSION COVERAGE 0.. TOWING AND LABOR l..~~-::'~ SCIlEOULE B Covered ..,. N.. $ $ $ $ .. $ $ $ $ $ $ 1? $ $ ?1 $ $ In ; .a~ ",,,, nl_<t. I O'lltn.1 CO.1 New $ $ $ $ RETURN PREMIUM $ $ <?7 TERRITORY; Town & Stat. Whe.. the Covered Auto will be principally garaged SCHEDULE C Co"",.d ,":.- ';::' .,::':':"~"~~;1f,~ , . . y.., Mod Serill Humw IS : V.hie.. ~~r::be' IVIH Orfcln.1 eolt Htw Acll&ll HEW (N) eo,l & . USED CUI TERRITORY: Town & State Whe.. the Covered Au1lI will be principally garaged "".~' ... . ,'-'.,' .' tl~ '. Co":':' :";"01 ::=-:,uu 5q~ GvV:hid.~y . Ac. No :r= ~:=~, SMt.1 c.PKItr Group ,. Primlry R.II". Facto, s.conda" Ratln. F.clor eod, ~. ','" 'EXCEPT FOR Towing all phY'Ic.l1 dam'i'lol. is pay.b1a'to ,ouand th.loss payee. named below IS Interests may Ippear a,t I~e lime of the 10sI . , COVERAGES - PREMIUMS, LIMITS ANO DEDUCTIBLES 1:~~a'T\:oo~~I~,:::,uf~i~~e o{,~~rr;:':I~IZ Igl'I~~ j.'~ff~n .~~:. r..~~:d\hal the limit or deduclibl. anlry II1h. corresponding L1A!ULlTY P.I P. A,Pr~~ ~~'!:ti ~~~~. AUf 0 MED. PAY ~~rJVI~~~ COMPREHENSIVE S'P\~tr~ID COLLISION T~~L'h~' c~." j"~l "..~. ~~, :,~~ ,~;::~. ~f' :::. '~~~~'l :::m '~~~~'I :::. ~~, :,~~ p~~:~:: ,~~}" ,,,.I,m :.~1~: Toi'ii-A4d'l Premium ~@;,!>i1l *i.~,* LII'.lIt Ihl"'" Hcll apelf<,b.. I . AddlG"l p, or ".1'1 lndoru",.nl ~~'\\ =-.~ ~"'-'\\ LI/II'IIIIl.d 1ft 11& """I' 01111. Poloc:, l,r.I,o", ~ FLf"-}" SCHEDULE - COVEREOAUTOS VO~~W.N n f::nno_ 7A.6. of.the INDIANA",NSURANCE COMPANY, Indianapolis, Indiana;' JEFFERSON COUNTY YEAR MODEL. TRADE NAME. TYPE BODY. GROSS WEIGHT OF TRUCK MOTOR OR SERIAL NUMBER DELETE EFF. 8-19-80 brr:;i1 DUMP TRUCK "i.952GMG 2~ TON6:X6 WATERTAlOOm CHEV. SUBURBAN - ALL COVERAGES 4194AFA9017it _ 03?79 . ' CEU166F152789 1PS1F179347 FORD 4 DOOR SEDAN Uabillty I. assumed by tho company on each of the automobiles listed horeln only for thoso coverages for which a specific premium charge Is entered in the respective columns below and for only .uch limits 8S' are specified. LIMITS OF LIABILITY BY COVERAGE PREMIUMS BY COVERAGE PRO RATE RETURN PREMIUMS .603 Spedfied Unln. CQl'np. ,- Towing Amounl 01 Amoun, 01 CoIlWon ,,' w,.., InlU"nc. I'''".r>ee Amounl .- ComPl''' SpecIfied ,~, Molal' ...CV OfACY of Oed. Uo.", ....- P',II. COlli,Ion S~ic:. ill. 148. 10. 3. 151. 3. 60. 13. 3. 125. 8. 3. "An 'iOU'" Itw)o,\n U\ 1h<N~ 01 dOIl,t., It'\llhleon ,ero, omillftdl TOTALS , ~~ .::. ~,..' . - '.'-- .. - ". . - ,.. .. ...;. ..-".. ~.>..., .:'.' '.. '. - . 1/6 CHANGE"IN DECtARATIDNS ENDORSEMENT, ' 0 A648 at 12,01 A.M,standardtlma, f~~yOOO-784 lEd. 1-801 . 1'his endor\ement, effective on 3-27-80 01 the INDIANA INSURANCE COMPANY issued to: JEFFERSON COUNTY Agency at HOMER SMITH 1/80081 @ PORT TOWNSEND, WA ...............~;,..~e<;-it.ep~eseiliiii;e..............................:..... It is agreed that the policy is amended as indicated by the following items designated by an '''X'': LNEW TOTAL POliCY PREMIUM] o The Insured's name and/or address as shown In ITEM ONE of the policy Declarations is changed as follows: ~ ~ r;t.~,,~ '. '.. - ' ._, 0 s~wn"':~pc;S~e~.'ffj~ C~vera&eCs) "in SCHEDULE A'-below';';~.fo~~:::~:lIddItlDn~I':"o/:;~tU;~~~';'I';";~iS';~i~;t~/~'6.rai;'e~-r~p~~~) the limiHsl shown :Coverage(.s) In, .1TEM\1W().:.of 'the policy' Declarations.. ",::' ",:"".::.-:~~.;:' ..~,~t.)~"?r~"::~f' ,~:;:;,"'.~:~::- ,:~:":':,:',)':~::;.,,:!~:;.:;;.;:,::-~i:~ ".' ,~, ~~":' :';: ,.,' B . : ";Iitdl~a:'b~ .:~t~'~ pnimlum in SCHEDULE A below is (are) b~rebY~1t~~;,j~.}~~~:~:,;~~;::~J;~~j-".,;:;:":.;,~;:::;>;,::,~,~,:,":'{~~; Uolicilad lnSCHEOUlE.'Abelowforrffilch an additional premluRr-charg.'RhO~wra)~'tO.,~ . ,~Plies lapply) to the .bY'1)1a CO'Ie.r~Ault'D..lgnatlon's)'l1lbol(slfrom Declaratlons'ITE!-l"TH,~~S!K>w,n1~'f,~e.""C!l'lE!l_EJl:;~~. ,J;;. ,.' '0 . in . SCHEOiIu:~beloYi':"ra ~ereby Included under 'the 'pol/tj: COveragelsi; indicated, in::SCkmu~irithif(' , charge /j deSC.rllied ~~P~~~U~::I:\ra h~rebY eliminated from coveragt~~d~,'lh~~~lic;,~~hii~):i:i~~;;ig:S~I;uli~'~;~'~;;~h.:Prem/um. . Ttif.~ra.Re(s) Indicated by a return premium In SCHEDULE A below Is (are) hereby terminated for Covered llittt'l' No:(sL.;:.....::.."...;;~:. .....~.....,..........._-'~:................ ............... '~;"'.'.;,':'--. 3-12-81 SI/dg' __.' ' SCHEOULE A COVEREO AUlDS LIMIT (Enlry ot one or more oflhe PREMIUM COVERAGES symbols from fTEM THREE THE MOST WE WILL PAY FOR ANY ONE strowswtrlchlutol.re ACCIDENT OR LDSS Additional Return covered...,os) LIABILITY INSURANCE $ $ ~O/. PERSONAL INJURY PROTECTION IP.I.P.) SEPARATELY STATED IN EACH P.I.P. ENOORSEMENT MINUS (or equivalent No.faun coverage) $ Deductible $ ADDED P.I.P. (or equivalent added No-f'ull co....) SEPARATELY STATED IN EACH ADDEO P.I.P. ENDORSEMENT $ $ PROPERTY PROTECTION INSURANCE (P.P.!.) SEPARATELY STATED IN THE P.P.!. ENOORSEMENT MINUS (Michigan only) $ Deductible FOR EACH ACCIDENT $ $ AUTO MEDiCAL PAYMENTS INSURANCE $ $ $ UNINSURED MOTORISTS INSURANCE $ $ $ .v. '" COMPREHENSIVE COVERAGE "'"" r ".~.. ro, ~ ."."'~ ~"' $ $ :I~ g~s~o~~L8f LOSS EXCEPT FIRE OR LIGHTNING 49. ~~ SPECIFIED PERILS COVERAGE REPAIRE $25 Deduclible FOR EACH COVERED AUTO FOR LOSS $ $ 5;;: WrJC~~~ R CAUSED BY MISCHIEF OR VANDAliSM ~~ COLLISION COVERAGE MINUS $ Oeductible FOR EACH COVEREO AUTO $ $ TOWING ANO LABOR 1,.Hcol".....ble $25 for each disablement of a private passenger auto $ $ """",,. SCHEDULE 8 TOTA RETURN PREMIUM $ S ""0. CoverR DESCRIPTiON PURCHASED TERRITORY: Town & Stale Where Ihe Covered .... Yllr Model; Ttld. Name; BodW TyPll I Ori,inalColI New I Aclual NEW (HI Auto will be principally garaged 'No. S.rl.1 Number S. Vehlcl.'denllhcalton Number (VIN) Cost & USEDlU) 48. INS. f1"~", ."'~~ WILLYS JEer ovv,.. I I ..o-v., 59. INS. 1/215) 1~7" GMC SUllIJ1<.lllU'l I ..o-v..r SCHEDULE C eo",.. h ,~ DE IPTION PUR HA TERRITORY: Town & Slate Where the Covered .... )i'<;'; '-" : '~riil-'HlI=r~~.~~:I::~~~:I~:: ~~:ber (VIN Orialnal Coil Hew Adll.1 NEW IN) Aut.. will be principally earaeed 'No. eol' .. U5ED{U ::'..,;';" "v.., ".' ,'. .. ..- ,'-,.'; ,-~. .' _,~ll' "';'. , .. .'. .',~,.....- ., Conrld '_of ....... u.. Su. avw, GCW Primary Stconury , EXCfPT FOR Towing all phy.lcal damage"" Is payable to ,ou ond Iheloss .... ~Qptrstiolll :' ........ orV.hlCl. ... Rllln, R.tin, Cod. Plye~, named belo,w .sinteresls may Ippear al the time of the toss .0. r...... Crollp (III'JlIIn) e.~"" Sellin, Clpat:ty rector fielD, . . . . -t~.v~~'f , '- -- " .. , ~>.t":',.."" "'''',.~'''' COVERAGES-PREMIUMS, LIMITS ANO DEDUCTJBLES (Absence of a deductible or limil enlry in any column below means Ihallhe limit or deductible entry In Ihe corresponding ITEM TWO column In the Oecla,.Uons of the Policy applies Instead) LlAOILfTY ,,,p ADDED PROP. PilOT AUTO MED. PAY UNINSURED COMPIIUlENSIVE S~\~r(fD COLLISION TOWING & P.l P (Mlell only) MOTORISTS LABOR toYfrH LIft'" Lltru1- Llml'. LImit Llmrt Llmlt-. Llmrt-. S2'!l per .... II. """ut Pr.- Lilllrt- flIlnUI P'" II. P,.. ", Pr., flIlnUI P,. Llmlln mlnUI Diuble. .. I"retlllu'" -.... ....... -.... deduchblt Pr.mlum YJlou. II'lo.n ""U", P,.",lu," IIIo.n mlum ThOu. mlum Ttrou. mlum IhO_" mlum P,.mium Ihown menl SIndt) ..~. belo_ IIndl) Sindt) btlo_ bflo. Pr.mlum 148. ~U/. I J. I :l'J. IbU. 5. 49. TotJl Add1 Premium ,~~~~ m.~~~ ~\'.$:'$ ~=-.,,"''' ~~ ~' ~ll 11,,_ ~ ..ell ''lplIUOIf I . A40ftf ,. Of P PI "dOnlm,nl .LIlI'lofUII.dln oflll.Pohc., ""!IO", I This schedule is made" part of PolicV No. Issued to "JIiI".r~ COUI'l'!' INSUREO'S NO. YEAR MODEL. TRADE NAME. TYPE 800'1'. GROSS WEIGHT OF TRUCK MOTOR OR SERIAL NUMBER 10001 1SOOO!< . 23 1971 cm:v lUIP T1IIlCI( CB631P22S4S JII2OOCBBS.3296 CJD639I'817SSO 24 1973 IftIIIII.t.!.l. PU )1. 1!J69 CIIl!lV DIIIP '-'!lIlClt 32 1973 I'OIiDl 1 'l'l!I PlJ '31~J9 34 1976 CIII!:f JIIlIIP ~ CCJl666nOOS79 35, ;un - ~ ... -- ' 1r.lll".L]1faO ,.~~):""'.~..,'....- -.,..:.:..;:~~~\&.. ~-.";'~..".'~' .-~,,"...:~;---,'..~,." )7" 19'73 cm:v lDIP TJlIJCI:" ccm663V174101 38 1973 cm:v lllDIP TJlllat ccm663V174138 8001 39 1!J69 CIIBV lUIP '1'JlIJCI: CB639I'8189S6 8001 qs 1973 cm:v JIlIIP TJIDCl: ' CCB663V17411lO . .....' -;"....... .~-;-.-_...:..';...O,.... FL,F~T SCHEDULE - COVERED AUTOS YOl' 'WN This schedule is made a perl of Policy No. 01-000-784 of the INDIANA INSURANCE COMPANY. Indianapolis. Indiana. IlSued to 01_............. comrrr ITlM IHSUflEO'S NO. NO. YEAR MODEl. TRADE NAME. TYPE BOD.,.. (jROSS WEIQHT OF TRUCK MOTOR OR SERIAL NUMBER 1. 1 2. Q ~.: I ~I'7~' ' 1971 CIIBT JIlIIIP '1'JIIlCI: . ~ c.w 197.3 CJe -.sri_ 6. , 1m ~ It .. '--'Y-=.., 1. 12 1m ~ It .. ra e. . ,"" _ . .. 11!11 ""I}""';' ~.. .,.,..~, ;;;;::..; ~"L,~ 10. 18 1970 cur 314 '.!'aIr PU 1m ~JlD 4 JIil. IIr'll '1972 J'OJ!J) 4 JIil. IIDl1J 1m c:DY i 'f~ PU 736311178247 2!S1J'1.382S1 00J.I447.ns~ ClI6.3lP122S29 'rJIIJ.63lJS13S16 ~~30 'I36.311803i12 ~ l:sf~jft.... ~n669S2 CJD6.31Pl22S12 CJD6.3lP22S47 21 1971 C!D" JllIIIp TJIDCl: 22 1971 ClIft" JIlIIP '1'JIDl:I: ' 514 lV6 )OOl COST NEW COST NEW CLASS TERR. 01 CLASS TERR. 7398 011 7391 · 01Jm · (1.00) 33479 · (2.4S) 1398 · 7398 · '7398 · "" '""",=~.,..""v ',,, ,4 ratG.8.a,Q.:QIa) . ..0'. .... 'n, >>~,,', :::'-.;'gS ' 'U_'...:O, I ~~_.~:. 10.*,0_.,'0. ..1a~:J]n_':e'B" .';Q\',""gre'~o',. ~ ,I ~ ~; !' -;".;:"',,::~_... . .... p" .,Iit. , .'eBC;OOO~ ...c.on.. .,Q C ,.CY\C'O._~O':!:!! .-_D~O;O'.DC ".U"O,OOi.O'G: -._.00.'.0. '.(1110-o;o,.-o'~ ..'0'00008. z ~ --.------..,--- ~ l- S . " " . * ] ~~ ~~ ~ ~~ SlO SlQ I~ ~W ~~ ~~ i ""~ t"'\e c- ,,,,,e S"~ t>....:."~ C "",e Me. I""\e '" ~ ~ ~ ,~ i ] ~ l\ ,: ~ ~ ~ ~ z 0 " .;::r .. ...' :; ~ ~ ~ ~ 0 :?, u w U Z " a: ~ ::> '" ;; . "" ?; " ~ g.~ 8-* '" ~ z ~ &; " 0 ..., 0 0 ~ ~ I' ac ~ 0 ~ f1 I 0 3 '" 1 , ~ Gl !ii ~ ~ ! ~ c '" ~ ~ I 3 ..::t ac I i ~ ~ ~g ... :~ ~ 0 ,- II I I S ~e ~ ~ ~ I I ~G ~~ I' I ~ I ~ I 0 Ig e: I z ,/ ~ ~ I ~ ..::t ... ~ ~ i ~ ~ ~ -, ~ B 0 ~ ~ ~ it c l'! ~' ~ ~\8' ~ l8 $ ~ S :8 @ ~ ~\ ~ ... ~ '" '" ~ '" ... ... ... ... ~ -" ~ ] e. S 8- ~~ ~ ~ S l=!. P '" s ~9 t- ~ 'li . ~ ~ ""J ... ~g ~ ~~ ~ .0 g} ~ ~ ~ ~: N o > rJ) o .... ::> <t c w a: w > o u W ..J ::> c w :I: U rJ) .... I.. '" ..J U. ......~.:--... - .,' .~.~. ...,.. ..; -.., )... .1,... .. This schedule is made a part of Policy No. 01-000...784 FLE~r SCHEDULE. COVERED AUTOS YOU OWN of the INDIANA INSURANCE COMPANY. Indianapolis,' Indiana. Issued to JEI'J'BRSOIJ COlllITr ITEM INSUREO'S NO. NO. YEAR MODEL, TRADE NAME, TYPE 800'1'. GROSS WEIGHT OF, TRUCK 17 1976 CBEV' JllIMP TBD'CIl: 80 1970 CBEV' 1 TOIl PU 81 1970 CBEV' 314 TO.IIJ PU 82 1976 CBEV' JllIMP TIlDCIC 89 19 S3 l'!lIIli:H.U7.P 'l'llIIlo!:a !IS 1974 1l'.r1:Ln'r DAn.Ba 97 19.52 GII:l2i T. 6%6 1ilTER TAKER 40. 98 19S1lX: 2i T. 6X6 lUTll2 T.ODa /.., ~..1~1976 COY lIDaD&Jr / I 1&9.1 16C:/ 1910 ~ S&. 15 1978!U1'l'I.&C JICDJ:VILI.g n. 2 . 1978 PCIfI'UC c.lT.lLI!U. 4 lIR. sa. 83. 1,.,3 IlI'1'EIW'ItBL 3/4 T. PU lIS r-,1 ~5 (!? 1979. CIm 5' D. ... 1979 CIm 5 D. !llIIP 1979 CIm :BDSBr, 5' DI. ~ 1979 ~ 5' DI. ~ q.3 1979 CR: JIDS!:L MOTOR OR SERIAL NUMBER COST NEW CLASS TERR. CCB666VlooS97 1SOOO -20000} 33479 017 (2~4S) Cl!J33ClJl67S32 4S01 6000/6 01499 .. (1.00) CE24On6667ll 3001 4SOO/6 01499 .. (1.00) CCE666V100S73 IS 33479 .. (2.lp) WB32S$ f?~ 1f.I."I2lSJ05 30001' ;~ 0'5719 33499 .. (2.$0) 1830 33499 .. (2.$0) I CC16&1'1S2T70 r-30001~) I .. I I~ q./6 I 2000 I 7398 I .. I ar6n8P19313S 7/3 6SOO 7~J .. 2L69XBP192979 6/3 6500 7398 .. 2OCEIlS)2S8 4OOo/i 01499 .. (1.00 lD.~ 2517312 r- ~1 2.A&5) fl.~67 2S'1131z l3479 .. , 2.J&5} T1~3OOIIlI 29S631z l3479 .. 2.l&S) T1~30229 ' 2956312 l34~ . 2.~ !'1~)0240 2956312 J34~ (2.16), ::j,~i./'; ,J Cit.n CL"'I" "'/1'1 oS p, ?;~'S' LI ,?) ~31 . ~ . ;,g: ~ '~'~ i ~; i 0< ('( ~, I ~ . ,;) .~ ~ f>p:::r (.lo ') y.>~ '... I< ~ l.-t ~ .~>'-"~ C t<: i - t /' t ~ J<...j i , ... Vo'rr .~ .' <"',t f '.'. L ;!J. , g ~{ :;r:::J.. ;; '-- -- VJ ... z +: ~ , r.. 1"- I u- ; (~ r; ; ~ : ":1 ~ ~J~ ~ ;:/0 ; ~ ; '" g Ji! ~ ; g ~ z 2 ... ,', ~ ;. I j 1)::1 ~O'- ~ ~ :;J I ~ ",~; :O.:r rn J. - r: g:; " Ii")....cr _ "" - <'" . I tJ- ~I "I ~'l.~ ~'~ ~ is ' .J ~ I ; t:: '~ ~ "a- ~ \j'~ ',' : ~ () '~, '~,<):~ ~ '-;. ~ ;.:: r ,~, :T ,-(,. fr'" :r '._ ~ ".:; g '.~ ~ ~ 1~'~ S ~,,',)9,~ '~ ~ _:~ ;- l! f. .~ ~ 'T " g , -r ii: -Z, :~ w 'c i'.J.:' '.... ~ ,. ',':'11 o i, c: Q ~ ~ ~ ~ ~ ci ., ~ !, C:::""J' ~ -I'-" ~ ::> ~ if 0- '-;) be ~ 0- i- :r .g: -( 0 '0 ~ ).[. ~ e.<: _ eLl[) ::l.r ~,"J' _ M" ,'.1-c.:y;::r ~ ~,p; ~ 'ff! :~ r; ."-~,<1 _'("'1:,6- . ,\ 1 ~ ~\ ~ ; \ C ~, ~ '~\'- ~ ,;'~.r;). ( \() ~ I>: ~ .1", ;<:" ;.': .... - . '. r -=f- ~ ~ ,'giu~ :~@~;Q!l{ -=- rt) :r ;:r-"'-l: ~ ,_!'..... ""':.. r- '^ - ~-= I ,--..- ~- '" ~ ,'i 1 ~ I)~ ~{l ~ ~,'~ 1j1' .'- ~~~'u ~ Jj H 'i ~:1~;, ~ ~ ~ ~~ ~ i>; "';;;.:11 '2 " . C$ <. :0< di (1 o ~JI.!I '7 ~ r- 1': (l ~ 1~ ;- ~ G o 3~C!I~ ~ 4 g; .~ N ~; ~-t c.. & !" cJ lr a- ...! ; ,\oj' ;r" -c: -fJ ~ ~ ,lJ ~ = r: I() - t !'f,IC c[:. !iu . \ ~,\: (.p- " c-' ~ .~ ff ::'i:; ~ 3 II" . ',= ;. '-:!, ~ :; J,,; : , ~ ~ "~ ~ ,:;.. :;:.: :- . - ..... (. ... ~ ;'"' . " . ,. ~ ".:, .~ . ( .F. ~ .~ .;3 ~ 1'-- ~ ~ d ~ <:; ~ICL: 'f ci C. If) r-----,- ~ <<) ~ Co VI --t - ~ 8 , ) 1-; ~ '" '>. w e 0 ~ 0 (,J < - w ~ (,J ~ ~ I~ u: II. 0 W (. :E g i2 " 0 I: ~, :I: .. ~ ~ lI! ( ~ b ~ " { B l!l ! 8 = -=, t. ~ ( V:'g = ... L ~..:> 1'"1 ~ ~ '"t ~ 1 . r ( r ~ ... .J ! t -.!l " t U 5 R :Ii ~ ';l.t' . " ~.' ~:...'t.._"-,, , --, I I ; ~ -~ +\ "11 ,J 112 -s -, ,of; I ~ ~ ~I : I~c~~~~ 0~c~~I~' ,= .. ..". Os 1 co \ .1 ~'1 <:'1 ~ :q-~ g~CCs I ~ d,H ; A l" '~I' ~ ~ ~S R: ~ '?2:; ~ &, . ~ ;. rd. ~ I ^ ~ CC; ~ Jr I C<:: '"'- ~ c?S i;:~ 4; :- I~ l~ cl !i~ V' I f 1:!- ~1k~.r~i!"'i '1j j" uCh ~ ~d\1 ~ 0 (~lJ'~ ~l~~~t ~ ~ ~ V :3 ~ -, I- ~ ., I~~~~ ~ t \~ ~ ,'- ;-- ~ I V t'- ;:;S I stl ~ i ;;. I ". ex 9:; (, !- ,~ ~ fZ e ~ ~i0: ~ 'I. lr. ~ ~ ~ :J ~ ~~ I ~ ~ ~. ~ ~ 1& S I.~ :11.: ~ VI) ~ _ I ~ 0 --- ! ~ ~ (i 0 => ~ J~ ~~ S0 ~ 0 ~'r--!:~ Q lit"'-.!, ~ ~ :E U \\'" I(~ ~'J ~ ,-o....;y ~''"'' CO!, J ,j;,' h'-...Jll' Q':<I ~~ I~ - "" -.;;. ~ ,,;< CX'L_- r/I lirr~ 0 ::; b,~~ j f ~I~~I~~~ ~~ i ~ i:~ ~ ~ Sl~~ ~ I 111 ,~! ;i :: ~II ~.a.....t ~ ixl~~ -..h I! i' , ,~.'~ j I' l ,~. 8 ~ ~ ~ ~ ~ -I I~~ l - ii 'I' ~ '$ ~ ...", c ~ ~ ~ I -;t .' ~ i&: 9 ~;r-~ ~ <::0 G ~ ~ ~ <6= M "l~;; (')O~,,~~~.~ . ~) ~I 'cc:~t ~ ~. t ~~, Ii> l.- ~ . c - t'- ~ ~..:; ~\.~ ..:: l.,...,- s.j ~ ="J' ..... . J ~ ~ c.i Ii ~J~ ..~ !~=~I~~ ~ ~ J ~ ~;c:5 ~ ~ I i ~ ~ ~. ,i ifi ~~ ~ ~ "~ ~ ~ ~ 1 ~ c I ; i 1 ~:!ll~~,~i~~1;~II~ I ~, <5fI !..9::.. ,-. '-.....), ,,-, ,I'" '" Ir ~ ;; ::; ~ ! I~ I , , 4- ~\ ~ .~ 1:' '. -'h iV; j'~ .:: ~ .