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be fulfilled by the assured as part of this contract as fully as if they were recited at length over the signatures hereto affixed.

Io witness whereof, the company has caused this policy to be signed by its president and secretary, at, ; but the same shall not be binding upon the company unless countersigned by a duly authorized representative of the company. President. Secretary. Countersigned at this

General Agent.

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MANUFACTURERS' EMPLOYERS' LIABILITY POLICY. The hereinafter called “the company,” in consideration of

dollars ($ j estimated premium and the statements hereinafter set forth in the schedule of statements, which statements the assured makes and warrants to be true by the acceptance of this policy, except the statements concerning the number of employees and their compensation, which are estimated, does hereby agree to indemnify

county of State of , hereinafter called the assured, for a period of months, beginning on the

, 190 , noon, and ending on the day of , 190, noon, standard time at the place where this policy has been countersigned : Against loss from the liability imposed by law upon the assured for damages on account of bodily injuries or death, accidentally suffered while this policy is in force, by any employee or employees of the assured while within the factory, shop or yard described in the schedule, or upon the sidewalk or other ways immediately adjacent thereto provided for the use of such employees or the public, in and during the operation of the trade or business described in the schedule, including, however, drivers mentioned in the schedule when on duty in the vicinity of the locations designated in the schedule, subject to the following conditions :

CONDITIONS. A. The company's liability for loss from an accident resulting in bodily injuries to or in the death of one person is limited to dollars ($ ), and, subject to the same limit for each person, the company's total liability for loss from any one accident resulting in bodily injuries to or in the death of more than one person is limited to dollars ($ ).

B. This policy does not cover loss from liability for injuries or death to or caused by-(1) Any person unless his compensation is included in the estimate set forth in the schedule (provided that this exclusion does not apply to loss from liability for injuries or death (a) caused by the assured himself if an individual, nor it a firm by any member thereof, nor if a corporation by its president, vice-president, secretary or treasurer, provided such officer is not managing or superintending ai the works; or (6) to or caused by drivers of teams for which the assured carries concurrent teams insurance in this company; (2) Any child employed by the assured contrary to law or any child employed under fourteen (14) years of age where no statute restricts the age of employment; (3) Any convict; (4) Any person in connection with the making of additions to or alterations in or the construction of any building or structure or plant or in connection with the wrecking or demolition of any building or structure or plant or any part thereof. Ordinary repairs when made by employees of the assured whose compensation is included in the estimate set forth in the schedule are permitted.

C. Upon the occurrence of an accident the assured shall give immediate written notice thereof, with the fullest information obtainable at the time, to the company's home office or to the agent who has countersigned this policy. If a claim is made on account of such accident the assured shall give like notice thereof with full particulars. The assured shall at all times render to the company all co-operation and assistance in his power.

D. If thereafter any suit is brought against the assured to enforce a claim for damages on account of an accident covered by this policy, the assured shall immediately forward to the company's home office every summons or other process as soon as the same shall have been served on him, and the company will, at its own cost, detend such suit in the name and on behalf of the assured unless the company shall elect to settle the same

or to pay the assured the indemnity provided for in condition A hereof. E. The assured shall not voluntarily assume any liability, nor shall the assured, without the written consent of the company previously given, incur any expense or settle any claim, except at his own cost, or interfere in any negotiation for settlement or in any legal proceeding; except that the assured may provide at the time of the accident such immediate surgical relief as is imperative. Whenever requested by the company, the assured shall aid in securing information and evidence and the attendance of witnesses and in effecting settlements and in prosecuting appeals.

F. No action shall lie against the company to recover for any loss under this policy unless it shall be brought by the assured for loss actually sustained and paid in money by the assured in satisfaction of a judgment after trial of the issue; nor unless such action is brought within ninety (90) days after final judgment against the assured

has been so paid and satisfied. The company does not prejudice by this condition any defenses against such action that it may be entitled to make under this policy.

G. In case of payment of loss under this policy the company shall be subrogated to all rights of the assured against any person or corporation, as respects such loss, to the amount of such payment, and the assured shall execute all papers required and shall co-operate with the company to secure to the company

H. If the assured carry a policy of another insurer, whether valid or not, against a loss covered by this policy, the assured shall not be entitled to recover from the company a larger proportion of the entire loss than the amount hereby insured bears to the total amount of his insurance.

such rights.