~ So C' ~ :- ~ ----:/ ;:;-..J 8 1 I I ! ~i ! o o ! 8 E ~ ! L - ~ e :! I U ~ ~ I o ,- it ,; ~ .., ~ (> STATEMENT OF VA1.UES ;-) (FOR USE ONLY WITH RATJr'iG PLAN FOR COVERING puat:IC PROPERTY OR EDUCATIONAL INSTITUTIONS. CHURCHES AND HOSPITALS) P. t. FORM NO.6 EDITION APR. 1967. Page No...~..__..g.._~_._-- ALL VALUES SHOWN ARE 0 ACTUAL CASH VALUE taREPLACE:lIENT COST. INSURED_.___.._Q.Q.w..l'!X....9.E..._.;m.fY.~~Q:!!"...:..__._.__..._----_..--........-. COURT HOUSE . OFFICE _illDRESS.._........?..?..::.g,!!....~~f..~~l?.Q"[..El~~?.;..,.....1'~~~~..! \-m ..!........,2.?]?~,._----- VALUES PROPERT't .,.THE. OPi:N THIS S?>ACE' FOR RATINC. ORGA!'IIZATIOH US.! OESCRI,TION AND LOCATION OF PROPERTY BUILDING OR STRUCTURE CONTEH':'$ SHED, slS UPPER HOR JEFFERSON COUNTY, \'iN ~ 4;400 / ~,OOO ./ 7,600 .,/ ~,OOO 94,800 .,/ 23,000 ....~8,000 ./ NIL 129,900 ./ ~5,OOO j 500 0 NIL 7-1,600 ./ ~,() CIa BRINN ON GARAGE~ BRINNON, \'/N ~~T~i1i~Eh~lHOP, HADLOCK,' \-IASH. VEHICLE STORAGE BUILDING, HADLOCK, 'vASH. VEHICLE STORAGE BUILDING AND CARPENTER SHOP. HADLOC , 'vASH. 4 ~~ ~ t-yr,J,j~ ~~~ ~M~QO....- ~~ '..J..I;.SCJt:J ;/ ~):r". Fl. )",STI\L'CTtO~5: _ (al Inclu,lo In building valu.., .rchltect. fc.., ",,,hlntry a",1 'qulp..e". .",1 p..m.ne". fi'III'" pemlnln; ,~ 11<; omlr.. .1 tl1" blliMill~-lIhu .ncehed .Iltn., plnl[llrmt, ,h~d. Gnd luJdtllon.t.' ' (hI Sh.,,,''''mp,.''em.n'' a"d ~.lIrrm.n"" ".1.... ro, all b..il<lln;. nol ."ned. d..ignalln; ,1"" ..111" ,,) &< n" "I.....", Ih.y .ppear III tl:r "S'a"""...'." leI Ind,,,I,, In "Co".n"". ,.1.1.. 01 .11 co...n" In each hulldin; "hlch h 1101 ..,Iom.h. a PI'" "r h..lhlln. ,.t.... an,II,"'IO"..1 p"..p.tl)' vah... (", ~Irlel' ,," I..""d I.., ",,,m.d liaWily a",I. IInl... .,10.....1.. c.,...d, ,h. v.I". .1 ,h. 1"."rcd'.lnlmOl In pmon.ll".prrIY hd"nr1ng In "hnl. 0' I. r:nt 10 fllh", ~1~:ln~:..~~::I;I~~~~~d':';~I~~~l~;I~~~n~~I:~;I;~I;;o~~r r,l;~,~~.;;~~i::n,1,:~~.~II~~~c n:~n~fl~:I::d y,.;~,I,~l~:.iF.Jj,::n:::'~~I~'~I~r~n:::r.~;::i,~I,~I\~I.~1'i:~"~; "Slatt'l.\t'lIt". NOlr: The rono,,'i"~ .re not co\rnd and thelr value ,1lOuld not be Inc1udtd in ,'alm!' .hb",'n; (1) Lfid.:, tlUll"!' or concrete fU\I"tI.tlnn" Lnc1udln: foundallont of mllchineryt bulleu and en;lnell, ","hlth Gre bet,,'''llle "ud!.":'llr':u.:., (If lh.-Iow"" b:l'~. ml"nt Ol)l)r, or wh*r. .her... l. M hurm..nl. which are ",.10W' 1hl! lurraCI! of.hl' crotlnd In,lde tltl'l 'ouncb11nn \lAth 0' t1,,~ hunJln~; I:!, IllIlnl, pl('", rlp-.. ft..... . ;,h'J and ~..ln. ohlch .re u"d"~,,u",l: (31 11.". ponlo", 01 .alla, ,.,d....y. .nd nil.., p.v.d ....fac" "hlch ar. ."hl,)e "I and .,or" ~~~.~~:lr:"~::~~1r~~i..I~,:,I:~I:.~.lli!; aln~1 :li~;:~~il~.f~~\.r:I~'.;"rv~:~~~.i~~:'~~!p~' ~~\~J;,~"~,I~~~~~,:r:.:i il~;~.~,r\~:;':,..~r~;~u'\,lr~~r.~~~ahl~~~~ uy..way ameo.d.. extend or aUer the coverages afforded by said policies.. .... . . . , . . The.Company, will mail to the party to whom ,this cerWt~}te is issued a notice of cancellation ot said paffcy or,,~les but takes no responsibility (or fadure: to do so. {- ,~~ IWlf AHO ADORESS Of PARTY TO WHOM WnFlCATI IS ISSUED, lllfiTE1l S'l!M.!ES OF AMERICA DEPA.Im!ElR OF !U.VY C/O W. H.. BEIlNES-R&ALTr SPliX:nLI5'r ~~T~ RC;fI'I'PR ~~~~.~~_.=~-7;-_-::~.-':'':. :..:.~. _~'__"_.. . nC2ma SKI!J!R AGE:IlCY 160081 gOl. 'aI!>~_ ~~ FLEET SCHEDULE of the INDIANA' I~SURANCE COMPMI)', rndia~apoils, lmf;,lna, TEIlRITORY 17 YEAR MODEL. TRA.DE NAME. TYPE BOllY. GROSS WEICHT or TRUCI( 1971 FOOD CUSTOM 4 DR. 2 1972 FOOD C1JS'.L'('!! 4 DR. 1973 :nmm..UTIONAL 3/4 !!ON PU #6,000 3H2JQCHB532S8 3-5 1971 CHE:VROLET DUMP TRUCK: #24,000 CE6 31P.I.22529 4-6 1959 FEllGUSON TRACTOR MOWER 181169 7939 1964 FOOD MDL. 4000 BACKHOE LOAIlEll lJllI4!I5 7917 1973 GMC RALLY WAGON mn63U513561 5-5 1959 GALlON' GRADER 118001856 7917 liability is assumed by tlia com;lany on e3ch of the auloJmobBes Ilst~d hficln only !Oi l!':ose co\'erages for w.r.i~t: 2 Silecific premium charge is e:'lteredln the respeeU 'specified, :!'~~'" LIMITS OF LIABILITY BY COVERAGE ITE-.t NO, '~ul~O~ill! BOdlll Injury Ea~1: [1(., PerSOIl Occur. A~:o-.' I':'lJt.Il", PrOlletty O""'''l. , i MEDICAIJ NIL C=~p, .tr:-:"Jnlol 'nsur3llCe o,IoCV Ccllb!cn A~;tu"t 01 pt~, f ;~~ r".!~", XXlCIXI: ';,U"~I': '" InSl,lr3nc. 0,;'1;'/ Automobile 611~:.It '''Jury ,\ut;:r.cblle ~ Pt;;.rl)" DJr.1J,te 48.00 41.., 48.00 NIL ~1 37.00 NIL 92.00 NIL mOL. NIL INCL. NIL 48.00 NIL 66. INCL. NIL NIL 2. If If If If Aav " If If II " Aav " .. II II If lIIL " .. II II .. lIIL ." II II II NIL If II II II If Aav If If II II II NIL " Aav 5SO. .160 ' i 97.00 197.00 55.00 34.00 1. 500 1000 100 MJV NIL s. INCL. 6. 2,000. .280 mCL. 7. ~n.oo 8. 4,000. .280 INCL. .." ......._~ .......-.. ... .............., nf tt"llo.., 1I..'t ''''e. ,arc>" emittod), TOTALS or ''1ch loss caused by malicious mls~h(e 2. The company wlli pay, COVERAGE V-TOWING-for lowing and labor cosls necessitated by tho dlsabi, ~;~~I~e~~~en~ IUfomoblles, provided the labor Is performed at the plllcel COVERAGE YOWPrtlHEHSIVr-trom Iny cruse ...cep! collision; but, for th. :gJ:gl~~ ~~~~ht~.W~:)~~ce~r~':r~35~r~~o1~:II~ned~,'IOhS~f~~,S:~p~tsl~~~S:I~~' o~~~I~ff commotion, mlllclous mischIef Dr v~nd,J1sm, ':I:ller, flood, or (~S to a covered .ulomabll. ot the prIvati plllen,., type) COlliding with a bird or animal shall nol be deemed loss caused by colllslonl ' COVERAGE '-COllISIOli-caused by celllsl,n, COVERAGE ~IR[. L1GHTNIHO OR TRAHSPORTATlOH-ca..." 'by lJl Ii" or lIahlnln,. (b) slmo'e or smu<!ll due to a sudden: unusual and bully opeution ,~t an - {hRTIFICATEOF INSURANCE;) . This is' to ce'rtily that the following policies, subject t~ their terms, conditions and exclusions ha'Je hean issuitd - by this - Company. but this _ certificate does not in any wa''J amend, ~xtend or _ alter the coverages afforded by said policies. _ _ _, .. _ . '-".iif&'company win mail to the party to whom this Certificate is issued a notice of cancellation_of said policy or policies but takes no responsibilIty for fallure~o do:so: NAME AND ADORESS OF PARTY TO WHOM CERTIFICATE IS ISSUED, 1lNITEIl STATES ,OF AMERICA llEPAR'mENT OF NAVY C/O W. H. HERNES-BEALTY SPIDIALIST 1l1i!.lT. ~A!I'R nmSTOli ..___ -:~--:-.- . 22 ',22. 23 -23. 24 24. 2$ 12-128-339 JEFFERSON COUNTY, WASHINGTON FLEET SCHEDULE . HOMER SMITH AGENCY #80081 901 WATRB.,STllEltT I, ., of the INDIANA INSURANCE COMPANY. India1apo::lls, Indian:!, YEAR MODEL,' TRADE NAME. TYPE BO::':', CROSS WEIGHT OF TRUCK 18 1970 CHEV. 3/4 TON PU W/RADIO #6,000 1969 GRADMOBE S/O PER 19S7 MY CITY POWER SHOVEL W/CllANE BOOM & llRAGLINE 1971 CHEVROLET DUMP TRUCK #24,000 ,.1971 CHEVROLET DUMP TRUCK #24,000 . 1971 CHEVROLET DUMP, TRUCK #24,000 1973 mJ!EIOO.TIONAL 3/4 TON PU 116,000 1969 CATERPILLAR GRADER TEllRI'l'ORY 17 MOTO~ 'OR', SEPTAL ~lUMB~R i CE240J1669$2 TBD 6886 MD. 30 CE6JlP.l22S32 CE6JlP.l22S47 CE63J.PJ.22S45 JlI2COCl1BS3296 13R:2J.33{12F) II ::, 7917 4-6 4-6 4-6 3-5 7939 S" ~:30\ ,.,1 I I Liability Is ass:.:medby the corr.;.anj 01 each of the l!utomobiles I:sted he::h ::;~11 for tt~,)se coverages fo'\~hict, a ~pecitic prem:ul~ ~r.arge is e~,:~'e~ in' t~e respect;'" specifiad. :fJ r~' ....uICl~'h6bjl' BOdll,lnll,jry [,:r. [ole!'! P"~on Occur. ,t.ulOo- mellilt PrOIl'"' D,ITlU' Compo I.mourlt of Insur.nce or J.r;v ColH$l:l:l .r.~~u~t of Oec!. S'OO 1000 100 ArJV NIL " " " " " " " " " " " " " " " " " " " " " " " " " " ArJV " " II " " 20,000. .. ":"~"-- .. .... ........ ...,... omill_d. .. .. ~OO' .. Fir(l, Tt:,Il-". ~,ou~.: CI IASIH,roC. or Ar:'I 55.00 2,000. .280 moL. 4,SOO. .280 INCL. A.CV A.CV 134.00 134.00 134.00 $5.00 .160 DlCL. TOTALS <!~.( AlIl~'tloblle So:;htl' InJUfl 37.00 moL. mOL. 92.00 92.00 92.00 37.00 mCL, Automot:!:e Pro::,e:!)' DaToJolC C.,m~re. MEIDIQ..4L henSlll~ NIL 19.00 NIL NIL NIL NIL NIL NIL NIL NIL NIL NIL NIL NIL I 2$.00 NIL . . HOMEit '~'J:.Q ~v... 90l. WA']ER S'l!BElllI! :',' 0"" FL=:T SCHEDuLE made a part ~f Policy No. ~.l.~-- of the INOIANt. lNSURA~CE, COMPANY.- IndiJ..napolis, Indiana. ~l.7 YEAR MOOC:L, TRAOE ~.;,;m, T"fPE eo:)'{, GR~SS \'IEIGHT OF TRUCK MOTOR 0=1: SERIAL Nur.~B[i\ sy~.~aOl It::::::: ::,:COMPACTOR l.973 CATERPILLAR AUTO PATROL GRADER l.957'mr.mm WARCO ROLLER l.957 MICHIGAN LOAllER l.969 CHEVROLET DUMP ~ #24,000 32 l.973 FOllD l. TON w#l.o,OOO , 1'l.3K2l.42 '(l.2F) 51.48 l.3X4930 211969 l.0583 cE6)l'61.75.50 F37YRR20039 i 7939 7939 7939,' 791.7 791.7 2-6 4-5 33 1.970 GRAIWlBE SLOPER TBD 791.7 __---L_ ;::~W;~d~' mumed bl the company on mh c: the .ulomcbH" li'led herein "I)' I" those eO'''''l'' for wh:eh , sp"ific prem;"", ch".e Isent,,,; In the ,esp,el LIMITS OF LIABILITY BY COVERAGE ITEr.~ NO. .:'ulomobilt Bodily Injury Ea~h [3ch Plltson Occur. Com,. Amount of lnsur3ncII ot AC'; fire, Theft & ~1 In5ur3nee or ACV Auto-- mobile Pfoplrt'l Dam3a:c MEDICAL C:l11I510n A~ount cf Oed. 500 1.000 1.00 NIL NIL 22,000. " " I II 400' II II r )6,ooor " " 2'1' " " ' 600. " NIL " ACV " If ~ . ' . AOV " " 2aooo. n " " II If " " " " It " " " " -~"!! ..,.....-:.-:!::- :-:. ;:''':- II .... th.~. '.'1)'. nmlt1.d):...--~_~ TOTALS - ---. '~"-'--- " Autom,blle Autol"1!lblle Boclly Property l,njury OamBia INCL. INCL. " " " it i. it it it i. it it i. it it i1 1.)4.00 92~00 NIL' m:L SS.OO 37.00 lIf.IL lIf.IL .280 mOL. INCL. NiL m:L 3U~OC.:i" "jeO !i~O. " ,~., . . ~J~ .. ~~'; ~'~"'jl.. r:;ff., " " .1'.:::.,: .. 1"1"\' r~;I.( " F'~vO" '~r:l.) .1 IWlE AND ADDRESs Df PARTY TD WHOM CERTIFICATE IS ISSUED, . ' tlNI'l!E:D STATES OF AMr{'y::A '.llEPA!mlEliT OF NAVY ' ' c/ow. H. m:aNES-llEALTY SPECIALIS'l' .'OTOl&'L,~AtpR. nTVTRTC>>l._;__-:-. . -,"~_.. .- ..:.:-- ~':~':;'~"< ... .'~.'''':.~' n . HOMm SMrm AGENCY 901 WA~ ST.BEI1.r FLEET SCHEDULE This schedule is made apart of Po!icy, No. 1.2-128-3~_ 01 the INOIMIA INSURANCE COM?t\NY. Indianapolis, Ind:a:'!.:;, , 'I'RIlRT'MIlY 17. : JEFFERSON COUNTY. WASHIliGTON 197$ CREVRllIiE'r S YD. DUMP TIllJCK #24,000: C~6V1OO579 11973 CHEW. TANDEM: DlJMP #36,000 CME673V1376OO 1195$ LEIlor CClMPRESSOR T.D.D. 1973CmN. DUMP TRUCE-SINGLE AXLE #24'1 c~63V174101 38 1.1973 CmN.",.DUMP TlW, CE-smGLE AXLE. ,#24,000 ,CCE663V1741. 38 38. 39 1969 C1IEVROLET DUMP TRUCK' '=-1..' ,., ~39I'818956 .~. 40 'j', 1,96' , REVR<>LET 3/4'~ PU 1/6,000, C2546 Zl4332 40. 41 1959 ATHEY LOAIlER . , 11699m 7 I Liability is assumed t:J ln~com~i':iny C,n each cf the <lutomobil2s H:;ted t:erein. only for those cC";ilfages for which a specific premium charg<;! .is e:llered ,iri specified. ITEM .AlJIO~llto'~ Bccily I:l;:;:Y "" hell . fiI~~ Pc:~O" O;':l"If. 500 1000 II II II II II II II II II II II n, II :;-:5' .. 3:;- " ......... ~.... " s~. " YEAR MODEl; TRADE "''''~.~E. TYPE BODY. CROSS WEIGHT OF TRUCK S"~:6Cl MOTOR. ~R SERI~L m.:r.~B~R $-3 3-5 .3-5 3-6 2-6 LIMITS OF LIABILITY BY COVERAGE ih,;to-. r:'I~t:;;it Pr..;u'rw D4~;'i't C~"'P. Arr:ount or 1:1$L1ro1:'1tD or ;,cv CollisIon .ire,lr.!!t& Amc.u.,t ~ cl Otd. 1:'I5UranCe or AC'" NIL AfN .. AfN II 250. .280 If ACV If AfN ~.(. . .. ACV Au:omoblle Autorr.cllile ! [!o~lJy i"rcrer::I Injury Oo1m,l;::ti 1134.00 92.00 134.00 92.00 NIL 134.00 92.00 NIL 1,34.00 92.00 NIL 134.00 92.00 NIL 134~00 92.00 NIL 55.00 37.00 NIL INCL. INCL. NIL MEDICAL, 100 NIL II It n If .. II If II II II .. If 700. m.so If If s,ooo. .280 NIL -.... ..-.....~....._II_.., V\l.,."r.D'--O~ TOTALS " S'(;.Jv. .;;gO :r: 'lItI " 'r..... ~ 'J..:' ~, " t:J:.P 00.5 VC.l\ J3r " " " ':0'':. .5[10 Il9 INDIANA INSUR o CONSI""LIDATED INSURANCE t ) Indlan.pans, Indl",. CERTIFICATE OF INSURANCE ~'-;Th:~'ls,to Certify that the following policies. subject to their terms, conditions and exclusio,n~,have _been issued by this Company,but this certificate does not in 'any ,way amend, extend or alter the coverages afforded by said policies. , . . _ . . . . The Company will mall to the party to whom thisCertlficate Is issued a notice of cancellation of said policy or policies but takes no responsibility for failure to do so. NAME AND ADDRESS OF PARTY TO WHOM CERTIFICATE IS ISSUED, UNr.l'ED STA'l!ES OF AMERICA DEP.AR'JMEIlT OF NAVY C/O w. R. llEllNES-REAIIfi' SP.EX:IALIST ,m<!.l'L ~A'1'2 nTVT~TO)i', . HOMER SM:tTH AGENCY 901WA'J'RR, ,.,STIlEIl1J! FLEET SCHEDULE 12-128- ~~~ -of the INDIANA fNSURANCE.CN"PANY. Indianapolis, l;;cHana. sched~le is made a part of Policy No. JEFJi'ERSON CotmTY. WAS1IING'rON TEIIBITClRY 17 INSURED'S riO. YE.G.R MODEL. TRADE rlAME. TYPE 1l0D'/, GROSS Wf.!GHT OF TRUCK S'n.~I!Cl MOTOR ORSERI~l rlU~.!BER 42 l!4 4S 47 49- $0- Sl $3 ST4497 1.9$0 CATEIlPILLAR AUTO PATROL GRADER 1.962 SPBAY MACmNE' 'l'1lD 1.973 CHEV. lIIIMP TRUCB;.SINGLE AXLE #24,000 CCE663Vl7lJl40 1.962 IIil'lEllNATIONAL DUMP #24,000 Bl94AFA90170 1.955. EUCLID SCRAP.lm .'. 189238801 1.9S4.' ~ 'ASP1IAL'l!, D:IS'lmJlllTOR W/LJ!J!J!LE :842616)90 Fn:LD TANKER #24,000 ' 1.960 HOUGH &-70 PAYLOAIlER 3-6 7917 148579 . J 16 mt 1934 I 7917 liability Is 2:~surn~d by the co:npanJ' en nch of the automobiles listed herein only t'Jf thos~ ::"',erages tOf which.i! sj:!:citic premi<!m Ch3fi:;: is e:1:ered ir. therespecth specified. 1.963 HOTJGR LOADER K-$O LIMITS OF LIABILITY BY COVERAGE ....utomo::.lI. AIl1~. Camp. Colll.lon fln. TlltH,\ ITEM Bodily Injury mOllUli Amount of ~ AutD~Ot:i:ll .0, Ea:/'I h:h Properly InSllr31lce ArMunt t10dily ;"rson Oc~ur. D':l'I.a:e o~ ACV or O,d. t."llr,lI:u InJurt nr ACV U. SO<> 1000 100' JIlL 5,000. .160 :INCL. llICL. " " II' " " 150. .280 DlCL. DlCL. JIlL JIlL " " " " " 9,000. .3$2 134. 92.00 NIL NIL " " " " " $00.1 .3$2 ::J 92.00 I!lIL NIL I 4$. " II " " " 6,000'1 .280 137. . DlCL. " II 46. " II " " " 4,000., .280 92.00 I " II 47. " " n " " 2,500. .280 INCL. DlCL. " " 48. II II " " " 4,000. .280 INCL. INCL. " .. '..~--. ..'''~''.'_H."f t"f."_i'''O'_llmi~L- TOTALS " " NAMnHD ADDRESS OF PARTY TO WHOM CERTIFICATE IS ISSUIO, UNITED STA!l'ES OF AME:llICA DEP.AR'.mENT OF NAVY C/O W. H. ~llEALTY SPlJX)IALIST __,~~~.="'A'I'Iil nmSTON .:~':; J.2-128-339 FLEET SCHEDULE . HOMER SMITH AGENCY #80081: 901 WATER ST!IEIlm o. r the n.OIA:iA. INSURA:;CE COr':'PANY, Indianapolis, Indiana. . . .. . S3.! I 54. ; I SS. j S6.: 67 . 1967 IN'1!E!lNATIONAL TBAC~ DOZER D20TD204 20m I I lia:il:li i: assumed C)' t'1g comp~:li' on ei!:h of the a:.rt:Jm:l~iles listed herein only for Ihos!! c,J'..erazei for wn"':i a specific premium ci;:ge -~~n the respeet: speclli~d.. '. . . . .' . '. '_; "'>'< YEAR MODEL. TR~OE NM.lE. TYil~ BODY. GROSS WEIGHT OF TRUCI( 1964 INTEllNATIONAL DUMP TRUCK #36,000 J.967 AERSOL TAR KE'I'l'LE 1967 AERSOL TAR KETTLE 1968 WIIJ.:I:AMEa'TE TILT TRAILER J.973 PI{ TILT TRAJ:LEa '196S 1JHlT SHOVEL MODEL 614 1960 MASSEY FERGUSON TRACTOR MOWEll. LIMITS OF LIABILITY BY COVERA~E ."'utomo:lill!' Awln-o . Comp f;:'c::::i: I IH',! BOllll! InJurl m~:!lI~ Am:lunt of Colll,Jon fjG. h:" [adl PropertY IMEDICAL InlUfinct Amounl P'!,on OC:llr. Dam".e or ~CV 01 O,d. In~ur'n:t or ACV .soo 1000 100 I NIL !lIL NIL 2,000. .352 II " " " " II SOC. .280 II II II II " II ;0'500. .280 II II II II II II ACV II II II II II II ACV II 'II II " II 'II 9.ooo~ .280 " " II " " 400. .160 II II II II " II S,ooo. .280 ..-, '., .... '.*""~i"~~III'brJ&.,l..~'-':!t 1n~.~~tJ~;It,,,!1. TOTALS " 1-'000. ~S:'" S'~C(). " oj TEilRITORY 1 7 MOTG't C~ SEPIAl ril);,Ta:::\ ,RFl80PD503lI4 WN67336611 WN6733661S El$78 S2077 6523S 205478 it Iii ~:"!aTTl:l~II\1 B:l~lIy IrTJu:y /1134.00 INCL. I :mcr.. I, 14.00 14.00 I :mcL. I INCL. I : INCL. C~. Il1 I I, I I 4-6 6-4 SYMBOl 6-6 PREMJU~S BY C .\ut0710b!le I I Canl:lrt_ ~;~i~~ !lEDICAL! IIlnsl.".; 92.00 NIL NIL INCL. NIL NIL :mcL. !lIL NIL 9.00 NIL NIL 9.00 !lIL NIL INCL. NIL NIL INCL. : NIL NIL ~!lIL ,1 'ml .... ....-...- _." .........--., 'I"_~ . h' I'f' t d nolln ____-.l'r""" ...;..._-~,.,,' ........... ..._....~..~......~.._,l_... -.-... .. d I I' have been issued by this Company. but I IS cer Ilea e Des "." Thls.ls to, certify that the following policies, subject to their terms, ,condlllOns an olc usons ". ' , 'anyway amend, extend or ailer the coverages aV"<d{d by said pDllcles, II r I 'J liC/ JOlicies but tales no responsibility for failure to do so, -The c~inpant wli, mall to ,the party to wham this J~>"'icate is issued a notice of c.tnee a Ion (I sal po '_. NAIIE AND ADDRESS OF PARTY TD WHOM CERnFlCATE IS ISSUED, tlfIITED. STATES OF AMEHICA llElPA1mIIi:N'l' OF NAVY C/O w. Ii. HEBNES-1lEUlI!Y SPECIALIST ,,__IT.~rpA-1J12 ,nTVTS,[Oll._..:..,~~" ...._-~ . :T~!:;:<s}~e~U:le \~ad.e,: a p~rt. ~f~_ol~cy Nil. 12-12~3~ of the INOI,l;NA ,INSURANCE:COMPANY. lndi.mapolis, 'ndiana, ',ISSu"e~to:JE&'.FERsOl!l COUli'rY. WASlIIl\IGI.l'ON YEAR MaDEL, TRADE NAME. TY~E BODY. GROSS WEIGHT OF TRlICK '70 71 '72" 1956ElTCLID ROAD SCRAPER MOL. F-7 1959 FOllD MAJOR llACKHOE LClADEIl J.96O X. w. TRUCX TRACTOR #36.000 1972 FORD !mACTOR W/BROOM-:BRlJSR CU'l"l!ER 1966 Dm:IiNA!L'rONALFloo DlIMP, TRUCll"#36. 1966 . CATEllP:ILLAR T1lA.CTOR LOADER HIlL 955 1969 C1Il5VR0LET DlIMP TRuex #24.000 1970 C1Il5VR0LET:l !101i' Pll' 1110,000 'Aufllmcbfl. BCdl1t lnl:"Y' [,;n ,'heh P"IO" Dce:!f. LIMITS Of LIABILITY BY COVERAGE 1000 Auto-- Comp, ccllisl:):! ntl), Tt.~'~.1 m:lollt ~mour.t c! :r;x:lClXX ProotrtJ Insur.nee 1.Il':Junt ..mCllr., III D.m'l" MEDrCALi or AC'J 01 Oed. 1,1S~ta".:1 Ot ACV 100 NIL NrL NIL 6,000. n " " " 3,000. n n AJ::v " n " n 6,000. n " " " 2,500. " .. " " 2,000. " " " " ACV " " " ACV n n " " II " II " " ..~, ~.....,.,-...... *Yf~" \~"i3a.~'rl~.~!...th~~~!;t,e;~~;~ ., a'OCO. .:;:;0 ]10..>. .r,?" " II II II FLEET'SCHEDULE . lIOMIm SMJ:T.H AGENCY B8008J., 901. WA'l'RR STREm 22736J.0556 1283 72566 C329853 456080Gl88734 , 6OAl2989 ~.391'8175Il4 CE3307167432 Autumoblie 1 A~l~m~brr" Socii:, Prc;;:itt:t Illl!.r; I D.m'il!' .280 iNcL. DOL. .280 mCL. DOL. J.37.OO 94.00 .l.6O DlOL. DOL. .352 134.00 92.00 .160 DroL. DiOL. 134.00 92.00 I 55.00 37.00 Toms -----r- I. , IlK: D" S'l'f.~50L 7917 7917 7-6 4-6 7939 s-6 4-6 PREMIUMS BY C Ccm:m~_ hellSllI' rCAL NrL NIL " " II ,II n " II " " n " " " " " '" " " II " I -. UNITED STATES OF AMERICA m:PAR!I!lElN'l' (]J? NAVY"., c/ow. H. BEIlliES-R/, ).TY: SPECIALIST .'RlaAT. T.!..c:rpA~__ nT7TRTOll.. - .- FLEET SCHEDULE ,. I" '"\"IER SMITH AGENCY #8008J. W1. WATER STREBIr ~0J:l COlrn'J.'X'~ W~H -'1'I<!Im"J~RL1..7 This schedule is maj!! a pul of Poiiel No. --12.~12fb.339__ of the INDIAtj~ INSURANCE CGif.pM-i't, Indiall:Jpo:IS, In,!:ar:?., 86 89 90 y~~~ WJOEL. TR':'O::~;~~.~::. TYFe. SO:l~. i GROSS ~'jEIGHT ::IF T~UCK : J.970 CHEVROLET 3/4 TON PU /16,000 I I I. J.975 CHEVROLET 5 YD~ DUMP. TRUCK #24.000 ! J.968 CHEVROLET 3/4 TON PU #6.000 13.97J. GOOD ROADS SPBEADER J.953 SPIlElADER :BOX '-r-------'-'----'----.- , MOTOR OR """ ",.,,,m ~_ sy.,:o~~ I ru CE240.n66678 1.3-6 I . -CCE666Vloofi73 5-3 I CE248ZJ.6!,J.63 2-6 i I I I J.953 FRUEHAUF TBAILER J.953 CA~ AUTO PATROL TBD TBD WS3255 3U3877 '1'$5053 79J.7 79J.6 4-6 92 J.953 BEAL ASPHALT TANX I I Liability is assumed by the co:n;1!:'lY~:1 e~ch of the a;.:tomobH!!s listed herein Dilly fer t~?5e co...er;~es for which a spacific pemiur:1 C~Jrb; is e~:;red in the respec spe:i1i~d. . ' 7939 79J.7 LIMITS OF LIABILITY BY COVERAGE "'\ut~mol)jJ~ Auto-' Ceml), Collisl::.n Fi~~. Tiltft & ITEM Bodily Injurl mobl!e ,Il::-~uMt cf ~m..~nt ...,T;,;w"~ -:If :-10. E"rT, tac!\ Pro;e ~IJ In:;~ra:l:e Person Dee!:r. Oa:m3;e MEDICAL or AGV clOed. In$l,;r4rl::e or ACV 65. 500 J.OOO J.OO NIL NIL NIL ACV 66. " If II " " " ACV .67. .. .. .. " ACV " INCL. 68. .. .. " .. .. J.,500. 69. " .. .. II " NIL 70. " " " " " AIN .. .. 'II .. " 4,000. .. " .. " " 3,000. .... ...-..~ta\)O'.''tl..p\..6~~~~~~~itted). , ,.---.-..r .280 ;'utomo::~le Aut::t1cC::'1 BO,ChIY Property InllU1 04,,:,,",;/1 55.00 37.00 NIL J.34.ool 92.00 .. 55.00; 37.00 II I " INCL. I INCL. I INCL. " ", INCL. \ 14.00 9.00 II, . JmL. INCL. II " INCL. INCL. " " .J.60 .280 TOTALS ';:jT" II 1t....' ~;::. ...,.... ~:;. 00.$ VOiL :r~j1. '~S' 00'$ r~'i.:I:''O. .j~~1 :;:;:r. p-' '.WI .' ti'~CU' .~.~S J:.il"'. ~n. r~'ocvl 're-" IIAME, ANO ADDRESS OF PARty TO WHOM CERTIFICATE IS ISSUED, UNITED S~TES OF~fCA IlEP.ARTMElI'r OF mVY ;.,' C/O W. H. HEIlNJ;S-BEALTY SPECIALIST lllilAT. ='1'A~ ,m:v:rS1:OH. '--::::-::- c ' . iJmSMITll AGEN~Y#800a1 901 WATER S~ FLEET SCHEDULE 12-128-33? of the .INDIANA INSURA~ICE. COMPAi~Y. l:1dianapolis, rndi~n3. 'J.'EJIUP:TORY 1L--.. YEo'oil MODEL. TR;'OE N1ME. TYPE BODY, MOTOR OR SERIAL WJI.~aER SYMBOL GROS~ WEIGHT OFTRUC~ 7916 7916 1.9.52 m<<: 21 roB 6x6 WATER TAl'lKEB. #36, 1.9Sl m<<:21 roB 6x6 WATER TANKER #36, 14 1972 FORD 4 DR. SEIlAN T.E.A. It-5 78. 16 1970 PLYMOUTH FllRY :III T.B.A". 4-6 79. 201 1970 PLYMOUTH FllRY 4 DR. w/BADro ~rom90108 4-6 '-80. 202 1970 PLYMOUTH 4 DR. PM41TOm86SB5 4-6 liability is aS5;lmed bjl the comj)3ny Oil each of the automobiles listed herein only for these coverages for which a specific ;lremium ch3rg!! is entered in theresp,ec! specified. . LIMITS Of LIABILITY BY COVERAGE" -Automobile Auto-- Compo COllision Firi!. Th,lt & B:I(:;11Inj'Jl')' m~bita A:lIOLln! cf xz:::cca; . Automobile Automobile E~':~ EJch Pre.=e~y Insurance Arr:ount "moul'lt 01 Bodily PrO~l!rW ptu!;)n Cecur. C,mue MEDIC..AJ, , c.r J.CY of Ded. .:tsur3nce Injury Dama~"l or ACV 73. 500 1000 100 ND:o mL 500. .280 :INCL. INCL. 74. n .. n .. n 350. .280 :INCL. INCL. .. 75. II II .. n II NIL J.37.OO 94.00 .. II 76. II II .. .11 n NIL 137.00 94.00 n " n ," -" n ACV n mCL. 97.00 48.00 n II ..11 .. ," ACV " INCL. 97.00 48.00 n n .. II n ACV II 97.00 48.00 n " .. n II ACV It 97.00 48.00 .. .....,.. y" th~iIrl1l 1i doll an. Il3St Itlree zrr~, omittedl. TOTALS *Vr.:.~O !' C".IU::;-WU~-';: - ;:)U:"':"'~lIU~J]:tzJ._. " 3-()ou' .S80 :i! II II ji-r.OO. .rr!u :"J ......U~ Tf " " !~::1' n ,."CERTIFICATE OF INSURANCE Thi~' IS.,toce.rtify ,that the 1oUowlngporicies,subjp.i',. ;)rheir terms, conditions and ex~lus;ons have been is )bY this Company, but this certificate does not fn anY,way amend, extend or alter the coverages afforded, by said policies. "na~' Company ~i11 mail to the party to whom this Certificate Is Issued a notice of cancellation of said policy Dr policies but takes no responsibility for failure to do so. IlAME AND AODRESS OF PARTY TO WHOM CERTIFICATE IS ISSUED, 1ll!IITED STATES OF .AMEIlICA llElP.AImlENT OF NAVY C/O W. H. HEBNES-JiEAII1':C SProIALIST _AT. 1i!!::f!lA'I'R nTlT.T!'lTOll . HOMER SMJ:TH AGENCY ;l!80081 901 WATER STREIll! FLEET SCHEDULE Issued to 12-128- 339 JEl!'FERS0lf COUNTY. WASHII!IGTON of the, INDIANA INSURANCE' COMPANY., Indianapclis, Indiana., ITEM ; NO. lNSURE~'S NO, . YE~R MODEL, TR~OE m.ME. TYPE BOOY, GROSS WE::>HT OF TRUCK TERRITORY 1 7 1 MOtOR OR SERfAl r.U~.lBE.R , i SY~.~BCl 4-6 h-6 4-4 7917 1-4 h-h 7917 212 1966 CHEVROLET BISCAYNE 1970 PLYMOUTH h DR. 1974 CHEVROLET CBEVELLE h DR. 197h CA'1!EIlPILLAR JYT DOZEIl. 1974 U'l'ILI'J!Y TRAILER 3 AXEL 1974 CHEVROLET :IMPALl 2 DR. 154698J216120 PM!jl.TOm9oo4L 1C290421I62130 9/jE7525 505 T.:B.D. 1I47U4C107J.29 h8 1974 JOHN DEEIlE BACKHOE 7l1I10 77 1975 CHEVROLET 5 YD. DUMP TRllCK #24,000 cCE66Vl.00597 ' 5-3 ,_ .-1- U~bility jsa!i!c~!d by tl;e eom~any on. eiich of the ilutO:T:ccHes I;sted her~in only for th:Jse cl:'''(l~iJges for wh!ch e sj:e::ific prc'11ium ch.uge is e'~e:e::! In the respecti... specilied. LIMITS OF LIABILITY BY COVERAGE a " Celllllon Flft'.TMlrt. k:no"n:Q! AutO"l'lcbflo AmOLlr:t B~::Il)' of Oed. Inl.Uran('ll Inlar;- or ACV llIL 97.00 II 97.00 hB.OO II II 97.00 ~.OO a II 71,130. .260 moL. INCL. " " JfJV 1h.00 '.00 I " II 97.00 M.oo II 19,372. .280 INCL. INCL. i " NIL ACV 1)4.00 92.00 I " NIL ITEM .~"':~fl\cbllll Allto-~ Bee,if In/ury mobile flO. E.aell. [,:h Prc~erty Penc" Occur. D~rn.11 500 1000 100 II " II II II " II a II II " " 99. ft " II " " II 101 " " n MEDICAL ! NIL Cem:!. J.rr:cl.l:'\tof tns,,'''nce or AtV ACV " " " .. II ACV " NIL " 9IL ''''" lip'..:t>lo il10Yil'n in t'1':llJund4 of dollars lLast tt.~ee zeros ornill;d). *~'C:!O V1T Cu~:frC:!:~ ':-"~C.';~~C5\m~.ttl;; TOTALS I of the INDIANA INSU!W.CF CO\IPAN'i, Indianapolis, Indiana. ",) , TERan'QHX _J.L_____________ _______,__ __ VEA:r MODEL, TRADE ::;~,:E, TYPE S,)DY, GROSS WEIGHT OF. TPUCK i,~OTOR pi! SrRJoi.L r:U~,~e~R 5'1':,1BO(. SNOW PLOWS SAHIlEIlS 1976 CHEVROLET 4 DR. PANEL 1976 CHEVROLET 4 DR. PANEL 7917 7917 CKUl66Fl52789 CXUl66FJ.5277o 2-2 2-2 LIMITS Of LIABILITY B-t COVERAGE Au!?-" Camp, .' f;'~. TI1~r: .!: 0,'"''''1 CI' ITn.~ r.:~~j!! .t.;:l!;;lmt of C,IliS:lln :z:xxxx: ;'\O:!l~a::'He Alllcmllbile r-iO. Pr~t'er.i' MEDICAL ! I"S\lr.:!n,:! ':'rr:JI.r.t oI.nololnr ci E~lIifl' Pr:lcerty hen:aive c ,,~ ColITiS:" cr ;'CV afD<!d. Insl.lrJIl:e Injury OimJi!:e MEDICAL ACV -102. 500 NIL NIL NIL ,1,200. .280 n1CL. mOL. NIL NIL (9) 103. " " " " " 700. .280 INCL. nroL. II " " Aav " 55.00 37.00 II " " ACV " 55.00 37.00 II NON WNFIDA1l'l.'O 34.00 6.00 ':' J '. .~';~IL!ja:l!.~eS.Sh~w~)n ,t,hous!,nds 0' dollars (Last three leros omitted), . ,~OTALS ~y.o.tO -.Tr ,iou'sya::::.;;;:' s01vcO"~('M'l!U. 12.1.78)_ " " JlII' yeA r~' OO'S rd'~.1s' 'seo :;1( 'J:IR ':.\' OO'S yell. rr' 'IItl !,J'r4U' .SJO ~H " Cl.1' .. , ,. 0., II ;~n' II "!'.1f.. Ii II " " " II 0 g 0 0 0 0 ~ 0 ~ 0 0 0 g,\g 0 0 0 0 0 ~ 0 ~ ~ 0 ~ ..; cO .; N ..; 0 cO . "" ~. ,... ... ... 0 0 CO '" '" N N .... .... '" 0- '" ~...j. ~-\.. ... , ~ -' ~ cl~ <:.l~ ;'..>0 ... .. ... ~ -r ,. ... ~ :; '1 ;g. ~ ... 0 q 0 0 g 0 0 0 0 0 0 0 ... ~ ~ ~ 0 0 ~ 0 ~ ~ ~ ~ .... 0 ... .... .D N .; .... ....; 0 '" "., .... .... .... '" '" '" .... "., '" IE .". "., '" .... '" ~ '" 00 00 00 00 00 0 0 00 00 00 00 00 00 00 00 00 00 00 ~ 0 ~~ ~q 00 00 qc; ~~ ..;~ ...4...4 M...4 cO~ ai' ,..; ... ....; 0"" <00 ...;,.:. "'''' "'~ "'.... '" <0 "., '" ~ "., '" "'~ ""N '" .... ....'" 0'" .... .... '" N .... "'N 0 "'~ .". "'.... N ~I 0 0 0 0 0 N '" N N 0 0 0 '" 0 "., 0 0 .... 0 0 0 '" g '" .... '" O. O. O. .... .... '" '" '" "" 0 '" ~ '" "'0 .... .., ....'" .... ~N NN ....'" ::lg ::l~ ::l~ ::l~ ~ '" "'CO .... ~:g "'''' NN ~.... "'~ ....'" 00 00 00 00 00 '" ~ "'''' ....., ....N ",,0 ~~ cO . cO . cO . cO . cO . ...;' oiO: ...4"i N . sl N.... ....... ",. ....'" ....'" ....'" ....'" ....'" .... '" ....'" ....'" ....'" ....'" ....'" ....'" "'... "'... "'... "'... "'... '" "" "'... "'... "'... "'... "'... "'... 0.: " " .. .. .. ~ .... " " " " " ::> .. .. " .. .. 0' il il il il il '" .. ~ " e ~ j 5 .... ... ... .... ....... ... ... ... ....... 0 .... '" .... .... .... .... .., ...." ""." .... 0 e-~ CON CON CON 1:'::1 CON ... "'" .... "':>\ "'" ".... ...... ..... ...... ...... .. N ...'" :1'" ..."., ...'" ""' .. .... .. "., ,.. '" :;~ :;~ .... .., "N ",,:8 ...'" " "'" .. .,,'" .,,'" ."... 0 "" -5'" 8'" ...tJ ... "tJ .... .... ... .... .... 0 "" " ,,'" 0. ~!:t :l!:l :l!:l :l!:l :l!:l -5 t; <Ufo< =H B!:l ..... "'lij ...... ".... "'.... .:3:0: .:3... .:3l!l ",0 "'0 "'0 "'0 "'0 '" 0 ....0 ",0 11>0 .!. I ,J, J. J. N .... ..: N ...; .; .,.; .,; ,..: cO ~ si ..: ci "' -::: :, . .. . ' . 1 :t, 0 0 ~ 0 ~ ~ 0 '" .... ;..; ~ '" .". .... .... .". "" "'" II 00 ~&.,I~ 0 0 00 0 ~ ...4cC .......:r .~ ..; 0 ....~ ........ '<) , .... -4' ........ .... "'.. .". 0 .... .". 0 0 0 0 ~ o. .... ~ U'\ .... .... '" .". 00 """" i.~. ........ ........ -4'0 q~ ....; ...; . 31 -4' "'''' "'''' "'Q ..... ..... ..... II 8- " 0 .... .. t'~ .. ~.t ... ....... ~ ".... u 1: ~ fl'Q go ~: .. <It ..; .; :0 .... .... . COUNTY OF JEFFERSON HOMER SMITH AGENCY PRODUCER CODE POLICY CHANGES SECTION I: ADD TO FORM 56-75 : ITEM 1149 1978 JOHN DEERE GRADER IIJD770, 115789 $ 1150 1980 PK 40 PUTCH KING 113722T 1151 1979 PK 40 PUTCH KING 113038 SPECIFY FORM NOS, AND EDITION OATES AFFECTED BY POLICY CHANGES; Coverage Loc. Bldg. Description No. No. 56-75 SECTION I-PROPERTY COVERAGE LIMITS OF LIABILITY RATES Previous New Previous New $ 597 813 $ $ $ 666 69 $ $ $ $ $ SECTION II-LIABILITY COVERAGE LIMITS OF LIABILITY COVERAGE Previous Naw Previous SMP Liability Insurance Form: g~~~~g~n~:ti~r: Properly (Combined Sin Ie limit) Premises Medical Payments o SMP liability Insurance form o Medical Payments Covera e Part , 0 Forms other than SMP liability Insurance form Specify Coverage Part ea. Occurrence ea. Occurrence A ra ato Ag ra ate ea. Person ea. Person ea. Accident ea. Accident BODilY INJURY LIABILITY ea. Occurrence ea. Occurrence ea. Occurrence o Revised Dual limits: FIR -.082 Aggregate Aggregate INSTALLMENT PAYMENT PREMIUMS Previous Installments $ $ 2/2G/-lH Additional Premium Oates 01 sUbsequantlnstatlmenls, 2, if a able in annuallnstallmenls: 3. PREMIUM DUE AT EFFECTIVE DATE OF ENDORSEMENT: Tot,nor remainder or policy term: MP 12 01 (Ed, 02 19) Previous l 7. PREMIUMS New Roturn Premium $' Revised Inst.llments $ $ " _ 118 CHANGE IN DECLARATlONS-fNDORSEMENT A648 ~:Thls e~dorsement, effective on 8-20-808 at 12.01 A M. sta,lldard tIme, forms a P. policy No ~1-000-7 'Ed.I.BO) .,'ofthe ,l:NDIANA INSURANCE COHPANY ~ I;sued to,IEFFERSON COUNTY Agency at HOMER SMITH 1180081 @ PORT TOWNSEND, WA . " , , , .,.. ...,.... ,.. Authorized Represental1v& It,isagreed,that the'p,olicy is amended as indicated by the foJlowing items designated by an "X": DThe,lns~red's' na'meandlor address as shown In ITEM ONE of the policy Declarations is changed as follows: I NEW TOTAL POLICY PREMIUM L~ . 0 r~re !~~~~%eS~~~~r~::(~~i~~_ :r~M CTVioa~rrner~;,Tc~E~~~f;~tfoe~~.w,and for, which an additional or return premium is indicated, repJaces(re~lace)'the Iimit(s) ,:shown B The Coveragefsllndicated by areturo premium in SCHEDULE A belowjs (arel hereby terminated. '. The CovarageCslindicaled in SCHEOULE A beiow for wbich an additional premium Charge is shown is larel added to the policy and suchCoveragelsl appllestapply) 10 the autos indicated by the Covered. Auto Designation symbol(s) ~rom 'Declarations, ITEM THREE shown in the"COVEREOAUTOS" column in SCHEDUlEA. ,0 ;~~w~u~~~os~;:C[;b"~P~Ii~;b7;Dg;~r~g~~II~W are hereby inciuded under lhe policy Coveragels! indicated in SCHEDULE A beiow bylhe additional, premium charge ~ Th,eautofs) described,in SCHEDULE 8 below are hereby eliminated from coverage under the policy Coverage{s) indicated in SCHEDULE A by a return premium.',' G TheCoverage(s) Indicated by a return premium In SCHEDULE A below is Carel hereby terminated for Covered Aut,ofsl No.tsl,\..............,:'.._.. .:....,;-.....:."..,:.:.:.......'.~....m:.'..:'..'......., .., 3-12-81 SI/dg . SCHEDULE A "I COVER EO AUTOS (Entry of one or more 01 the symbols from ITEM THREE shows which aulosale coveredaulosl >' , ... ,". liABiliTY INSURANCE PERSONAL INJURY PROTECTION (P,I.P.) (or equivalent No-fault coverage) ADDEO P.I.P.(or eqUivalent added No.faullcov.) PROPERTY PROTECTION INSURANCE (P.P.I.) (Michigan only) AUTO MEDiCAL PAYMENTS INSURANCE .'. UNINSURED MOTORISTS INSURANCE ',. LIMIT THE MOST WE WILL PAY FOR ANY ONE ACCiOENT OR LOSS PREMIUM I COlliSION COVERAGE TOWING ANO LABOR SCHEOULE 8 (NoIAweil.b~ ...C.I>Ior".. " S SEPARATELY STATEO IN EACH P,l.P, ENOORSEMENT MINUS S Deductible SEPARATELY STATED IN EACH AODED P.I.P. ENDORSEMENT SEPARATELY STATED iN THE P.P,I. ENDORSEMENT MINUS S Dejuclibie FOR EACH ACCIDENT S S $ $ $ ACTUAL j$ Oeduclible FOR EACH COVERED, AUTO FOR ALL $ g~s~oWgf LOSS EXCEPT FiRE OR liGHTNING REPAIR, $25 Deductible FOR EACH COVERED AUTO FOR LOSS $ wrJCL~~~ER CAUSED 8Y MISCHIEF OR VANDAliSM MINUS $ Oeduclible FOR EACH COVERED AUTO S $ $25 for each disablement of a private passenger auto ' , $ $ TOTAk RETURN PREMIUM $ $ ..u..>. PURCHASED TERRITORY: Town & Slale Where Ihe Covered J Original Cost New I t~~~~ ~~ro \~l) Auto will be principally garaged Additional Return $ ~7? $ $' , COMPREHENSIVE COVERAGE $ $ $ a $ ~' = ~~ ~~ ~= 5;;l ~z SPECIFIEO PERILS COVERAGE 24. . I Covered ~~~, I I DESCRIPTION Serial Nu~e~:r ~~~eVe~f~J~el~::;i~fc:l~gX ~~~bllr (VJN) AS PER 01-54 ATTACHED I I I I SCHEOULE C '-. Coveled Alllo No: DESCRIPTiON Year Model; Trade Name: BOdy Type Sell" Number IS). Veh,c1e Idenlllicalion Number fVINl Dllllinal Cost New PURCHASEO Actual NEW (N) Cost" USED CUI TERRITORY:. Town & State Where lhe Covered Aula will be principally garaged , C,'",~d R.d'" " No Operll~" {Inl.Mnl BtUlnUI use J=setvlCe t=rtl.il c=tomm', i-I"A' SI::r (lv~ic~CW ~'e SU!inIC,tp.Clty (loup Plim..ry Ratml F.ctol SllcondalY R.tlng raclor Code EXCEPT FOR Towing all physical damage loss is payable to yauand the loss pavel! named below as inlerests may appear at Ihe lime of ' the loss .." COVER^GES~PREMIUMS. LIMITS AND OEOUCTlBlfS (:~~e'T~oo~gl~~~uf~j~~eeO~~~~i:itil~I~~ i~f~~~ ~~ff~na~~~:S ~~~~:d\hallhe limil or deducliblo cnlty In the correspondIng l.IABILITY PI,P AtPp~.D ~~~~,~~~~ AUTO, M[D PAY ~WrJ~I~~~ COMPREHENSIve S~[EWFtr~o COLUSION T~~h~~& Ca;:.,:d LUM ~I~~: Lirllll. l.lml'. Lim'l Lim'l PIt. li~tl" limll" ~~~.; $25 pi'll No f~~:. PrrmlUIlt ~~e :'~e~ Pfemu~m ~~e :/:~ T~~ll' :I~~ T~~lJ' /lHUm ~~~~1I :1~1I~ P'lImlum d~t~e;I~11I P'lImilJm O~:~:II' Unlfs) Delollil' be!". undll Unlfs) billow below Ptemlum Tal" Add'l Premium .~~*"~~ '~'~~~~f LIWhl '11tl'd In .,:ft ,tpl<.bIt' PI p,. Adll~ P.I p,'" PP I (/IlfOlurn,nl %~~~ ~''R'%:.~~~ :~~~~'% ULmll1 sl.ltd In Ail W... 01 thft Puhe, PK""'mnt ~,~~~~ U'U'OI"" '1I'IIUUtB " Ill"". DIV, , ' 117 CHANGE IN DECLARATIONS ENDORSEMENT .1hls endorS,ement, effective on 8-19-80. at 12.01 A M. standard trme, forms a P-70licgY. 1-000-784 Of. the INDIANA INSURANCE COMPANY -;;('/ ISsued 10, JEFFERSON COUNTY ,nEf!tfr ,_ . Agencyal HOMER SMITH 1180081 @ PORT TOWNSEND,WA " " , . ....~"j,:;n'p'.""t,tI" A64B (fd,l-BOI It is agreed.that -the polley is amended as ,indicated by the following items designated by an "X"; o Th~l~sured's name,and/or address as shown in ITEM ONE of the policy Declarations is changed as follows: NEW TOTAL POLICY PREMIUM 1$ '. IJr~; 1~~~~s~:~0~~r~f~g1il:r~:Mc~oa~lc:~;np;IY~yEDo~~1a~I~~:~' and for which an addilional or relurn premium is indicated,replacesCreplacel Ihe IimltCs) shown o The Coverage(s) illdicated by a return premium in SCHEDULE A below is (are) hereby terminated. ' - , o The',Coverage!s) indicated in SCHEOUlEA below for which an additional premium charge is shown is (are) added 10 the pollcy and such coverage(S)apPliesiapPIY)'~~, the '. "", : autos jn?jc~ted :bY theCo~ered Auto Designation symbolfslfromDeclarations, ITEM THREE shown in the "COVERED AUTOS" :~olumn, in SCHEDULE A, _' : . 0 ~~~w~U~~~los~r:C~Weedad;[j;;b~;D~;;er~g~~)~w, are hereby. included under the policy Coverage(s) indicated in SCHEDULE A below" by the. a,ddltion~.1 ,prem~u'm-charge [XI Tneauto(s) described in SCHEDULES below are hereby eliminaledfrom coverage under the policy Coverage(slindlcaled in SCHEDULE A by a return premium,,:-' o TheCOveragefsJ indicated by a-return premium in SCHEDULE A below is (arelhereby terminated for, Covered Auto(s) No.(sL.:.,....:.....,,:.... .:.. _.....:..........,....;.....:.;.....;.............:.., . '., ',' , ' ,_ I ?_Q' eT ' ' , " , , SCHEDULE A ",,' (Enl~~~~~~~r ~~~eOo~ the LIMIT PREMIUM , ',', symbols trom ITEM THREE THE MOST WE Will PAY FO" ANY ONE "'-," , ',' COVERAGES sho~g,,~~~~ha~~~~i are ACCIDENT OR lOSS LIABILITY INSURANCE S PERSONALlNJURY PROTECTION (P.I.P,1 SEPARATELY STATEO IN EACH P.I,P. ENDORSEMENT MINUS ;,_-,:,: (or equivalent No.fault coverage) S Deductible :" ADDED P,I.P.(or eqiiiva'lent added No.taiJlt cov.) SEPARATELY STATED IN EACH ADDED P.I.P. ENDORSEMENT ,;' PROPERTY,PROTECTION INSURANCE (P.P.!.) SEPARATELY STATED IN THE P,P,I. ENDORSEMENT MINUS (Michigan only) S Deductible FOR EACH ACCIDENT AUTO MEDICAL PAYMENTS INSURANCE $ . UNINSURED MOTORISTS INSURANCE $ ~ ~ COMPREHENSIVE COVERAGE g~~~ml:gfj S LOSS EXC~~d~:~~I~~~~G~~~~NCGOVERED AUTO FOR ALL ~ ~ SPECIFIEO PERILS COVERAGE WREl~I~ER m Deductible FOR EACH COVERED AUTO FOR LOSS ", <=> ~J LESS CAUSEO BY MISCHIEF OR VANDALISM . ~;!; COLLISION COVERAGE MINUS $ Deductible FOR EACH COVEREO AUTO 0.. TOWINGAND LABOR !..~~~~~~~bl<I $25 for each disablement 01 a private passenger auto SCHEDULE B . ITOTA Covered DESCRIPTION PURCHASED ,~u~~ Seri.l Nu~~:( ~~~e~e~r:'~l!I~:~IW;C:t~:~ ~~r::ber IVlNI 1 Orillinal Cosl New .1 t;~i~ ~:ro ((~\ Additional S Return S ',Q/. S S / S S ',. S S S S $ S I? S S " S S In S $ S S RETURN PREMIUM $ S <?~ TERRITORY: Town & Slale Where the Covered Auto will be principally garaged Ie """ nl_<I, I I , SCHEOULE C Covered Aulo N. , .' OESCRIPTION Yellr Maflel: Tnde Hlme; BolJ~ Type Semt Number (5); Vllhiele Idel1llllcdtlol1 Number IVIHI PURCHA ED Ofllllnal Cosl New t;~~i1l ~:ro ((~)l TERRITORY: Tow'n& Stale Where the Covered Auto will be principally garaged Coverfd Aulo R.III'" 01 I,' N~. ~~~I~~~) BUSlneSlule s=-sel'\llCo r""reUIlI c::cornm'l CL^SSII A It( N 5'~~r ;~;c~cw G~:f! Sealln.: c..p,clly UP PllMary Rilhnll FaClor Secondlly Ratlnll Facial Code EXCEPT FOR Towing all physical damage loss is payable to you and the loss payee named below as inlerests may appear at lhe time of the loss '. COVERAGES": PREMIUMS, LIMITS AND DEOUCTlBLES i:~~e~WOolc~I~~~uf~I~~e Ob~~r~:a~I~I~~ i~f al~~ ~o~n~n a~~~:S ~eS~~;d\hal fhe limit or deductlbh! entry hllhe correspondIng ,,: LIA81l1TY f'.l.1' A~p~O ~~~rh.~~?t~' AUTO. 1.4(0, PAY ~~lr6~,~~~ COMPREHENSiVE s~~~rLI~D COLLISION T~~~~~ <<. C~t:ct limit ~~~: Pr~. Unll'- ~~~: Pre- Llml' Pre- Llmll PII' L~~~~:e PIe. Limite. L~~~~e: ~~,~~:~ No T~~nU' P'rrn'l,jm ~~(I "uum Pr,rnium ~~c.o mlurn 1~~:- nllum T~~". mlum ~~::~e m!um Premium tl~~~'~I~'1l Premium ml'lnl und" belo. belfl'lt unds) unds) DillOw b~low PremIUM 10iii Add'l Premium ?W~~"'~:~' ~::$~~'t~ pm., ,l.aIN In u<:" .pph,.~lt 1" 1', AadU I"" or P P I, f/ldol\..rnOllnl ~~~~~~~ ~~~~ .~~~~: el.1rnl! 'l~lltd In I Wu 01 tlle Pc'.c:, DeclaratIOns ''i!.~ Ufoll'O,...""tfolll"G, 'U"L'(DIV. " - 116 CHANGE"IN DECtARATlONS ENDORSEMENT ' AB4B >-"coo . ,"','''' ",,',"'~ "... o. ~OOO- '" (fd,l-801 . 1'hfs _endor~ement, effective ,on olth. INDIANA INSURANCE COMPANY ~ issued to, ,JEFFERSON COUNTY .'( r~- Agency at HOMER SMITH 1180081 @ PORT TOWNSEND WA ,..........,.,. ......,.,........,.,.....,....,...........,........... ..................."........... , AuthDrlzed Representallve , It is agreed that the policy is amended as indicated by the following items designated by an "X": I NEW TOTAL POLICY PREMIUM D'The Insured's nameand/or address as shown in ITEM ONE of the policy Declarations is changed asfolJows: 1$ [JThe' limitCs) shown opposite the Coveragefs) in SCHEDULE A below, and for which an additional or return premium is indicated, replaces(replacel the Hmit{s) . shown forthesame CoverageCs)In ITEM TWO of thepoHcy Declarations. B The CoverageCsllndlcated by areturn premium in SCHEDULE A below is (are) hereby terminated. The Coverage!,1 indicated in SCHEOULE"A below for which an additional premium charge is shown is lare) added to the policy and such coverafelsl applies lapply) to the ,:' ,a~IOS,jndj_ca.led by I,he Covered Auto Designation symboHslfrom Declarations ITEM THREEshovm in the "COVERED AUTOS" column in SCHEDU E A. o Tl1e. auto{s), described ,in' SCHEDULE C, below ,a~e., hereby 'included under' the. policy Cov_eragefs) indicated in, SCHEDULE A below, by the additiona,I,_premium ;charge~ . :', shown opposite 't~e -applicable Coverage(s). EI Theautelsl described ,in SCHEOULE B below are hereby eliminated from coverage under the policy Coveragelsl indicated in SCHEOULE A by a premium, '. ',",', The Coverage(s) indicated by a return premium in SCHEDULE A below is (are) hereby terminated for Covered Auto(s) No.(s) ::....;"....._...... ',.. ,.. .'. 3-12-81 SII dg SCHEDULE A COVERED AUTDS liMIT (Enlryoloneormoreofllle PREMIUM .. ,. COVERAGES symbolslrom ITfM THREE THE MOST WE WILL PAY fOR ANY ONE , shows which aulos are ACCIDENT OR LOSS Additional Return coveredautosl LIABILITY INSURANCE S S S ~O/. ...'. PERSONAL INJURY PROTECTION (P.I,P,) SEPARATELY STATED IN EACH P,I,P, ENOORSEMENT MINUS , ,', (or 'equivalent No.fault coverage) S Deductible S S ADDED P.I.P.{or equivalent added No.failll COY,) SEPARATELY STATEO IN EACH AODED P,I.P. ENOORSEMENT S S . PROPERTY PROTECTION INSURANCE (P.P.I.I SEPARATELY STATED IN TIlE P,P.1. ENOORSEMENT MINUS (Michigan only) , S Deduclible fOR EACH ACCIOENT S S I, AUTO MEDICAL PAYMENTS INSURANCE S S , S UNINSURED MOTORISTS INSURANCE S S S lU. >, COMPREHENSIVE COVERAGE .~, r "~.,"OO - _eo.ro ~ '" S S ',' '" ~~f{ili~: LOSS EXCEPT fiRE OR LIGHTNING 49. ~~ .'.., ::~ S25 Oeductihle fOR EACH COVERED AUTO fOR LOSS S S .. ~~ SPEClflEO PERILS COVERAGE SS CAUSED BY MISCHIEf OR VANDALISM ~ Z COLLISION COVERAGE MINUS S Oeduclible fOR EACH COVERED AUTO S S " ,', ~ TOWING AND LABOR l:g~~,~~~!::~ $25 for each disablement of a private passenger auto S S " SCHEDULE B TOTAk RETURN PREMIUM S S ~~O. ,'...'. Coveted PURCHASED TERRITORY: Town & State Where the Covered Aulo Y"'~T'" I Orillmat Cost New I ActU.l1 NEW{N) Auto will be principally, garaged No, Serial Number Number (VINj Cost'" USED (U) 48. INS. 1/214, 195:J OUU/4 I ~u-v., 59. INS. 1/215) 1970 GHC SUBURBAN TCS~ooF"~"4O" I ~ o-v " . SCItEOULE C Coycled DESCRIPTiON PURCHASED TERRITORV:Town & State Where the Covered Aulo Yeal Model; Trade Name; Bod~ T~pe Orillin..1 Cost New Actual NEW (N) Auto will be principally garaged I,' No, Serial Number IS); VehIcle Idl!nllhcation Number IVIN Cost & USED (Ul " L II I N Cov"f!d R..dillS at BUlmeSSllle Sizo GVW, GCW Primal)' SecondJry EXCEPT FOR Towing all physical damage loss Is payable to )'OU and the loss Auto Opeutlon S"",e'lIle, olVllhlC:le '" R~tinll R;tling Code payee named below as interests may appear at the lime of the loss No, !;:::IIeull G,Ollp (tnM.ln) C!:lcomm'l St-,!inlt.1ll,1cily factor faclor .,' COVERAGES--PREMIUMS. LIMITS AND DEOUCTlBLES (Absence of a deductible or limit entry in any column below means thai the limit or deductible enlry in the correspon'ding ITEM TWO column in Ihe Declarations of the Policy applios instead) LIABilITY P,IP ~OOEO PROP, PROT AUTO, MEO P~Y, UNINSURFO COMPREtIENSIVE SPEGlFlED COLLISION TOWING & " PIP, {M)ch onl~1 MOTORISTS PERILS lABOR Covl\'r.d lImIt Llrnl!- Liml'- l,ml! l.!mit L,milu limit" S2~ por Aulo {I, fIllnu, PI" Limit- minus Pre,' (t, PIli' (t, p,~ ml""l Pre. llmi'-- mlnUl Diuble- No Pffiniu," drWc:tlble -.."., d<<luctlble delfuclible Premium Tho":' sho"," m,ufQ Plemlum shown mlllm Thou' mlllnl Thall' mlum shown mlllm P,emlum shown mltnl '''ndl) belo* belo1W Urtrfs) sandi} bello.... belo... r,emium 48. ~u/. 1 ~. ~~. '!JU. 5. 49. . T Olal Add" Premium ~"%.'t't ~~~'{ ~,'~~~ ~~\~~t\ ,~~~~, .~~ " Lltllll s!.alld It'I tx'" 'I)p/<Ulr. PIP, Alldfd P,l 01 P,PI (ndo".menl "lImll SWelt In I EM 'nO 011"11 Polity Oecl.ar,1tlons ll"IFOAlII '"1"'1110 I Sll',U D '00"'"' This schedule is made a part of Policy No. FL. SCHEDLItE - COVERED AUTOS Y09N 01...000.:.784 . of the INDIANA INSURANCe COMPANY, Indianapolis. Indiana. Issued to ~Ofl QQTJIiTY' ITEM INSURED.S YEAR MODEL, TRADE NAME. TYPE BODY, MOTOR OR SERIAL NUMBER NO. NO, GROSS WEIGHT OF TRUCK 1.3. 23 1971 CBEV llllMP TIlD'CX CE6.3lP2254S 10001 24 1973 Di'1'EIilIlATrOlfAL PIT JII2OOCB:BS3296 3001 .31 1969 CBEV llllMP TRll'CK: CE639P817SSO 10001 32 1973 P'OllD 1 TOll PIT l!'37YHB2do39 34 1976 CBEV llOMP T1lITCK: CCE666vlOO579 CHJn" UIIOIl;& l'lI1XP !I.'liIrCII[ CD673Vl37600 , ';"",.,".':l',~il;~!'~Wl:~ii 37' 1973 CBEV llOMP TRUax:, C0E66JV174101 20. 38 1973 CBEV llllMP TllI1CX CCE66JV174138 21. 39 1969 CHEv llllMP TIlD'CX CE639P8169S6 This schedule is made a pan 01 Policy No. FL. SCHEDULE - COVERED AUTOS YO~N 01-000-784 of the INDIANA INSURANCE COMPANY, rndian~polis, Indiana, Issued to~tJ'BTY ITEM INSURED'S YEAR MODEL, TRAOE NAME, TYPE BODY, MOTOR OR SERIAL NUMBER NO, NO, GROSS WEIGHT 01' TRUCK 47 ~~'L. lJUHP TE1CX ' 4194AFA90170 --.----. - ..-.+_.... ~..----'- SO 1954 GMC ASPHALT DBL l342616390 54 1972 :roJUl 4 DR. SEDAN 2PSU'1)8250 55 1964 DlT'L DtIMP TllIJOK: , HPl80~.344 58 1968 Pli TILT TAILER El578 59 1974 Pli TILT TllAILEIl 8207 61 1m CBEV'i T. PIJ CCL447J1.5')633 71 1960 IWlWOlml TllIJOK: TRACTOR 72566 73 1966 DlT'L IllIMP TRUOK: 45'60800188734 76 1969 CBEV' :ooKP TRUCK CE639P8175'44 TERR, 8001 10000/6 331179 017 --- ' (2;45') 4000/6 33499 (2.50) 4/6 7398 2000/6 33479 (2.45') OVER 10000/6 67419 (.25) OVER 0000/6 67479 (.25) )001 450016 '01499 II (1.00) 8000/6 36499 (2.55') 331179 (2.45) 331179 (2.45) This schedule is made a part of Policy No. 01-000-784 'FL. SCHED~LE ~~~~~E~E~;~~~~~~~'~ Issued to JEPJ'ERSOll cotlliT!' ITEM INSUREO'S NO. NO YEAR MOOEL, TRADE NAME. TYPE BODY. GROSS WEIGHT OF TRUCK TT 1976, CHE'7 mMP TllIl'CK: 35. 80 1970 CHE'7 1 TON PI1 81 1970 CHE'7 3/4 TON PI1 82 1976 CHE'7 mMP TllIl'CK 89 1953 J'BIJEIWD' TRULER 95 1974 1l'.I!ZL"I'l'r '.I!BAXL1!lIi 97 1952 GI'lC~ T. 6X6 WATER 'l'AlIlOm 98 19$1 (Xl ~ T. 6X6 WATli:R T.&lIlICm 36. 37. 40. I~~t~~=~,~ . "'''-:'.. ",'.::' '.'. ~:...,..,. ....... .. .... .'. "."',' ..,". , ,..".'." "". ..'.' " ..": .'. ',-~ 56. 15 1978 POII'1'UC JlCIImEV:I:LLE S7 . 2' 1978 POIITIAC CJ!1'.ALIm 4 DR. sa. 8;) - 1973 III'l'ERllJ.TIOIUL 3/4 '1'. PI1 79. so. 1).3' r,.,J/ 1979 (Xl 5 Yll. llUIIfp, 1979. GMC 5 Yll. llUIIfp, 'is 1979 (Xl llIJ:SKL. 5 Yll. JflrC70042 1l2. eg q3 1979 GMC llDISEL 1979 ~ 5 Yll. ~/j2 83. of the INDIANA INSURANCE COMPANY. Indianapolis. Indiana. MOTOR OR SERIAL NUMBEA CCE666vloo597 CE3)OJl67S32 CE2IlOn66678 CCE666v100S73 ws32S5 WA721S305 03779 'l1'7ll1l!1T6.302l1O ~~~"tn Q{.7::l c~ '-IN 29.563/2 29563/2 S,P, %'1') COST NEW CLASS TERR. L,.lll. ~:3/ r:- COMPANY CODE G G ~G CTI 0 PREMIUMS ARE DUE ON EFFECTIVE DATE OF POLICY HOMER S. SMlTleGENCY P.O. BOX 591 PORT TOWNSENO, WA 9836B PHONE 385-3711 FOR ALL YOUR INSURANCE NEEDS REAL ESTATE JEFFERSON COUNTY ENGINEERS COURT HOUSE PORT TO.mSEND, wn 98368 INSUREO'S "''''ME IF CIFFERENT FROM CUSTOMER FILE 1]/14/71 E1'FECTlVE DATE IIM;.~;A; -;;q I RENEWAL DATE 13~~-;~Y~~R ~56Mjjol DESCRIPTION OF COVERAGE ADD 79 G14C DIESEL, END #21 I 10S 00 ] ADD 79 G~lC DIESEL , ADD 79 I 210 00 I Gl.;C DIESEL, END# 20 I J ADD 79 GNC DUMP TRUCl<, ADD 23d.OO 79 GHC DU~lP TRUCK, EtlD #19 I , llALANCE' 8XP eo D49.00"--- 1 HOMER S. SMITH ~~~~9h) AGENCY . Cl '" 0: ii: >< '" : I ~I I I q(i ,.. f-I- 0\ i f~ It '. " 0 "0 f" u t ~ ~ ~ ~ 7 I i C' .:; ~~ " ~ 0 I , o! ir ~! ". 0 0 u u : 8 ! i ~ ~ ! , rL ! ~ 0 ~ u ~ r ~ i " ~ ~ ! I~ ~ .' , ;... :, io, . .!.. :'. .- I '; , i:..... ' .. .,! .!..- "", ri;;}'!.';, i 6 ! .... ?:: ~ ,;" T':~, .. - ~- c ", .. ,n ~i c! : .~ L. " ~ "', , "" ,. .: ~i', ~L, <. . ~ ~, ~ c -p: eel." , ":~_:__:__~ ,~~ Y",., p",,~ -:.:>; ," c i~ T, 'R~7'- ,~~ > n' i. ;'~ ~" ~, ,< ,'" / '.: ',,~ ., . ''''-,-_, ':~ .", ~ " .. - ,~,~ "7~, 'J'^'~' /.. , 1" ,ni~ "" · , .. ~, i ,<, ~, ',. ,7_,,, ' 1:1-, -'" >7." 'i~~ I, ~ i--:~ ;p,~" < :, c.. ~ 0:'" ? 7 ;' " .: _".. '..~ ih ' ~ c_" , c,,, '" ! ~_z '~',., , I : ~ , ,,:~, 110_ ,p J~, 31 7 . ",p,'4" ____, ,5 '" ... ~'"- -V coo.,. -;~. qq, d ,~i~ i' . , 7. 'r ! J~ -'~ ~,;, i '~ cc -, .);. . ~, ~_. ,'3,' g. '. c, ~ 'i:' -, , . , ; '''J. < :m, ~ .~ 'p, "..'!.~ _ i "', ~i '?~: ,~ '_, "'" ...~' : ~I~' I ,~~ '" ~ '''.~ "", ,; ,'. ~',~~ , i ,- ,s' · ~, : P.',."" _ '" 'L ~~, ,"' ~" c. ' '_~' , ~ n.:_ I,' ~'i ; . ~ '~i ~''''~'" _ ~', _ '- " '--- -. . . n.: -.n__L_ '__'; -;;-:;:: ~: .. ~ -'.. --.- , -- -- ~c-, "<;' ,"S '~ -- . " ~ ,~~ : ~ · " , .' '" ~ Ii'I.-' ~~,.,; ".. "" f",,,~8'r,, ~ 1: _~~~ -- ,~. . ~' ~: · i' ;i i '. '" . . - '- - - e . " ~, --=---' L, '~f'i7'r<' i ~~~~', n p ." ':,:. ~,::, -. ,i _ :; , . ::: _: -.- .. _ , ", .~, ~L, ,_,. n.~., _ ' :~., ; ;~'~ ~ ~- i ~ , ~ : _, ' ~~ ,> .. ," ''',~ , '7 " ,~~,~ ,'~ . -, ~ ~ ,~ ~~ ' ~ ' ~" ": 1~, ' r r': : : ,,~ , ~ .. .., "r.', ;,' ~~~: c' , ~, ' ~~ ~. " i,I '". ", :.. 'f' !'" '. '~~'E':"- -j-- " _L-" 'I '",: , . ,.. . ~,~ nl .. i~-" ',' ~ ~. ~ , . _, " ~; ,. ~ - i . -f "'.,. ;;0 d'"f i',.. :, ' J 'I,: .' .' ~,~ :~ .,,/ ,~' dP:+'" ~"', ',~ ; _ " 'if'[~F" , - , ":'., ~ I" ~. L . , i , . :, ,. , .' : ,,~ i- ~" ' ': . ,j, i ~ " , '.. " i . , , "P' :. ~ " , '" , n ! ,~ ~ I,. 1 " ",.. ~ " ' ' i :" '; I , . _i", ~ i.' "'~.. ,i ..~.., ,~~ " , . ~ , n.. '., ' \';;',,; , ',' ", ' , .. ., any_way amelld, extend Of alter the coverages alforded by ~aid policies. ,Thecomp,ny will rn:lil to the, party to whom this ce,.le is issued a nolice 01 caneellalion of said policy "iles but takes no responsibility for failure to do so, HAMf AHO ADDRESS OF PARll TO ,"HOM CEllllflCATf IS ISSUED, UNITE:D STATES OF AMERICA. DEP A!m'!ENT ,OF :tL\ VY C/O '0/. H. m;!lIDS-RE:ALTr SPECIALIST _..~_~AT. -~~~ ~~~s:.TOlI~..=.::::~.:;:;;:~. . BOMER SM:!'m A.GElICY qO~ '1lA~ fi'T'llRl1T' FLEET SCHEDULE Tl1ls::;chcd:11e is mad:! a P:Ht 01 Policy !la, _1..2~l.2~339.-.:.......-~---_.- or the 1~IOIM1A l~~Sl!RA.NCE C0;,lPM1'J, Indis:1apolls, f:1u:ana, :"''''10 _~ON CO~ '- WAS.!J:QlS!~N ,.' .'i,~:'\ ."";"~~'s r ' ,"" "'g~Jh \.::,~~i'~F"i"W,E "",. 1~ i · 54 i ~971 FORD CUSTOM 4 DR. I ! ~972 FORD CUSTOM 4 DR. .__,__~~~:L~7-_-.----- 197J.CHEVROLET DUMP TRUCK #24,000 ---l-----~~;:-:" ".,,, ":J,~;,;-----r"'-;~;;;;;;~---'r-'~~i:-;R~i' --------;---.---------.----- ---1'-----'---1.-, -. i 11'515~ 79347 i 4-:-6 I 12P511':L3825~ ! 4-6 \' 3H~OCBB53258 3-5 cE6311':L22529 4-6 1811.69 7939 ~973 IN'l'Efu'U.TIONAL 3/4 OON Fa 1,'6,000 1959 FERGUSON TRACTOR MOWER 1964 FORD MOL. 4000 BACKHOE LOADER . liability _is Jssumed by tha ciJ~;:anyol1 each of the J'JtJr.!Jbiles Ii$t~d her~;r. 01'1; :or t~I::;O:; "(~::;fJge5 for ,,'.t.i'~l:7;;;:;cillc p~i~;-' clmge is. e.,tered -;-t~p. fe5pecth~ spccirieu.- 1973 GMC, RALLY WAGON 1959 GALION GB.A:DER 414445 TGX163U5J.3561 118H01856 7917 5-5 7917 LIMITS 0; LIABILITY DY CO'JER.\GE -f,om",,, r-=r---r-- r:'r-;-r;:-;;n:- .;''Jt'''''Obil~ A~:o-' ' " c"",p,'.' B~ci:1 illjufY IllJ:)ilo! ,tr:-,",'Jllt of Ctll~~:Ci'1 == E3~t: Ear;~ PrJO'Ht)I I' ' IrlSur31'lC'C J.m~\;I'l~ ';,,:';';;;'.;..t I Doc.lf f'C!r$Ol\ Or.c.ur, c~:::~.~_~J~P];~ or';'CV ell p~~, i t'! ~:J~ ~~lt 0: I Ill/11ft or;"::' 500 1000 100 NIL AfN NIL --r97.oo 48.00 II II " " AfN '\ 97.00 48.00 NIL II " " " AfN " 55.00 37.00 NIL II II " " NIL ACV 134.00 92.00 NIL NIL II II " " NIL " 550. .160 INCL. INCL. NIL NIL II II " " NIL " 2,000. .280 INCL. INCL. NIL NIL 197.00 48.00 4,000. .280 INCL. INCL. -'''--'TiiT:\'sl!--~---- ------- COVERAGe o....:-COMPREHEHSfVE.,;.;.from an)' 'c.1use except collision; but, fOf t;;R' of each IllSS caused by malIcious "'mls~hitl or ~~~dlllisnt'\l"l." I,Qm n,~ 1',"""I~' ~gJ:gts~ ~:e~h:~e~r~e:~~~ce~~~lI~f~3~r:r~~i1~~U~ned3r'tOhS~U~:~s~~p~lsl~ss:I;~' o~3~I~fi 2. The camp.my will pay: (om mol ion, malicious mi~chl(lf or vJn~fJlI~m, w:Jter, flood, Dr (as to it coverlld COVERACE V-TOYlHIG"':for towing :lnd labor costs neccssltilled by the disable. ~~IQ:eQ~'~:mQ~d t~~l~~~::l~:scl!:I~I~lo~pe) collidlnit with 3 bird Dr animal, sh311 ~~~ll~~e~~~erej automobiles, provldl!d tho labor is performed .:It the plilce of , COVERAGE P-COlLlSION-<,""d by colll.lon, 3. SUPPlEMEHTIRY PAYMENTS COVERAOE Q-F1RE, lIGHTNIHG OR TRANSPORTATION-em'd 'by In .addilion to tho 'ppllcobl, limits olll'blllly, tho company wlI" . , (3) WIth rttspcct 10 such ffJnSporhtlon InSUfilnCQ ilS Is a(forded heroin' PilY gOne~al (a) fir!! or Ii;hlnlni. il\'r.r3~1l :lntf sal'lJge) cfmBt5 I~r which Ih~ named Insured become, leglJlIY lIahlel (bl s~o!llet.l~ SrntH~:;J C:::e 10 II sudd~n, 'unll~uJt ;!~"I f3Ult'l o,\!oti=:n of an' ~bl ;ril;~I::oc~~;r~3~:to~~::{I~doJ~ht~f! evant Or.1 theft cO'lorod bllhls '"'UnneD " " " II AfN " 1lIL II " " NIL " NIL HAME AHD ADDRESS Df PARW TD WHOM CERTIFICATE IS ISSUED, , 'mTITEll STATES OF ~A ':DEPMiTMEllT OF UAVY 0/0 W. H.. HE:RNES-REALTY SPECIALIST ,~~AT. "R.~rpA.rrri1!._nTU'TRTON' --":':'~~:7;'~~_.._, .._~~~., FLEET SCH EDU LE l'hisschcdule is made apart of Po Hey No. 12-J.2~3~_~___ of the IND!ANA INSURANCE COill?ANY, Indi3nailolis. IncJ:a:la, Issued to __~~'b'l!:.~<m. COllNTY .....w...ASHING~~__TERR.ITORY..1~_--------.._._____. ~::1"3;'" 1197, ,":::l~'~:''':::: ~~,,J ,,f,~;;:;~,,~T~-I1!.! . ! I I 34.1 35 I ~973 CHEV. ~lDEM DUMP 1136.000 , CME673Vl37600 5-6 35. 36 i ~955 LEROI COMPRESSOR I T.B.D. 79~6 36. I ~973 CHEV. DUMP TRUClt-SINGJ.E .AXLE #24. Of 0 CCE663V174J.01 37. 38 I ~973 CHEV. DUMP TRUOE-SINGLE .AXLE #24.000 0CE663V174138 38.39 '~969 '. CHEWROLET DUMP TRUCK' CE639J?8~8956 39.1 40 i ~966 CHEVROLET 3/4 TON PIJ #6.000 C2546Z14332 1~0. 41 1 ~959 ,ATHEY LOADER 11699Hl7 _L-_L ITEM ,0, '''Il:Ci''"::t'!i'~ Bt:~ll'i IlljUry [l~ll r:~~!i P'mc'ln 0.:.::.1(. LIMiTS OF L!~B.ll\T'( OY _CO'iERAOE ~u:\:~i~ ~~o~~'Of :;;i~;~:r MEDICAL! '~~u~~2~o ~._- ~II 1:'l3!.1ranc.! or AC'.' liabilily is 3ssumei.! !;, the comp;n, 011 each of the automobilas l!:;t<!d herein.ollly for those cr.'lerages for which a specHic premium charge: is (!:ltered. sp~cified. . ---. Co:n~lon Amr,unt 01 (l~d, 500 NIL ACJV ACJV ~Ooo ~OO NIL II II II II 250. ACJV ACV ACJV II " " ." II II " " " ;. tt " @L.50G " NIL 5.000. -- -- ._~-_. -. ~ '. ..~...._"......." ....I lhlQ1.:JJ"Jl'.::J~_ II 700. II ~\;'JJ. ~r,:;~.!. ::,:;:.\' .,~, , \ I~\. " " - ~T;;,:"m'bl" ~;j~}~ ~34.OO ~34.00 92.00 NIL .280 ~34.00 92.00 NIL ~34.00 92.00 NIL ~34.00 92.00 NIL ~34.00 92.00 NIL 55.00 37.00 NIL .280 TOTALS j_ IN~_ INCL." -t~- NIL .,")gO I; ~, :r';r OO.S ~20'.;. . .s~F.J ~Ai.iE AND ADDRESS DfPARTY TD WHOM CERTIFICATE IS ISSUED, UNITED STATES OF .AMERICA DEPARTMENT OF NAVY C/O W.H. IlERNES-REALTY. SPECIALIST 'Rli!A T.' la'l'l'A'l'RnTVTRTON. . H01-IER SMITH AGEnCY 901 WA~ STRElllI! FLEET SCHEDUI_E ;Ti:i~':;'C;,;duI9 ismadaa piln of Policy tb. ..!2-128-~;3~___ of the H;D!i~:j.; INSURl\:;8E Cr;i.:P;,:;y, India~ajlLJil:;,lnrHana. . Imed f'. JEF.E'E!lSON CO~ WASJmlGTON ~().!!J.l,7_..___.___..__.,._._._.___,----":' ~~.. '":" 1964 ...::;:':'"~:: ,,~.ooo J-=~;:;;,';2i'~l&~'=-tC",'! 50. 56 1967 AERSOL TAR KE'l'l'LE WN67336611 I 7916 :: I : I:: == ::: __ :;;:36'" Ii ::~6 53. I 59 I 1973 PW TILT TRAILER 52077 6-4 .54. I 63 1965 UNIT SHOVEL MODEL 614 6523.5 ]7917 ' ;: I ~~l:::;;::'~:E:;~{~~._____;:. __ Li<;:;il:ty i!..Jssumed by thecl1mprHljl on 'e;,;h of Ihea:J1G~~bHes listed herein only for IMs<' CJ~erilzp.i for wn:Cl a sp~cHlc. prc:niUJli 'cha~ge is e:ltim.:d if 1 thE! r~spec~i"'e ~p€~ili~d. ~ .'sl/tomob-lfi!! ;rrcM I" BOlllf/lrl;::r( t.c., "~~;;n' o~~~~. 49. boo 1.000 :{ :~:I" :: :: :: :: .:: 9~:0.1 .280 5.5.1 11 11 11 II II 11 400.1 .160 .J6.t~. ," _~_,~_ ~_. _!..:.~~{,:~~~ '/'_ ,. .h.... "*""'~l""(1'1~\;i1:-j::J!".vulti~:P 1~~.a~:{.Q~~~~!L- TOTALS j 11 LIMITS OF L1AoiilTY B!~~E ~=--~T":':'=:::['~~==------:'--?ilEM1U..IS BY ca m"bll~ J1~'"'' ,. 1;011<"" [!iccocc I I, ":.I!C"'cl)lI~ ,l,utl'l~ob't" I c,~~~.. P:;;::V I I~~:w~:c~ I ~'IM;J'nt f::::w~: ;':;f Ii,l . B:.j,ly "roOlU':/ h "n~';~. Cl~:n,)l" IMEIDICAL I or :..cv' ~Oj 0:11 1~~uA~nJc -J1 ,nil/I)! Oil~I.ltu :MEDICAL . 100 I NIL NIL-- NIL ' 2':~~~ '~~52 /134.00' 92.00 NIL 500.{ .280 ! INCL. 500.1 .280 INCL. lJ.OV ' 3.4.00 14.00 " " " INCL. NIL " " " " " INCL. NIL " " " " NIL INCL. 9.00 9.00/ NIL INCL. NIL INCL.: NIL I INCL./ NIL t-'---i- , --_L__-j"':":' :~.T' ~ CO.!! DICL. INCL. " r:'o')J' .:5$1) I!~ /I S'~CO. .~~O :m mlITED STATES OF .AMIJ:RICA DEPARTMENT OF UAvr ~~?T,'Y;c<:~~~~:n SPIDIALIST . .'lER SNITH AGE/ICY 'IJ\Il'I. l;ATF.a STRE:l!;T This'S1;r.eduie.i~ madea,p<:n,-of'pciicyNo. __12~12~339_~__~_ of the lNnrM)~ HlSURMICE COMPM:Y, Jndi,lnapo:is..lndianil, FLEET SCH EDU lE I,;ued .ic _~ON_QOmm:._W~ElIN:G'l:PN_____:TERRI'l'ORY_l'L_______..____---,-_____ 'ul!.~" I i':"~~:D'S ! :--;'A' "5iJis i;tl~;'i~~\,1~~' ;~;~:'---r--";';';~'~:~'~~I~::;;'-'--'T" --s~~~~~'--F-dsiR;; 65-:r;---!1970 C~~L~-;-/4' ~N ;;-;'-.-~~--'-'T~~0;;:66~;8--'-'- -''''I---;'6'~T-- 82 ! 1975 CHEVROLET 5 YD. DUMP TRUCK 1124,ooo! CCE666VlOO.513 5-3 I ! 1968 CHEVROLET 3/4 TON PU #6,000 CE248Zl6!M3 2-6 I ! I ~:;: =~;PREADFIa: I 1953 FRUEHAUF TRAILER WS3255 4-6 I 1953 .CA'l!E:RPILLAR AUTO 'PATROL 3U3817 I 7939 I 1953 MAL ASPHALT TAIDr T55053 7917 -,. ". . . .... ,-.- -----.---------"":----:--:--~.~ -liability is mumed ny th, ""'p"y" mh of tha ,u,emsb;:" Iist,d 10"''' o"ly for le,-". CO""',,, for whi" a ,p"'fie PlemiuITJ c,or?e i, "'eredio"e :"peeti': spec-Wed" . =:JC::::=-~-Pa~c I ;, ",m,"" "f';tom," " I I r,fl~'g ,. ~~c~~~t: ~;~~~~. r- 55.00/37.00 134.00 92.00 " " 55.00, 37.00 u LIMITS Of LIABILITY By COVERAGE ;Aut:m::!)iJ\l I,:lto.~ CUmp. Collisl:jn Fi~". T~~ft i!o ITeM EIi~g'Wyrlll~%!t mobile A~:)u~t cf Jlme;;"t ~ ,.~O. Prc;:~r!1 MliIDrqAL In"~uJn:e cID,!d. . "s'-'~ ~,~ C <l P",r~on O':ccr. D.1m'!;1 or AC.." ~ ACV "65. 500 1000 100 NIL NIL NIL ACJV .. " .. ACJV " " Arw INCL. " .. .. .. 1.500. " .. NIL " .. .. .. ACV " '.. .. .. 4,000. " " .. 3,000. ~.,~.........'tf'oi'u~)\)I...t':L'l"'nl,t'i~~~~~.hJ;~~~s o~i,;Jj:-- '-- < ''-';-'~''''-'"-~.I.U' .280 INCL. INCL. INCL. INCL. 14.001 9.00 .160 I nICL. INCL. _~~~~. L-=-L.I_~~L. TOTALS II i " " II ~ " " .. '--l OO.S ~tc",\ 21~. ~r'JlJ. rJji- " l'.:5'i..\j:';O. ':i!;CI Z;:r: \Sl~GU' .~'~~ T~p. " J'1?)O~(). .r~J I'""" .j... . L ~crTR AGENCY 90~ WATER STREH;'!! FLEET SCHEDULE sch~d:jle is made a parte! Policy No.1.2-1~339__~ of the INOIM1A lNgUIlMfCE CN,iPAiIY, l;1dianapolis, Indiana. I"oed to ,_~OliJ CO~.. W~HJ;NGTON ~l;~QgL:j,7~_,_._._--- "I5Y,6EO'si "" "2RJ~s 1'~tl~i,;'~'i'iR[{Z/ BODY. ---==1' -:';~:;;:~::~;':~;;~_.._l'~~:'~;__.. g~,)" . Ii 46 1~958 PATCHING MA.CBINE TllA 7916 96 I ASPHALT RETORT BEATER TBD 79~6 ~952GMC 2! TON 6%6 WATER TANKER #36,009 037799 ~951 GMC 2! TON 6%6 ~TATER TANKER #36,006 ~830 ,14 ~972 FORD 4 DR. SEDAN T.:B.A. ' 4-5 ~6 ~970 PLYMOUTH FURY III T.:B.A. 4-6 20~ ~970 PLYI10UTH FURY 4 DR. W/RADIO PM41TOm90~o8 4-6 202 '~970 PLYMOUTH 4 DR. ___ _PM41~~~658~.__ __ 4-~ liabi:ityis _355umed b:f the company on e.1ch of the autorr.cbiles ,l:st<?d herein only fer thc.;~ coverages for which a specific p:emium Ch3i;;f.l is, entered 'intheresoecti\' specified. . LIMITS OF LIABILITY BY COVERAGE" I Au!o.. CCl'l"p, COlll$lr.n Flr-l, Th~n & I ;'titomobilo m~OII~ ";nI}:J1'l~ 0' = PrG;~rty tn5ur~rrC& Amount iHll~l.:"t ll! aodUi' Oam,l!Je ~lQ4L' or J..C'I of Oed. 'H\lrJntn Injury or ACV .500 ~ooo 100 NIL NIL 500. .280 II mCL. tl II II II tl 350. .280 INCL. tl II II II NIL ~37.oo II tl II tl tl NIL ~37.oo , II I II II II ArJV II nJCL. I 97.00 II .11 II II ArJV II nICL. I 97000 II II II ArJV II 97.00 II II II Acrv II '-TorAlSJ~~~.~~ __-1__ ~:-:.-;,_...... ....V~.~..dhvr~n",$r..g ,d.".U~~!. .iL~lt '::'0": l~'';; omitted\ ...,. ..OJ, _, .'~_I.,.:.. t:!-.,-:" ~u;";" '\"~i.;.'t.;~."::v:r":I' ~,. I., .\". .. }'GOO' '~8':; .~! .\J'. " 1:Ir.OO' , ~.(!v ::; .\0. ',\:A IT 1':,)' ~ ".J: l' )'., Jl.utcmoblll! Propl!rtl D,1ma!l:" n<eL. INCL. II 94.00 II 94.00 II 48.00 II 48.00 II 48.00 II 48.00 II .f{ .-','. 'IIH 'UN: 'Un CERTIFICATE OF INSURANCE _ that the following policies, 'Ubje.lhei, term" condilion, and e,"lusio", have been ie by thi, Company, bul thi, certificale does not in e:dendior. :Jlterthe . covaragesafforded by said policies. wiUl1laiJ' to the 'party to whom this Certificate is issued a notice of cQncellation of said policy or policies but takes no responsibility for failure to do so. ADDRESS OF, PARTY TO WHOM CERTIFICATE IS ISSUED, UNITED STATES OF .AMERICA DEPARTMENT OF NAVY C/O W. H. IlERNES-llEALTY SPECIALIST ~~A~ ~~A~ nTVT~TnN . HOMER SMITH AGENCY #80081. 901 WATER STREIL'l? FLEET SCHEDULE is made a part of Policy No., ~2-12~3J__.____ of th~' !NDIANA WSURMiCE' CO:;;PAN'{, IndiJ:lapciJ5.I:1dL::J:11; issued 10 ,~Jr!!!@.Q.N COUNTI'..L...W~SB:qi~~__~Q!!-L:J,.7________~. r T ~ ~ . '\l~ '- ,------1-.---------.--------r----.-----r:-'~ I YEAR r.W~6ks;..~F.:~~ri'o'F-h1rKt. Boor,. '[" i.~OTOR (If! S~q:,\~ I,U.',lBER, I S1.'.~BO!...' i 'g~si i 1.968 CHEVROLET JlISCATIlE .--'---r-~4~~-8J2161.20-----.-- 4-6 i PM4J.TODl9004l. 4-6 1.974 CHEVROLET CHEVELLE 4 DR. 10290424621.30 4-4 1.974 CATERPILLAR 1rl DOZER. 1.974. UTILITY TRAILER 3 AXEL CHEVROLET DlPALA. 2 DR. 94N7525 7917 1.-4 4-4 T.B.D. lL47U4C1.07l.29 1.974 JOHN llEE:IlE :BACKHOE 7D4J.0 791.7 1.975 OHEVROLET 5 YD. DUMP TRUCK #2h. 000 l CCE66VJ.OO597 i 5-3 , ---------, ---...--.--____,._l__-'-_.___ UJbiIHi' ,isassu:-ned by tl;a c:)m;any on each of th~ automoc:!es listed hcr~in on!y for tho.se cl.lV~rar:es for which a specific prc!'nium ch1rgeis e:'l:e~ed in the re3pectiv~ spf.cified. ITEM NO. "),:.:.;.onoblll! I!oe'lj Injury E;.~" (.J:h t'ct1el1 CC:'Jr. LIMITS Of LIABiLITY' BV COVERACE Auto.. I Ccm.,. mob;:\! t'.'r.cu:'lt M ~;Jo~;~~ MEDICAL L l~~$r,,~~se Callisi.,n ,1rnoutlt 01 O~d. ----11". fir,]. rl1~ft !. - = 11.1\0.1111'-" In'll.or,lIIC(l or Ar.V Aut(l'nobH!1 El..:;i!y l:'Ij;J'! 500 1.000 1.00 NIL ACV NIL II II II " II 71,1.30. .280 97.00 48.00 I 97.00 48.00 I 97.00 48.00 " INCL. ;OL./ " NIL 14.00 9.00 ' " NIL 97.00 48.00 INCL. mCL. " II II II " " II " " " " " 97. ::/: :: : I AaV :: ~L~J_~~~___~I :;____ ;;: '.\11 "r,.lT'~lr.:.W~ in Ilt'JtJ~~I1:!~ of rJ~llM1 Il:UI H:rC'e INO~ orniltcr1.\ .",~;c.;~O ..ri.~I' cO:'Gtrfc~a ":'~:1():~~CS\~!E:'It: ArJV .280 IOms Thl'S,:h'd'';' i'm'd, a,p3r'ol Policy No, J:I!k339----- 01 th, INDIANA INSURM"O'.iPAN'/, Indi,,,,,nh,, Indi,,,a, ,I',""d" ~>!!;;;!~~~..QM__Q..Q,~,..!INi ,_GXQ!i______,._..,_,____.!l'E!!RIT9RY L,. _.., ......._...,... ,_, "'; I .".., .. """" "''' '0'" W' .,,,' -,~" - r-~ ~::,;;;:::;~ :,,:;:;"'-' i -;;~,:~--T"J,,,", ';.,:.o.'I'...,NO.;. GR05S~"EIGHTOflP.UCK I _~~~__ I _~~__~~ I 102. : 9 SNOW :PLOWS 7917 I 103. ! SANDERS , 7917 ! I 104~ I 1976 CBEVROLEr 4 DR. PANEL 105. PAl>lEL CKU166Fl$2789 CKU166Fl$2770 2-2 2-2 _L__L .. .~--.,---~"~.,,_~1 liability .3 aisUJil<:d by Ij',3 COmr;;Il'f un ~~<:;hijf tlla "ai.:tcmc:Jil::s I;sted hE,c-;;; l)r,.y 10; tho:;!! cm.;r:Jges flJr which a specific premicm- ch<lrge is enter~d in ;'spc.::Hiect. IT(M .'10 ....\ll'lm"biip. g';<1ilylr.:ur/ EJ.~,h ~J,:h f,,:'\~n Cco;:~r. LIMITS 0; lIABllIrY BY CO'IERAGE u'-;" temp. C"I,',','n""'lf~'::I' ;";":I'!! ;'::l<;:ull!of ~ ;!ro:;t:ert:;, I I~stlr;:n<;e ";rr:~t..r.l ,<.;;i1>lr,t Cf" I :;:"~J,"~ ~.!CAL I cr ,:C.... of OeJ. ,(;:.$u~'hnJ~ 100 NIL NIL NIL 11.200. (9) 700. " " " " " ACN " ';ut~motlHe f.utcmobilc, .1 r~j~i:: P:Oi:~rl:f Oa~;Ji!t: MEDICAL .280 INCL. INCL. NIL .280 INCL. mCL. 55.00 37.00 " $5.00 37.00 " 102. 103. 500 1000 ;,' 104. 105. " ACN 134.00 I ..<J"..I:':f_lllll.reS,~Sho.,yn~Jn.JhoUS!!ndS of dollars (L<:l~,i,thrl!e zuos omitted), . TOTALS, r-, x-YlliliO VrI' coA;.;r'=i:CiZ2.... s01fci? &n:']1."8'f.'I'OIl'AL 12.478) ,!..P 185_.,QQ..3132.0 NON OWNED AUTO 6.00 1:!II' VGA r?f' 00'$ ;~I1" jCJ)~..~S. 'S80 :.;;( 'II1l " " .,ttl.\. <:.V 00'$ "t.GA, n" " ..l,r'r~lJ' ':.:;<JO LH ,U' , " 0", ';' -',::1'~: ,~, ~ ~e;.;~-"" ....~ 'I .....................'............- ............................ ;0000 000 , t- to; r-; t-; ........ ........ t- ,r- r- ......... ~ E~! ~ ,.-.,... ""- q ~ ~ ~ ~ ~ I ~ I !?::"'It:::: t::: t:::' ";:;;,.- ,... ~~t:::',... ,._ il -np ,.- ,... ,... _................ .,.... .,..... ,... -.- ,'::" l:r"~_U_iU_~_H-cji 11!~~i Ii L .', . ..' . .!~ li~~i t ~ ;1 II !:I ~'" 'f i ,~ .:r,-v.! 8 ~M i ~ II' _":\_-:3"____6--' i'! '.' )= II, 111~"__J: J: J: Ji ! ,,; ~ <=:'. ~~ ~ ~ I I I! l'i II II ~ i II: ~ 1/; ~ ~ I j Ir-I I! 1 1.1 L<: ii, ~ I; 0 Ii II ~~ '~'_' ! ! :~ I'~ r;,z~l i~ I H~! 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Court House or 'Administrative Office BuiJdinR's - square rootage 7. Are there any County owned cemetllri es? Yes - No_ 8. Are there any County owned mausoJeums? Yes - No - List an,)" owned housins;: projects. Land Le..ed to Others- DcrClDf:e Use $ $ $ $ $ $ D. AUTOMOBILE LIABILITY EXPOSURES Attach a list of owned vehicles licensed for highway use and mobile. construction equipment. showing .year built. manufacturer. body.'type and cost. vehicles as follows: or Scooters - one ton or less or Paramedic Trucks Collection Trucks Fh"e - Pumper Trucks Fire - Other Trucks fire - Cars Trailers Misce11aneous (de'scribe) Number of Units Road Department Sheriff Department Rem~ of County Operations NtA NtA NtA NtA NtA NtA NtA -- NtA NtA NtA NtA 10 jl 61 .;: ~ ... tl tl u... u... ~CI) ~CI) '" '" ~I ]1 E 5 ... ~ ~ ~ ~ ,.., ~ ~ .. !f ~ ~~I ~~I u .. u .. ~'" ....'" 'till 'till ..'" ...'" ~ ~ ] g~~:,^'J)~~... ~ CD i ~ ~ ~ ~ ~ ,.., ~ .... 1""4 ~ ~ ~ .!1 s ~ ~ ~ ~ ~ co ~ i CI) ~ ~ ~ ~ r-i ~ .... ~ II II ~I ~I u"' u"' Uo-< U.... ~'" "'" ~ ~ A ~I !\ ~ ,.., 8 r:l ~ ,.., ~ ~ ~ ~ '" " l2 r:: u 0 l;j " ::l ~ ~~I ... ~~I ~i U .. ~~ ...'" ~z ~ .. ~ .!1 I ~ j ~ ~ ~ " ~ .... ~ 1""4 ~ ~ ~ ~ .!1 ~ ~ ~ ~ ~ ~ 11') ~ ~ ~ ~ ~ :!l :!l :!l ~ ~ - . . D. AUTOMOBILE LIABILITY EXPOSURES AttAche list of ownedvehiclcs, licensed for, hi2'hway use and mobile construction equipment,. chowinz year built. manufacturer; body. 'tYpe.ad cost. Par. medic . Trucks Truck. P~p.r Truck. Other Truck. C.r. (d..cribe) . l'101 Appllc.ble Number...o! Units Ro.d DeDartment. Sheriff DeDl!lrtment. N/It. N/It. N/It. N/It. Ntlt. NIA HIlt. NtA N/It. HIlt. NIIt. :ilt . Number of Units Remainder Dr County ODcrations Road DCDartment 6 N/A . - 4 N/A 3 N/A 2 N/A 0 N/A 5 N/A l' N/A N/A " NtA construction equipment N/A Road Department $ 2 41 , 220. alaxlmum "alue of vehlelea and mobIle construction equipment ear'Red . at one . location: . _ V.lue Address County (exeludlnR Road Dept.) Road Department $173.208. 371 Chimacum Road Hadlock, WA. 98339 Doea County operate or affiliate wIth or finanelall)' aupport an~' uanalt diatrlct. uanalt authority Or dlal-a-rlde prol:ram (includinlr eIderI)' and handIcapped a)'.tem.)~ I( )'0., deacrlbe: N/A N/A N/A .. (. E. HISTORICAL EXPOSURE INFORMATION Summarize, the. CounU'.c ',historicalexposuTe' infonnation On the (exclude, information lor, hospitals. Dursin&: home~. department. and Ro~cl..J)cpar1.meDt). Endin~ Ceneral Fund Balance County Payroll ;.- Total Vehicle Counts 3,479, 758 ~40 3.407,873~51 .3,357,766 632,058 3,491,195 568,770 3,724,347 499,388 610,121 3,693,754 Not avaIlable yet. the Road Depanmcat.-. historicatexpOlure lnronnation on the chart below: Ol'eratlnir Budl!et .Miteazc Dr JoIiIea~e or State Road. Total County-Owned )IalDtained VehIcle PaYTol1 Ro.da by County ~ N/A N/A N/A N/A NiA 757,629 824.316 NtA N/A N/A N1A Nf,A N/A N/A N/A N/A N/A N/A N/A 408.2 N/A N/A 418.37 N/A N/A . . l' exposure infonna- Number of Jail Vehicle Payroll OffiC?ers Capacity (Beds) Counts 782.740 26 17 16 709.012 25 17 ' -16 706.523 23 17 14 23 17 14 22 17 15 12 37 16 . '. LIABILITY LOSS HISTORY Calendar Year of Accident No. of ~ Paid to Date~l ~ Amount of Ca~e Reserves!ll AmouDt Total Amount Incurred Cenerat LiabiJitv...(excludin2 hosph;.j';'nufsil12 homec ..nd Road Department) 1982 0 0 0 0 ,- 1953 00 0 0 0 01984 0 0 0 0 1985 0 0 0 0 1986 0 0 0 0 1987 0 0 0 0 Losses VAlued a.. of: 12-87 AutomobiJe Llabi1lt~. (excludinlt Road Department) 1982 0 0 1 112.00 1 1113.00 0 0 0 0 0 0 0 Unknown Un kn own 1983 .. of: 12-87 Liability - Road Deoartment 3 15;478.00 0 15 ;478. 00 3 2569.00 0 2569.00 457.00 0 457.00 2 304.00 0 304.00 353.00 0 353.00 281 00 n :>91 00 vlllued'.. or: 12-87 (. 2773.00 0 2773.00 15.6.9.00 0 1569.00 5 758.00 0 758.00 5 537.00 0 537.00 . .3 547.00 0 547.00 2 548.00 0 548.00 0 0 0 0 0 0 0 0 n Un known 0 n Un known 0 n 0 0 n n n 'n n n n R17?oo Unknown Unknown Un~nown n ~ :nctude anome)'.. fec.and other case-specUic expenses other than adjustor fee.. 2. Check one: The claim r:Ount Inctudea an claims The cl.im count excludes cl.ims clo.ed wIth no payment . . , 5 LIABILITY LOSS HISTORY No. of ~ Paid to Date(l) Amount of Case Reserve:s(l ) Amount Total Amount ~ 0 ~ 0 I'J JL l) 0 -D- C) () () () - 'l:> 1) "" 0 ~ 0 o IIC-z.,..,oo II 1'3,D() (j o o o UP 1:".0."''''; -~ ~'" 1~-3, Ie; Y'~ Of ~ I ~ '-1'7B. oD d~'?"o 6 ? Q-~ 9,00 - 15"":) .~ 0 1./$;7. CD "2- .J 6,/, "0 0 Sf>-/.D1l ~ I ~!S-t3; oll ~ S.s~. tJe) f .2::l1. {)iJ 0 2-ill,ou valued as or: I z.,..-Z7 . 16 :J." ./ -z,77? 0 ;; '7 7..3 . IQ~'} .-0 /~G,,9 7b'i? 0 7.<~ S ...53? 1) S""37,' .3 <!,<-l> D ;;:47,00 1- . DC/I> 0 SY8,o I;) :'/ Z I o as of: Profess'ional Liability (3) ;() _'V U 'D '5 I va lued as 0(: ~ tJ 0 0 1) 6 1) () u....k..ow___ 'b lL",l...,..>.... 0 ~ () '0 ~ V 0 - 'l) 0 U u 0 U () 0 () 'i? 17 d' .. V "r,,~. u.. ,^,\:...o~ !..AAJ ~U'lP..v :nc1udeattornt!)..s rces and other case-specific expenses other than adjustor Icea. 2. Check one: The clairn count includes all claims The claim count exciudes claims closed wiU. no pD)'ment ;,~' 0 r:) ~ .~.... ;~ .;.~. ~~I N ~ ~ Oil ..... :; ~I'- ~ ~ 0;' ~ ~."'I u... "'" ~ <l<) <:> <;J ~ l' ~ ~ E ... ~ ... I ~I -~~.~~;?' !~ 1, ! ~ :I ,~'~' c8 ~ 'J i ...... ...::: ~ ......- <' ~~tW ."...~: . ~cf\ ~ I : ~ ~ ~ ~ H <S~ r~j~ .. "'/.1 ;:J \J ~ ~ lJ J'~li ~ 1.""'t. ~ ~ j-;<t~1 ~ ,,~~-c~..... I \ l.i ,.l 't: ':l U Nr-, ~~\: ~~ $ ! ~ : :a i pot ~ ~ '" ... <0 <0 <0 <0 - -... ~ .~ b" '" ~I~~ ~ ~ '~J' ~n,~ ~l ~ "':;j:: p.S I;, I' ... -..... . ~(V) tl U... .gtn A ':;::)~'O~~~ & ,., <) ~ ~. . , :J ~I ~ ~ .; ,,>' '" ')^ , ~ . ., " . . " - -' -..' .:: -' ...:: r:l ;:l ~ ~ ~ < ~1,* t j:~~"~ f:::\)~ ~ ~ .81 ~ ,... ~ :: tf'\ M H :o::;~-~~ ).!, 0 V\ -t: '"";i- S t ~~ 1. ~ """ ""l. -rq;--!.1J,J .". -,... u ~ .> , .... \,,- '-s .. ~-... N,\ ~~~" :::-!!!: ! ~ ... ~ i ,... ~ ~ '" ... _...:l it; ~ .-4 :=.4 ! . D. AUTOMOBILE LIABILITY EXPOSURES . Attach a list of owned vehicler. licensed for, highway use, and mobile ,construction equipment., "showin2' year. built, manufacturer, body' tYpe, and cost~ follows: Number of Units Road Department Sheriff Department N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A (describe) Rem~ of County Operations 10 ~ .~I ~ ... tl tl u... u... ".. :gel) :! '" ~I ~I ~ ~ ~ ~ I r; ~I ~~I ~'" ..2 'tig ~i ..... ~ ~ ~ .!1 . D. ' AUTOMOBILE LIABILITY EXPOSURES . AttaCl1,B li_st, of owned -- vehicles licensed for highway use and mobile' construction equipment, showing year built. manufacturer: body -tYpe '.snd 'cost. or Scooters - 'one ton or Jess - Pumper Trucka - Other, Trucks .Cars (describe) :\/A . :\ot .~pplie.ble follows: Number of Units Road Department Sheriff Denartment Remainder of County Operation's N/A -- NtA N/A NtA NtA NtA NtA NtA NtA NtA NtA 10 2/14/93 REIH nL RATE ACo. DATE DESCRIPTlOlI $191.97 $290 PER MDrITH 3/19Bl FORD FAIRMONT $97.02 $2BO PER MONTH 5/1979 PONTIAC CAHLINA $ 92.32 $300 PER MONTH 5/1981 OMC PICKUP $101.36 $ 9 PER HOUR 3/1971 CHEVROLET 5-YD ,/ $ 17.06 $ 15 PER HOUR 4/1959 FERGUSON TRACT ./BRooM. $ 36.11 $ 15 PER HOUR 1/1964 FORD BACKHOE $203.26 $ 15 PER HOUR 3/1979 HF MOWER $175.20 $280 PER MONTH 4/1981 FORD WMDrI $92.88 $ 0 PER MONTH 12/1973 CHEVROLET CHEVELLE $ 91.51 $ 20 PER HOUR 10/1968 HOUGH LGADER $ 39.81 $ 0 PER HOUR 3/1961 KoLMnH GRAVEL SCREEN $181.97 $280 PER MONTH 3/1981 FORD FAIRMoUllT $17B.17 $ 40 PER HOUR 1/1980 ETNYRE CHIP SPREADER $181.97 $2Bo PER MONTH 3/1991 FORD FnIRMounT $ 99.41 $280 PER MONTH 3/1979 PonTInC BONnEVILLE $ 17.40 $280 PER HoNTH 7/1973 PLYMOUTH 17. $ 59.63 $300 PER MONTH 9/1979 CHEVROLET SUBURMN $ 32.91 $300 PER MONTH 8/1970 CHEVROLET PICKUP $ 81 ;10 $280 PER MONTH 6/1977 FORD LTD $ 57.23 $ 0 PER HOUR 2/1957 BnY CITY SHOVEL $101.36 $ 9 PER HOUR 3/1971 CHEVROLET 5-YD ,/ $101.36 $ nER HOUR 3/1971 CHEVF:oLET 5-YD v $101.94 $ 9 PER HOUR . 3/1971 CHEVROLET 5-YD v $ 32.93 $ 20 PER HOUR 6/1981 UNIPRo WACKER PACKER $161. 84 $17 PER HOUR 12/1969 CATERPILLER GRADER $201.46 $ 17 PER HOUR 12/1969 CATERPILLER GRnDER $ 49.63 $ 15 PER HOUR 4/1963 TOPEKA MOWER $l99.07 $ 17 PEP. HOUR 1211972 ". CMERPILLER GRADER . $ 28.BB $ 15 PER HOUR 5/1957 HUBER ROLLER $ 63.23 $ 20 PER HOUR 5/1957 MICHIGAN LOADER $ 6B. 96 IS"'$ -91'ER HOUR 10/1968 CHEVROLET 5-YD/,,-,kA>J>ICt- $ 47.67 $300 PER MonTH 11/1972 FoRII 1 TON FLATBED $ 27.74 $ 6 PER HOUR 1/1970 GRADE-HORE SLOPER $143.91 $ 9 PER HOUR 12/1975 CHEVROLET 5-YD.-' m5.68 $ 9 PER HOUR 11/1972 CHEVROLET B-YD/ , $325. i7 $ 17 PER HOUR 1/1991 JOHN DEERE GRADER $ 96.57 $ 9 PER HOUR 10/1973 CHEVROLET 5-YII-" $ B6.57 $ 9 PER HOUR 10/1973 CHEVROLET 5-YD.-' $ 69.96 $ 9 PER HOUR 10/1968 CHEVROLET 5-YD'/ $417.04 $ 20 PER HOUR 6/1977 HICHIGMl LOnDER $ 52,95 $ 20 PER HOUR 12/1959 ATHEY LOnDER $434.88 $ 17 PER HOUR 1/1981 JoHI/' DEERE GRADER $236.00 $ 9 PER HOUR 9/1979 GMC 5-YD $ 6.75 $ 20 PER HOUR 12/1962 7 SPRAY HACHWE $ 96.57 $ 9 PEP. HOUR 10/1973 CHEVROLET 5-YD..... $ 19.82 $ 20 PER HOU" 1211980 MILLER CURBER 1145.29 $ 15 PER HOUR 9/1974 JOH/! DEEnE B^CKHOE $ 86.45 $ 25 PER HOUR 8/1962 EUCLID S-7 SCRnPER I 39.00 $ 28 PER HOUR 1/1954 Or.C DISTRIDUTOR $161.54 $ 15 PER HOUR 4/1978 HF HOWER - 1 - ,.,. . EQUIPMENT LIST DEPREC. RnTE NO. PER MONTH RENTAL RATE nCO. DATE DESCRIPTIDrI 52 $ 68.53 $300 PER MONTH 5/1978 GMC SUBURBliN 53 $353.86 $ 20 PER HOUR 2119BO TEREX LOADER ;V $101.37 $280 PER MONTH 6/1977 FORD L TO $115.49 $3$PER HOUR 10/1963 INTERN';,T. TRUCKITRACTO -- D / S-,-; 56 $ 23.99 $100 PER MONTH 5/1981 TOTEM-ALL TBAILEB 57 $ 31.98 $ 8 PER HOUR 6/1967 7 TAR POTS (2) 58 $ 32.35 $100 PER MonTH 5/1968 PUBLIC WORKS TRAILER::::/ 59 $ 60.50 $100 PER MOIITH 10/1973 PUBLIC WORKS TRmER 60 $355.66 $ 40 PER HOUR 5/1974 CliTERPILLER 0-7 DOZER 61 $ 43.91 $300' PER MONTH 4/1977 CHEVROLET PICKUP 62 $ 58.37 $300 PER MmlTH 12/1971 FORD LID 63 $105.69 $ 35 PER HOUR 7/1965 UNIT SHOVEL 64 $100.35 $ 15 PER HOUR 2/1980 O,;LION ROLLER 65 $ 43.91 $300 PER MONTH 1/1977 CHEVROLET PICKUP 66 $ 59.43 $ 14 PER HOUR 4/1979 ? CHIPPER 67 $122.85 $ 40 PER HOUR 6/1967 INTERNAT. TD-20 DOZER 68 , 51.32 $ 25 PER HOUR 11/1955 EUCLID S-7 SCRAPER 69 $ 57.38 $300 PER MONTH 1/1972 FORD CUSTOM -70 $ 44.79 $ 15 PER HOUR 2/196B FORD 8,;CKHOE __71 $ 39.18 $ 35 PER HOUR 1111967 KENWORTH TRUCKITRACTOR -IV $ 80.06 $ 15 PER HOUR 4/1972 FORD BRUSH CUTTER -.1; $ 77.80 $ 9 PER HOUR 1/1966 INTERNAT. ,-YO '{ _ 74 $217.25 $ 9 PER HOUR 10/1979-'- GHC 5-YD ~ 75 $337.07 $ 40 PER HOUR 8/1979 C,;TERPILLER 955 TRACK LOADER 76 $ 6B.96 $ 9 PER HOUR 10/1968 CHEVROLET 5-YDV' 77 $143.91 $ 9 PER HOUR 12/1975 CHEVROLET 5-YDV' 78 $101.37 $280 PER MONTH 5/1977 FORD L TD 79 $385.16 $ 15 PER HOUR 6/1990 FORD/ECON BRUSH CUTTER 90 $ 46.B8 $300 PER MONTH 8/1970 CHEVROLET PICKUP 81 $ 32.81 $300 PER MmlTH 9/1970 CHEVROLET PICKUP 82 $143.91 $ 9 PER HOUR 1111975 CHEVROLET 5-YD ---- 93 $ 29.06 $300 PER MOIITH 2/1973 INrERNAT. PICKUP B4 $ 7.50 $ 20 PER HOUR 8/1980 GMC 6X6 -2 112 T 85 $221.72 $ 9 PER HOUR 9/1979 GMC 5-YD 96 $ 7.52 $ 15 PER HOUR 5/1953 ? SPREAOER BOX 87 $ 13.72 $ 15 PER HOUR 5/1971 7 SPREADER 90X 88 $277.15 $ 9 PER HOUR 9/1979 GMC 5-YD v' 89 $ 27.38 $100 PER MONTH 7/1953 FREUHAUF TRAILER 90 $ 22.50 $ 17 PER HOUR 10/1953 CATERPILLER GRADER 91 $ 3.61 $100 PER MONTH 4/1977 PUBLIC WORKS TR,;ILER 92 $ 33.75 $175 PER MOHTH 3/1953 RmL ASPH,;LT T,;NKS 93 $221.72 $ 9 PER HOUR 10/1979 GHC 5-YO 94 $ 97.13 $ 15 PER HOUR 5/1981 CASE BACKHOE 95 $ 22.74 . $100 PER MONTH 5/1974 PUBLIC WORKS TRAILER 96 $ 82.32 $300 PER MONTH 5/1991 GHC PICKUP 97 $ 62.63 $200 PER MONTH 111981 P,;TCH KING 9S $ 3.50 $ 15 PER HOUR /1952 GMC (MOD) 'JATER TRUCK 91 $ 82.32 $300 PER MONTH 5/1991 GMC PICKUP 101 $ 4MO $225 PER MONTH / BlIDY PLOWS (9) 110 $ 36.75 $126 PER MONTH 1/1969 S,;NDERS (7) - 2 - RATES FOR AU-rOMOB J: LES MAf<E MODEL RATE 1981 FORD FAIRMOUNT 378.42 PER MONTH 1978 PONTIAC CATALINA 286.53 PER MONTH 1981 FORD FAIRMOUNT 286.11 PER I'IONTH 1981 FORD FAIRMOUNT 330.35 PER MONTH 1981 FORD FAIRMOUNT 33el.34 PER I'IONTH 1978 PONTIAC BONNEVILLE 187.97 PER MONTH 1970 PLYMOUTH FURY 91.56 PER MONTH 1977 FORD LTD 221.83 PER MONTH 1977 FORD LTD 213.16 PER MONTH 1977 FORD LTD 213.57 PER MONTH IS 253.98 RENTAL RATES FOR DUMP TRUCKS It YERR MRf(E MODEL RRTE 1971 CHEVROLET 5-YD 5.19 PER HOUR 1971 CHEVROLET 5-YD 6.17 PER HOUR 1971 CHEVROLET 5-YD 8.59 PER HOUR 1971 CHEVROLET 5-YD 7.46 PER HOUR 1969 CHEVROLET 5-YD 8.97 PER HOUR 1975 CHEVROLET 5-YD 5.63 PER HOUR 1973, CHEVROLET 8-YD 14.90 PER HOUR 1973 CHEVROLET 5-YD 8.36 PER HOUR 1973 CHEVROLET 5-YD 5.92 PER HOUR 1969 CHEVROLET 5-YD 13.59 PER HOUR 1979 GMC 5-YD (0) 11. 48 PER HOUR 1973 CHEVROLET 5-YD 5.84 PER HOUR 1966 INTERNAT. 5-YD 10.87 PER HOUR 1979 GMC 5-YD (0) 11.74 PER. HOUR 1969 CHEVROLET 5-YD 7.86 PER. HOUR 1975 CHEVROLET 5-YD 6.38 PER HOUR 1976 CHEVROLET 5-YD 5.24 PER HOUR 1979 Gt'IC 5-YD (0) 15.78 PER'HOUR 1979 GMC 5-YD (0) 9.39 PER HOUR 1979 GMC 5-YD (0) 8.45 PER HOUR IS 8.48 RATES FOR TRACTORS YEAR MAI<E MODEL RATE FERGUSEN BROOM 5..28 PER HOUR MF MOWER (D) 15.12 PER HOUR TOPEKA MOWER 7.77 PER HOUR MF MOWER (D) 12.92 PIOR HOUR FORD BRUSH CUTTER (0) 2111.36 PER. HOUR FORD/ECON BRUSH CUT.TER (0) 18.15 PER HOUR RENTAL RATE IS 13..88 RATES FOR BAC:~<HOES MAf<E MODEL RATE FORD BACf<HOE (0) 14.33 PER HOUR JOHN DEERE BACKHOE (0) 7.18 PER HOUR FORD BACf<HOE (0) 17.46 PER HOUR CASE BACf<HOE 24.54 PER.HOUR IS 12.22 RATES FOR LOADERS MAI(E, MODEL RATE LOADER (0) 21.66 PER HOUR LOADER (0) 24.69 PER HOUR LOADER (0) 17.55 PER HOUR LOADER 22.57 PER HOUR LOADER (0) 13.78 PER HOUR RENTAL. RATE IS 17.79 RATES FOR ROAD GRADERS YEAR MAf<E MODEL RATE: CATERPILLER GRADER (0) 20.35 PER HOUR. CATERPILLER GRADER (0) 11.1214 PER HOUR CATERPILLER GRADER (0) 12.50 PER HOUR JOHN DEERE GRADER (0) , 29.21 PER HOUR JOHN DEERE GRADER (0) 16.1216 PER. HOUR CATERPILLER GRADER (0) 8.91 PER HOUR GALlON GRADER 15.40 PER. HOUR RATE IS 16.45 10 hr. 500 yr. 500 yr. 500 yr. 500 yr. ) b 197]', Catehji 11 ar,Tractor/Loacle17 October 68 r G19,6,9.:\iC,b!!.'l;!;.o;l~:!;:'i&,\!mi1.i$I;l;UC"" (Hoh) December 75 f' tr975'!cneVl:oJ:!!,t.<1.QwnPl.:t,Tr:uCI<~ (Brinnon) , May 77 Lf e},~1'b1iF.o,l;!h\I;-:IQ>.~1!!L9.g,or,1 (Pl ann i ng) October 80 7 'Y.1980Trac:torJ.1ower(D)';':\!-" , August 70 6' ~,9cIO~IClie'v.rore~f1~Pi'2l<Up': August 70 .9 ~;l;9LQl:ChEl:a;\tlet;<;E3Y41.1l'l'll1P..iCt<U~~(WestEnd) l' tl9ZJi~Cl:JeirQi1~j:;;;Qu.mP%}1J;uc~ (C 1 ea rwa ter) Februa ry 73 e W19i3'~fnternattolfctl~1i\lia74:FiKF;mge.i'cI<UP " 5- J,953:;;~MC:l!6X6:J2~:;;T"''\liuckY September 79 10 1979:GMC;DieselDumpTt%krOii1i' May 53 /ro1.953';;Spreader:;fiBO)FJ May 71 September 79 /9 July 53 October 53 Apri 1 77 March 53 """'_ a95.3~ItEl,!tl;.l,~,~,Rl:J.AfLt~Tarik'" November 79 la 1979 GMC Di ese 1 Dump Truck May 79 / s- ,:t981~Cas'e1iB,Cl9$l19~;!.fi800 (Bri nnon V May. 74 /;;-19i4.3'::A~1~Utilit'y;Trai ler1) May 1981 r' J981GMC,Diesell}~T;)PJckilP:'(Sl ater)~ '1P' _Ii~~~e- /S-Wii'::1986'PK"40Piltc:hKing4:j ~I'; IRS" /6- 1l1952;f;GMC~~6X6'I'Zlir.~Tiltj'C!k~ May 81 cf'\:1981GM~Df~~e{~T:p.ickUP, (HOhHt Snow Plow - ,Hadlock tJ~ :>Ot/' r \.I - ,Hadlock' ~ ,Hadlock Snow Pl~w - Discovery Bay - Quilcene \~ - Quilcene " - Hadlock or - Hoh II' - Clearwater JEFFERSON COUNTY DEPARTMENT OF PUBLIC WORKS EQUIPMENT LIST October 1 , .1981 RATE $310 mo. 320 mo. 370 mo. 11, hr. 12 hr. 15 hr. 15 hr. 310, mo. 300 mo. 25 hr. 14 hr. 14 hr. 14 hr. 5 hr. 40,hr. 40 hr. 8 hr. 40 hr. 15 hr. 20 hr. 14 hr. 250 mo. 20 hr. 14 hr. 20 hr. 40 hr. ACQ. DATE March 81 May 78 May 81 March 71 Apri 1 59 January 64 March 79 Apri 1 81 December 73 October 68 , March 61 March 81 January 80 /larch 1981 Ma rch 78 July 73 June 67/' August 70 - ~)"..,-", ~De-r77 February 57 Ma rch 71 March 71 Ma rch 71 June 81 December 69 December 69 April 63 December 72 May 57 May 57 October 68 November 72 January 70 December 75 November 72 January 81 DESCRI PTION 1981 Ford Fairmpnt, 1981 1971 1958 Ferguson Broom (Broom 1979) 1964 Ford 8ackhoe-Loader (D) 1979 Massey Fer9uson Tractor 1981 Ford Fairmont Station 1974 Chevrolet Chevelle,4 ~Pli?_HoU9h Loader (D) 1961 Kolman Gravel Screen 1981 1980 Chip Spreader (D.) 1981 Ford Fairmont, 4 1970 Plymouth, 4. door 1957 Bay City Shovel 1971 Chevrolet Dump 1971 Chevrolet Dump 1971 Chevro1etDump 1981 Wacker Compactor 1969 Caterpillar Grader (D) 1969 Caterpillar Grader (D) / 1963 Topeka Mower 1973 Grader (D) 1957 Huber Marco Roller 1957' Michigan Loader (D) 1969 Chevrolet Dump Truck 1973 Ford 1 T. Pickup (Parks) 1970 Grade More S10per 1976 Chevrolet Dump Truck 1973 Chevrolet Tandem 10 yd. 1978 John Deere Grader (D) (Hoh) 2/3/82 EGlU I IP'I"'1EI'UT LX,S. DEPREC. RHTE PER MONTH RENTAL RATE ACQ. OATE OESCRIPTION :$280; 0IiPE~}'10NTH ". 3 1981 1981 FORD FAIAMOUNT f'Z80.03 PER MONTH 5 1978 1978 PONTIAC CATALINA . $300:0~1'f'ERHONTH 5 19B1 1981 GMC PICKUP CD), .... $ 8.50 PER HOUR 3 1971 1971 CHEVROLET 5-Ya ~07.~... $ 15.03. PER HOUR 4 1959 1959 FERGUSEN 8ROOM ~ $ 15.00 PER HOUR 1 1964 1964 FORO BACKHOE (0) , $203.26 f 15.00 PER HOUR 3 1979 1979 MF MOWER CO) $175.20 il:'280.00 PER .MONTH 4 19S1 1981 FORD FAIRI'.oUMT ~ 121973 1974 CHEVROLET CHEVELLE $ 81.51 $ 18.00 PER HOUR 13 1968 1968 HOUGH LOAOER (0) 1!CEll 3 1961 1961 KOLMAN' OAAVEL SCREEN $181.97 ':$'!2B0. 33' PER MONTH 3 1981 1981 FORD FAIAMOUNT $17B.17 $ 35. 30 PER HOUR 1 1983 1983 ETNYRE CHIP SPREADER CO) $181.97 f280:30 PER. MONTH 3 1981 1981 FORD FAIRMOUNT $ 99.41 $ 280.00 'PER' MONTH 3 1979 1978 PONTIAC 80NNEVILLE ~ $2BI!; 00 'PER MONrH 7 1973 1973 PLYMOUTH FURY $ 59.63 $ 300.00 PER MONTH 9 1979 1977 CHEVROLET S'UBURBAN .~ $ 300;30 PER MONTH 8 1970 1970 CHEVROLET PICKUP $ 81.10 $ 280. 00:PER. MONTH 6 1977 1977 FORO LTD f 45. 3lf PER HOUR 2 19S7 1957 8AY CITY SHOVa $ 8.50 PER HOUR 3 1971 1971 CHEVROLET 5-Ya $ 8.50 PER HOUR 3 1971 1971 CHEVROLEF5-Ya $ a.53 PER HOUR 3 1971 1971 CHEVROLET5-Ya $ 5.00 PER HOUR 6 1981 1981' UNIPRO WACKER'I'ACKER $161.84 $ 17.00 PER HOUR 12 1969 1969 CATERPILCEROAADERJD) $2\11.46 $ 17.00 PER HOUR 12 1969 1969 CATERPILLER OAADER CO) lIl8llI!!!I!: $ 15.00 PER HOUR 4 1963 1963 TOPEKA MOWER $199.37 $ 17.00 PER HOUR 12 1972 1973 CATERPILLER miADER (0) am!!! $ 15.30 PER HOUR 5 1957 1957 HU8ER ROLLER SiiU $ lB.00 PER HOUR 5 1957 1957 HICHIGAN LOAOER CO) .- $'339.03 PER MONTH 11 1972 1973 FORO 1 TON FLATBED ~ $ 6.00 PER HOUR 1 1970 1970 GRADE-HORE SLOPER U43.91 $ a.50 PER HOUR 12 1975 1975 CHEVROLET 5-Ya U25.6B $ 8.53 PER HOUR 11 1972 1973 CHEVROLET 8-YO $325. 77 $ 17.DD PER HOUR 1 1981 1978 JOHN OEERE GRADER (D) 1IillaF $ a.50 PER HOUR 18 1973 1973 CHEVROLET 5-YO ~ $ 8.50 PER HOUR 10 1973 1973 CHEVROLET 5-Ya SIil!!lII $ 8.53 PER HOUR 10 196B 1969 CHEVROLET 5-YO 1417.84 $ 1B.00 PER HOUR 6 1977 1977 MICHIGAN LOAOER (0) 1&l!lliIllt f 18.00 PER HOUR 12 1959 1959 ATHEY LOAOER $434.es $ IM0 PER HOUR' 1 1981 1981 JOHN OEERE GAAOER CO) $236.08 $ 8.50 PER ~.oUR 9 1979 1979 GMC S-YO . (0) '~ $ 10.03 PER HOUR 12 1962 1962 SPRAY MACHINE ~ $ 8.50 PER HOUR 10 1973 1973 CHEVROLET 5-YD. $19.82 $ 19.00 PER HOUR 12 1980 1980 MILLER CURBER $ 15.00 PER HOUR 9 1974 1974 JOHN DEERE BACKHOE (D) $ 22.50 PER HOUR 8 1962 1955 EUCLID SCAAPER (D) $ 25.03 PER HOUR 1 1954 1954 GMC DISTRIBUTOR (O&D) $ 15.33 PER HOUR 4 1978 1978 HF MOIlER (0) '-$300; 30'PERIlONTH~;;:C, 5 1978 197B GI1C SUBURBAN DEPREC. RATE NO. PER HONTH RENTAL MTE ^CO. DnTE DESCRIPTION 53 $353.96 $ 18.00 PER HOUR 2 1980 1980 TEREX LO,;DER lD) 5-1 $101.37 $ 2BO.00 PER HONTH 6, 1977 1977 FORD L TD 55 $115.49 $ 30.00 PER HOUR 10 1963 1964 INTERNAT. TRUCK/TRACTOR 56 $ 23.99 $ 10.00 PER HONTH 5 1991 1981 TOTEM-,;LL UTILITY TR. 57 $ 31.98, $ 5.00 PER HOUR 6 1967 1967 TAR POTS (2) 59 $32.35 $ 10.00 PER HOUR 5 1968 1969 PUBLIC WORKS TILT TRnILER 59 $ 60.50 $ 10.00 PER HOUR 10 1973 1973 PUBLIC WORKS TILTTRnILER ,60 $355.66 $ 40.00 PER HOUR 5 1974 1974 C^TERPILLER D-7 DOZER (D) 61 $ 43.91 $ 300.00 PER MONTH 4 ' 1977 1977 CHEVROLET PICKUP 62: $ 58.37 $ 200.00 PER MONTH 121971 1972 FORD CUSTOH 63 $105.69 $ :' 32.00 PER HOUR 7 1965 1965 UNIT SHOVEL (D) ,64 , $100.35 $, 15.00 PER HOUR 2 1980 19BO G^LION ROLLER 65 $ ,43.91 $ 300.00 PER HOlITH 11977 1977 CHEVROLET PICKUP 66 $ 59.43 " f 16.0OPER HOUR 4, 1979 1960 . CHIPPER 67 $122.85 $40.00 PER HOUR 6' 1967 1967 INTERNIIT .TD-20 DOZER (D) 6B $ 51.32 $ 22.50 PER HooR 11 1955 1956 EUCLID S-7 SCR,;PER (8) 69 $ 57.38 $ 200.00 PER HOlITH 1 1972 1972 FORD CUSTOM 70 $ 44.79 $ 15.00 PER HOUR 2 1968 1959 FORD BRCKHOE lD) i',', 71 $ 39.1B ~ 30.00 PER HOUR 1 1980 1960 KENWORTH TRUCKITMCTOR (0) 72, $ 80.06 $ 15.00 PER HOUR 4 1972 1972 FORD BRUSH CUTTER (D) <;.:73. $,77.80 $ " 9.50 PER HOUR 1 1966 1966 INTERNRT. 5-YD , ':74 $217.25 $ '8.50PER HOUR 10 1979 1979 GMC 5-YD (0) 7S $337 .07 :$ 40.00 PER HOUR 8 1979 1977 C,;TEI1PILLER 955 lR,;Cl( 76 " $ 68.96 $ 8.50 PER HOUR 10 1968 1969 CHEVROLET 5-YD n $143.91 $ 8.50 PER HOUR 12 1975 1975 CHEVROLET 5-YD , 78 $101.37 $ 280.00 PERHOlITH 5 1977 1977 FORD L TO ,:79' $385.16 $ 15.00 PER HooR 6 1980 1980 FORDIECON BRUSH CUTTER (0) 90" $ 46.88 $ 300.00 PER MONTH 8 1970 1970 CHEVROLET PICKUP .81 ' , $ 32.81 $ 300.00 PER MONTH 8 1970 1970 CHEVROLET PICKUP 82 $143.91 $ 8.50 PER HOUR 11 1975 1976 CHEVROLET 5-YD 83 ' $ 29.06 $ 300.00 PER HONTH 2 1973 1973 INTERN^T. PICKUP , >- 84 , $ 7.50 " $ 15.00 PER HooR 8 1980 1953 GMC 6X6 -2 1/2 T 85 $221.72 $ 8.50 PER HOUR 9 1979 1979 GHC 5-YD (D) 86' $ 7.52 $ 10.00 PER HOUR 5 1953 1953 SPRE,;DER BOX ,,'87 $ 13.72 $ 10.00 PER HOUR 5 1971 1971 SI'REI\DER BOX 88' $277.15 $ 8.50 PER HooR 9 1979 1979 GMC 5-YD (D) 89 . $27.38 $ 10.00 PER HOUR 7 1953 1953 FREUNI\lJF TRRILER 90 $ 22.50 $ 17.00 PER HooR 10 1953 1932 CmRPILLER GMDER lD) 91 $3.61 $ 10.00 PER MOlITH 4 1977 1977 PUBLIC WORKS TRRILER 92 $ 33.75 $175.00 PER HONTH 3 1953 1953 RE,;LL ^SPH,;L T TANKS 93 $221.72 $ 8.50 PER HooR 10 1979 1979 GHC 5-YD (D) 94 $ 97.13 $ 15.00 PER HooR 5 1991 1979 C^SE 8M:KHOE 95 $ 22.74 $ 10.00 PER DRY 5 1974 '.974 PU9LIC WORKS TRRILER 96 ' $ 82.32 $ 300.00 PER HllIfTH 5 1991 1981 GMC PICKUP (D) 97 $ 62.63 $ 200.00 PER MONTH 1 1981 1990 P,;TCHKING 98 $ 3.50 $ 15.00 PER MOOR 1952 1952 GHC (HOD) WRTER mUCK 99' $ 82.32 $ 300.00 PER HI>>ITH 1981 1981 GMC PICKUP (D) 101 $ 40.50 $2700.00 PER mR 1969 SNOW PlOWS (9) 110 $ 36.75 $1400.00 PER YEIIR 1 1969 1969 SIINDERS (7) 119 $ 21.26 $ 500.00 PER YEIIR 1 1974 1974 HYD.SlIHDER 119 $ 21.26 $ 500.00 PER YEM 1 1974 1974 HYD.SNlDER 120 $ 30.74 $ 500.00 PER YEM 11 1976 1976 HYD.T .G.SMfD 121 $ 30.74 $ 500.00 PER YEM 11 1976 1976 HYD. T .9.SRND . 2 . EQUIPMENT LIST OEPIE. RATE PRESENT ,Ill. PER KON1li RENTAL RATE 0Cll. DATE DESCRIPTIIIl , 1 $181;!l7 $ 319.00 PER ttONTH 3 1981 1981 FORD FAIRIIOUNT 2 $ 87.82 $ 32ll.1lll PER I'IlNTH 5 197B 1978 PONTIAC CATALINA 3 $ 82. 32 $ 371!.011. PER IlONTH 5 19B1 1981 GIIC PICKUP (0) 4. $101.36 $ It.e0 PER HOOR 3 1971 1971 CHEVROLET 5-YO 5 $ 17.1l6 $ 12. Bll PER HOOR 4 1959 1959 FERGUSEN BROOM 6 $36.11 $15.00 PER HOOR 1 1964 1964 FORD llAClOOE (0) 7. $2ll3.26 $ . 15.1lll PER OOUR 3 1979 1979 HF ~ER (0) 8 $175.20 $ 3111.1l0 PER I1llNTH 4 1981 1981 FORD FAIRIIlUNT 9 $ 82. 88 $ 3lllI.1lll PER IlONTH 12 1973 1974 CHEVROlET CHEVELlE 10 $ 81.51 $ . . 25.00 PER HOUR 10 1968 1968 HOUGH LOADER (0) . 11 $ 39.81 $ 3111.00 PER HOUR 3 1961 1961 KOLHAN GRIlVa SCREEN 12 $181.!l7 $ 31l1l.1lll PER PIlNTH 3 1981 1981 FORD FAIRl100NT 13 $178; 17 $ 4lIl. Bll PER OOUR 1 1980 1980 ETHYRE CHIP SPREADER (0) 14 $IBl.!l7 . $ 31l1l.00 PER IlONTH 3 1981 19B1 FORD FAIRIIlUNT 15. $ 99.41 $ 32ll.1lll PER IlONTH 3 1978 1978 PONTIAC IIlJlNEVILLE 16" $ 17.4lIl $2llll.Bll PER HOOTH 7 1973 19711 PL Yl10UlH FURY 17 ,$ 59.63 $3lllI.00 PER PIlNTH 9 1979 1977 CHEVROlET SUBURBAN 18 $32.81, $ 29ll.lllll PER PIlNTH B 19711l 1970 CHEVROlET PICIQJP .19 $ 81.10 $ 31l1l.1lll PER IlONTH 6 1977 1977 FORD LID ,20 . $ 57.23 $ 6lIl.1lll PER OOUR 2,1257 1957 SAY CITY SiOVa 21 $101.36 $ 14.00 PER HOOR 3 1971 1971 CHEVROLET 5-YD .22 . $101.36 $ 14.1lll PER HOOR 3 1971 1971 CHEVROLET 5-YD .23 $llIl1.94 $ 14.1lll PER HOOR 3 1971 1971 CHEVROlET 5-YD 24 $32.93 $ 5.lIlll PER IIlUR 6 1981 1981 UNIPRO WACKER PACKER .25 $161.84 $ 4lIl.illl PER HOOR 12 1969 1969 CATERPILlER ORADER (0) 26 $201.46 $ 4lIl.Bll PER HOOR 12 1969 1969 CATERPILlER ORADER (0) '11 $48.63 $ 8.1lll PER HOOR 4.1963 1963 TOPEKA toER 20 $199. Ii' $ 4lIl.00 PER IIlUR 121972 1973 CATERPILlER GRADER (0) 29 $ 20.sa $ 15.1lll PER HOOR 5 1957 195711J1lER ROLLER 3ll $ 63. 23 $ 20.1lll PER HOOR 5 1957 1957 MICHIGAN LOADER (0) 31 $ 68.96 $ 14.1lll PER IIlUR Il1l 1968 1969 CHEVROlET 5-YD 32 $ 47.67 $ 25ll.1lll PER IfJNTH 11 1972 1973 FORD 1 TON FLATBED . ...33. $ '11.74 $ 20.1lll PER IOJR 1 1970 1970 GRADE-l1lIRE SLOPER 34 $143. 91 $ 14.1lll PER IOJR 12 1975 1975 CHEVRllET'. 5-YD , ..35. $125. 68 $ 2ll.1lll PER IOJR 11 1972 1973 CHEVRllET'. B-YD 36 $325.77 $ 4lIl.1lll PER IOJR 1 1981 1978 JOHN DEERE GRADER (0) 37 $ 86.57 $ 14.1lll PER IOJR Il1l1973 1973 CHEVROLET 5-YD 3ll $86.57 $ 14.1lll PER HOOR Il1l1973 1973 CHEVRllET' .5-YD 39 $ 68. 96 $ 14. illl PER HOOR 10 1968 1969 CHEVROlET 5-YD 411 $417. B4 $ 25.1lll PER HOOR 6 1977 1977 "[CH[GIJl LOADER (0) 41 $ :l2.!l5 $ 20.1lll PER HOOR 12 1959 1959 ATHEY LOADER 42 $434. sa $ 4lI.1lll PER IOJR 1 19B1 [981 JOHN DEERE ORADER (0) 43 $Zlli.lllIl $ 14.1lll PER IOJR 9 1979 1979 GItC 5-YD (D) 44 $.6.75 $ 6.1lll PER IOJR 12 1962 1962 SPRAY I1ACHlNE 45 $ 86.57 $ 14.1lll PER IOJR 101973 1973 CHEVROlET 5-YD 47 $ 19. 82 $ 66.1lll PER IOJR 121900 198IJ "ILLER CURSER 48 1145. 29 $ 20. illl PER IOJR 9 1974 [974 JOHN DEERE BACKHlE(D) 49 $ 86.45 $ 35.1lll PER IOJR 8 1962 1955 EUCLID SCIlAPER (D) 51 $ 39.1l! $ 3:l.1l! PERHOOR 1 1954 1954 GIIC D[STRIBUTOR (0&0) SI 1161.54 $ 1:l.1lll PER IOJR 4 1978 1978 HF I'llWER (D) . 1 - PRESENT RENTAl. RATE ACll. ORTE OESCRIPTlllN $ 1iB.53 $ JSIl.B1l PER /fONTH 5' 19711 1978 OIlC SUBURBAN 53 $353.86 $ 25.00 PER HOUR 2 19811 19811 TEREX LORDER (D) 54 $101.37 $ 310. liB PER PlINTH 6 19n 19n FORD LID 55 $115.49 $ 15.00 PER HOUR 1111963 1964 INTERNAT. TRUCK/TRRCTOR 56 $ 23. 99 $ 65.l!ll PER PlINTH 5 1981 1981 TOTEi'HIU. UTILITY TR. 57 $ 31.98 $ 7.00 PER HOUR 6" 1967 1967 TRR POTS (2) 58, $ 32.35 $ 15.00 PER HOUR 5 1968 1968 PUBLIC WORKS TILT TRAILER 59 $ EIl.5I! $ 25.l!ll PER HOUR 1111973 1973 PUBLIC WORKS TILT TRAILER 611 $355.66 $ 4lI.l!ll PER HOUR 5 1974 1974 CRTERPILLER ll-7 DOZER (OJ 61 $ 43. 91 $ 32Il.1Ill PER IllINTH 4 '19n 19n CHEVROlET PICKUP 62 $58.37 $ 3lllI.80 PER I10NTH 121971 1972 FORD CUST!I'I ,63 $1115.69 . $ 6II.l!ll PER HOUR 7 1965 1965 UNIT SHOVa COJ 64 $1Illl.35 $ 15.80 PER HOUR 2 19811 19811 GAlION RDl.LER 65 $ 43. 91 $J4Il.80 PER PlINTH 1 19n 19n CHEVROlET PICKUP 66 $ 59.43 $ 211.80 PER HOUR 4 1979 19611 CHIPPER 67 $122.85 $,5I!.1llI PER HOUR 6 1967 1967 INTERNAT. ID-211 DOZER CDJ 68 $ 51.32 $ 35.011 PER HOUR 11 1955 1956 EUCLID 5-7 SCRAPER (D) 69 $ 57.38 $ 3IlIl.1llI PER tlONTH 1 1972 1972 FORD CUST!I'I 711 $ 44.79 $ 211.011 PER HOUR 2 1968 1959 FORD BACl(!{JE. COJ . 71 $ 35.18 $ 2II.1llI PER HOUR 1 19811 1968 KENhlJRTHTRUCKIT~R (OJ .72 $ Bll.lIi $ 25.011 PER HOUR 4 1972 1972 FORD BRUSIf CUTTER COJ 73 $n.Bil $ 211.011 PER HOUR 1 1966 ,1966 INTERNAT. S-:YD . 74 $217.25 $ 14.00 PER HOUR 10 1979 1979 GIfC. 5-YD CDJ 75. $JJ7.1I7 $ 35.1llI PER HOUR 8 1979 19n CRTERPILLER 955 TROCK LOAIlER COJ 76 $ 68.$ $ 14.011. PER HOUR III 1968 1969 CHEVROLET 5-YD n $143. 91 $ 14. "" PER HOUR 12 1975 1975 CHEVROlET 5-YD 78 $1111.37 $310.00 PER I10NTH 5 19n 19n FORD L TO 79 $385. 16 . $ 35.00 PER HOUR 6 19Bil 19Bil FORD/ECllN BRUSH CUTTER (OJ Bil $ 46.88 $ 32Il. "". PER IllINTH . 8 1970 19711 CHEVROLET PICKUP 91 $ 32.81 $ 3lllI.1lIl PER PlINTH 8 19711 19711 CHEVROLET. PICKUP 82 $143.91 $, 14.00 PER HOUR 111975 1976 CHEVROlET 5-YD ,83 $ 29.lIi UIlI1l.110 PER ttONTH 2 1973 1973 INTERNRT. PICKUP 84 $ 7.5il $ 10.1ll! PER HOUR 8 19Bil 1953 GIlC 6X6 -2 112 T 85 $221.72 $ 14.1Ill PER HOUR 9 1979 1979 GIlC 5-YD CD) B6 $ 7.52 $ 15.1ll! PER HOUR 5 1953 1953 SPREADER BOX 1I7 $ 13.72 $ 15.80 PER HOUR 5 1971 1971 SPREADER BOX B8 $m.15 $ 14.811 PER HOUR 9 1979 1979 GIfC 5-YD CO) 89 $ 27.38 $ 15.00 PER HOUR 7 1953 1953 FRElJlRUF TRAILER 9I!. $22.5il $ 411.00 PER HOUR 101953 1932 CRTERPILLER ORADER CD) 91 $ 3.61. $ 5I!.00 PER I10NTH 4 19n 19n PUBLIC WORKS TRAILER 92 $ 33.75 $ 2!l0.1llI PER PlINTH 3 1953 1953 REALl RSPlillT TANKS 93 $221.72 $14.00 PER HDUR III 1979 1979 GIfC 5-YD (D) 94 $ !l7.13 $ 2lI.811 PER HOUR 5 1981 1979 CASE BACKIIlE !l:l $ 22. 74 $ . 70.19 PER HDUR 5 1974 1974 PUBl.IC hlJRKS TRAILER $ $ 82.32 $ 37ll.19 PER I10Nlll 5 1981 19BI GIfC PICKUP (DJ !l7 $ 62.63 $ 2:ill.l!ll PER IlONTH 1 1981 19Bil PRTCHKIMi !18 $ 3.5il $ 10.011 PER HOUR 1952 1952 GIfC (HOD) WRTER TRU:K 99 $82.32 $ 37ll.l!ll PER I10NTH 5 1981 1981 GIll: PICKUP (OJ 1111 $ 4lI.5il $45ill!.1llI . PER YEJlR 1969 SNC4I PUJlS (9J liB $36.75 $24:ll!.1llI PER YEJlR 1969 1969 SANDERS (7) . 118 $ 21.26 $ 5BIl.1llI PER YEJlR 1974 1974 HYD. 5IlNIIER 119 $ 21.26 $ 5illl. 011 PER YEJlR 1 1974 1974 HYD. SfflDER 128 $ JlI.74 $ 5illl.1ll! PER YEJlR 11 1976 1976 HYD. T. G. WD - 2 - EQUIPMENT LIST RATE \ $310.00 per month 320,00 per month ~~~ YEAR ~ 1'7$/ // 1978 /--==1#'1- 1971 1958 1964 1979 ~ 1974 1968 1961 1977-/9'S"1 19BO HH-/9'&' I 1978 1970 1976 1957 1971' per hour 1971 per hour 1971 , 29.0...QQJ>er mo!!J;.b.-- 1-9-T3- 40.00 per hour 1969 40.00 per hour 1969 B.OO per hour 1963 40.00 per hour 1973 15.00 per hour 1957 20.00 per hour 1957 1/..00 per hour 1969 250.00 per month 1973 20.00 p"r hour 1970 14.00 hour 1976 1973~ {ffj , \ 197~ '1969 1977 September 15, 1980 DESCR~~~~~'ON7'" _ .)-.!)R- /Ford L'l'B'I "". (Milt) -('Pont. Cat; 4 dr. (Fred) v.'ChIlV l<T' P< o k1!p-(-CVUDt.-. v'Chev. Dump (Quilcene) . Ferguson Broom (Broom 19~9) ,p.ord Backhoe-Loade,r(D) . .... . ...'... /Massey ~rg . Trac tor with mower/'" ,/~~.~~~~~ . .... Ghev. Chevelle 4 d-r . v'HoughLoader. (Hoh) (D) Gravel Screen ~.Ko1man - ;Ford~"'1!()l{r: (Bud) .ChiPJ~~~g~,.sD) -.,/Ford.i;llB 'c AI;, (Carroll). --"",Pont. .Bonneville4 dr. (B.G.) '-"':P1}'I11outh 4dr.,. ...,.. /Chev. Suberban(Office) ...-thev. Pic k~p (Sh(~i' '/iF~/)_~-r.; llll.t/ . "~&~,0~ 'Bay City Shovel (Hoh) VChev. Dump '/Chev. Dump V"Chev. Dump v:"':EneLl7""P:l:ckuy-1'~k ..Jrv. ~Caterpi11ar Grader (Brinnon) _"V6iterpillar Grader (D)(~ Topeka Mower ' vCx-ader (D) Huber-Marco Roller /'Michigan Loader (Clearwater) hhev. Dump ~ord IT Pic~up (P~rks) Grade-More Sloper '/Ch"v. Dump --/~;,iJ~~Al~~~.b;u,/. /Ch"v., Dump.. .. . ....",' VCh"v. Dump VChev. Dump /~ichignn 75B :.OO~ per hour 40.00 per hour 14.00 per hour 6.00 per hour 14.00 per hour 6l:.n p:;r ~o,g: 20.00 per hour 35.00 per. hour 35.00 per hour 15.00 per hour 350.00 per month 25.00 15.00 per hour '1 Of) I v l:11"l1~ 7.00 per hour..eP-, 15.00 per hour _ 25.00 per hour 40.00 per hour 320.00 per month 300.00 per month 60.00.per hour 15.00 per hour ==1if,O ~bt. '-V() 2.e.99 F"'..... FiQJlr per hour per hour hour 11 per hour per hour per hour per hour per hour ,per hour per hour per hour II"Ut) per. hour 320.00 per month 300.00 per month 14.00 por hour 1959 T95't) I C)'fN 1979 1962 1973 1958 198" 1974 1955 1954 197B 197B 19BO _VYhjl{<\Y-~el t r;?;'der ~a~(~ (D) vGMC Dump Spray Machi"e ,/'Chev. Dump PJltching. Machine (HQh)..,. CU.e.!J ~4t>6-.. HAa/;iWe. ~John Deere Backhoe (D) /Euclid Scraper. (D) , GMC Asphalt Distributor ~assey Ferg. Tractor /GMC Suburban (Crew) Aerex Loader (Quilcene) (D) /Ford t-~ Seaaa (~ffice) ~nt'l. Truck Tractor (Hoh) :mz 1'7'77 1964 ~ .;2- 1967 " 196B ~/q7i 1974 1977 1972 1965 Shovel Unit ~ ~Yd. (D) ~ v'~~~~~(Vrinnon) 1960 Chipper ~.- 1967 ~nt'l. TD-20 Dozer (Hoh) (D) 1956 ,/i:uclid Scraper (D) , .'/J!IJflIf1?~;<', ViiI .... ,c<:>RtJ SE'Md 1959 ~Ford'Backhoe/Loader(Hoh) (D) 1960 v1CenworthTruck;Tra~tor (D)/" 1972 ~ush Cutter/Broom/~ractor/Loader 1966 /Int'l. Tandem Dump (Hoh) 1979 vGMC Dump 1977 ~t. Tractor/Loader Mod. 966L 1969 vChoV. Dump (Hoh) 1976,/]/. .~~~~.vCh9V' Dump (Brinno'J.~)' ',_ -/~'77 'fZV'#,,,,,,,.rv I/' .L. rL> - ,(5..0) ~~ 1980 . .tractor/Mower. (D) 1970 /Chov. IT Pickup 1970 vP'ev. 3/4T Picku)'-td,,",,...l.,., 1976 l/thev. Dump (Clearwater) ~s!ll T":'~"'u~~~i~";' ;.' 01- Aersol Tar Kettle"}' P.W. Tilt Trailer (Hoh) P.W. Tilt Trailer ~at. 07 Dozer (D) v/'Chev.~Pick~p v"Ford 4 dr. Sedan - 300.00 per month 10.00 per hour 14.00 per hour 15.00 per hour 15.00 per hour 14.00 per hour 15.00 per hour 40.00 per hour 50Ag~ .l!sJ;p'r~mth 290.00 per year ~O per ~~u.r".,( , 70.00 per day , 29e-~~~_Riig. .,,;R:tb J-~~o~.e;.?Q. 10.00 per hour ~,,!.,. ~ 500.'00 per year .!JOO.OO per year 500.00 per year 500.00 per year 500.00 per yeaF 500.00 per ye~r 500.00 per year 500.00 per year 500.00 per year 350.00 per year '350.00 per year 350.00 per year 350.00 per year 350.00 per year 350.00 per year 350.00 per year 500.00 per year 500.00 per year 500.00 150.00 -L!I- 1973 1953 1979 1953 1971 1979 1953 1953 11m 195.3 .;;7~y<' 1974 1b~ -1?9'0 }~~;:. ~ per year - per month Nov.Dec.Jan.Feb. 150,00 per month 1$'0..00 .. /".-;',,10' p g-tU) cJ 1. ~!:' p.4-<' Av' 4;) .t}cJ .' v/lnt'l. 1 3/4T Pickup (S. Waste) ~MC 6x6 2l1r Truck V(mC Diesel. Dump'" Spreader Box Spreader Box vGMC Diesel Dump(pJ Fruehauf Trailer.- J '~at Motor Grad~r.(Clearwater) Utility Trailer' (Park). RealI As~h Tan~ 8~OOO Gal. GMq,Dt,esel DUm!). (( "_. --#lI . ... . -A _ a.. ,_ 3 Axle Utility. Trailer. .' -ll~p'h-"""-~oA'l ,1>' TT - -..~~.: ~IS ~C ~!f - ~ - .p;...; r- tJ '/I-71!'#. /1(/6<- 'G~I1: 6x6 2~ Truck' .:;I!,:'>..14.., l ~~ ..:~ .. I 8a<""e -iraQ-Amp.. B ~ W~lAn~ '....;. Snow Plow - Disl!overy Quilcene Brinnon Hoh Clearwater Sander - Chimacum , Discovery Bay Clearwater Brinnon Hoh Quilcene " Chimacum Hyd. Sander Hyd. Sander Hf/j. Sander H1~' SMD~ t-I'I/J. .s~AlDe~ (f.4tJ/1,1'-fyJ. .D,CJ.aJ€~.e Sul.I!AH /J Ie (!tJ,q,.:J,e€$So.e VGAJ!./tJ...,j G~AIJ.f'.6 6'--hI(j . Equipment Rates: Do You Charge All Costs To Jobs? By Joanna Johnson Fails Management Institute A good equipment rale system helps management to make sound decisions based on individual cost structure. You can compare aClual to estimate, correct if productivity is out of line. or bid more accurately if the estimate is inaccurate. This information gauges your competitiveness in your market. and helps make buy/lease decisions. The benefits to your company of using internally generated equipment rental rates far out- weigh the cost and aggravation of cOllecting the basic data. Accurate job costing is a difficult management problem for contractors. Tracking materials and labor consumed by a job' requires careful record-keeping-often viewed with disdain by field personnel. The more difficult the cost is to track and charge against the job. the greater the likelihood for error. and the greater the need for careful attention. Contractors with heavy equipment have a particularly diffi- cult costing job. Equipment rates are complicated combina- lions of various expenses and costs. Fuel and maintenance, laxes and resource consumplion musl be included in the rate for full cost recovery. Often. quoles are based on a unit price. For example. a company building airporl runways might quote a unit price per cu. yd. of dirt moved. The thousands of yards actually moved could eXlrapolate a small error in equipment unit-based costing to a significanl loss. Costing procedures for heavy equipment are extremely important. If your cost is on Ihe high side, you don't get the job; the low side and you could suffer a debilitaling loss. In the recent downturn. many crmtrllctors charged jobs with equipment operating cOSls only. They felt that adding a re- source consumption rate would price Ihem out of the market. llnd they desperately needed work. If the unit was fully paid for or fully depreciated, they Charged only for operating it. Now. with funds available for highway and heavy construc- lion and repair, contractors can again make a profit. Make sure your rates are accurate-low enough to be competitive but !\igh enough to cover all costs. Oeffnltfon of co... For internal equipment rental rates to cover all actual ex- penses, three cost categories must be included in the rate pcr hour-ownership costs, operating costs and cost of capilal. Ownership costs are all Ihe expenses incurred from owner- ship-resource consumption. tnxe!i, insurance. etc., for the pc. riod. Operating expenses are incurred with every hour of equip. ment use ror fuel, oil and mainlenance. Cost of capital is the "rent" on funds lied up in equipment. What is resource consumption? The definition of asset or resource value used in an equipment rate system is significantly different from the asset value on your company's books-either your internal books or your tax Slatements. IRS regulations currently allow. accelerated depreciation (or capital assets which quickly reduces their stuled book value deferring recog. nhion of eo1rnings for lax purposes. Yet, Ihe value of the asset on internal books for management or credia purposes may be deprecialed on It straighl.line basis to expense the purchase price or the uset over a period of time. Suaight.linc depreciu. lion improves Ihe profit picture, desirable when presenling statements to lenders. However, depreciation expense, no matter which. method is used, is an artifical reduction of the asset's real value. An expensive piece of construction machinery doesn't Cease being useful when fully depreciated. Equipment may even appreciate in value and be worth more than it cost when new. The re- source value of your equipment probably differs significantly from its book value. The value of the resource is its current market value less any salvage value expected when the resource is no longer useful. Expected life span before repJ.cement Equipment also has an expected life span before replace- ment. The resource consumption rate is based on both the real value of the resource and its useful life expectancy. In equip- ment costing, life expectancy is measured in operating hours. In each operating hour. a proportionllte share of the resource value is consumed. That charge should be included in the equipment rental rate, not an artificial depreciation charge nor a replacement charge. Other ownership costs are easier to calculate. They are gen- erally incurred every operating period and can be prorated over the expected number of operating hours in the period. Typical costs of ownership are taxes, administrative costs. cost of capi- lal, licenses, permits and insurance. Operating costs are much easier to calculate than ownership costs. Basically, the costs are fuel. oil and repairs and mainte- nance. The costs are all included in the equipment renlal rate; they are not directly tracked for each job. 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