I. If the business of the assured is placed in the hands of a receiver, assignee or trustee, whether by the voluntary act of the assured or otherwise, this policy shall immediately terminate, but such termination shall not affect the liability of the company as to any accidents theretofore occurring. If the assured is a corporation, a change of title, or if a firm or individual a change of title or of ownership, shall in like manner terminate this policy, unless such change is consented to by the company, by an endorsement hereon, signed by its president, vice-president or one of its secretaries.

J. The premium is based on the entire compensation whether for salaries, wages, piecework, overtime or allowances earned by the employees of the assured during the period of this policy; whenever employees are compensated, in whole or in part, by store certificates, board, merchandise, credits, or any other substitute for cash, the amount of compensation covered by such substitutes shall be included in the entire compensation on which the premium is based. If such entire compeo sation exceeds the sum set forth in the schedule, the assured shall immediately pay the company the additional premium earned; if such compensation is less than the sum set forth in the schedule, the company will return the unearned premium, when determined; but the company shall receive or retain not less than dollars ($ ), it being agreed that this sum shall be the minimum earned premium.

K. This policy may be canceled by the company at any time by written notice served on or sent by registered letter to the assured at the address given herein, stating when the cancellation shall be effective. It may be canceled by the assured by like notice to the company. If canceled by the company, the company shall be entitled to the earned premium, pro rata, when determined. If canceled by the assured, unless the assured has retired from business, the company shall receive or retain the customary short-rate premium. (In either case the earned premium shall be computed on the compensation for the year as indicated by the actual compensation earned by the employees of the assured during the time the policy shall have been in force.) In any case the company shall receive or retain the minimum earned premium stated in condition J. The company's check mailed to the address of the assured as given

herein shall be a sufficient tender, but no return premium shall be payable until a statement of the actual compensation earned by the employees of the assured during the period the policy was in force shall have been furnished to the company by the assured.

L. Any of the company's authorized inspectors shall have the right and opportunity, wbenever the company so desires, to inspect the plant, works, machinery and appliances of the assured; and the company or any of its inspectors may suspend this insurance, so far as any boiler or elevator is concerned, because of any defect or dangerous condition found in the same. Notice of such suspension and the reason therefor and of the reinstatement of the insurance must be in writing.

M. Any of the company's authorized auditors shall have the right and opportunity, whenever the company so desires, to examine the books and records of the assured as respects compensation earned by the employees of the assured, and the assured shall render reasonable assistance; but the company waives no right by failing to make such examination. The assured shall, whenever the company so requests, furnish the company with a written statement of the amount of compensation earned by bis employees during any part of the period of the policy, and at the end of the period of the policy the assured shall furnish the company with such statement covering the full period of the policy. The rendering of any estimate or statement or any settlement shall not bar the examination herein provided for nor the company's right to additional premiums.

N. No erasure or change appearing on the face of this policy as originally printed and no change or waiver of any of its terms or conditions or statements shall be valid unless endorsed hereon and signed by the president, the vice-president or one of the secretaries of the company. Notice to or knowledge by any agent or any other person shall not be held to waive any of the terms, conditions or statements hereof.

O. No person shall be deemed an agent of the company unless such person is authorized in writing as such agent by the president, the vice-president or one of the sccretaries of the company.

SCHEDULE. 1. Name of assured,

2. Address of assured, (state street, town, county and State where head office is located). 3. The assured is (state whether individual, copartnership, corporation, receiver or other trustee). 4. The places where the factories, shops and yards are located, the kind of trade or business carried on at each such location, and the estimated number of employees, and the estimated compensation of employees at each such location, are as follows:

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The estimated compensation covers the wages or salaries of all persons to whom compensation is paid in the business or trade carried on by the assured at the locations mentioned and described in this schedule, including regular time and overtime, and all allowances, whether paid in cash, or board, or store certificates, or merchandise, or credits, or in any other way, including the compensation, of whatever kind, paid to piece-workers, also the wages or other compensation paid to drivers when there is no coneurrent teams policy, and including the salaries or other compensation of president, vice-president, secretary, treasurer, derks and office men, excepting as follows: 5. The total number of hand-fed cutting, embossing, pressing, parching and stamping machines at all the locations mentioned above, whether in use or not, is as follows:

state number and kind of each.) 6. The operations carried on are those usual to the kind of trade or busiDess described herein. 7. There are no steam-power boilers on the premises, except as follows: 8. There are no passenger or freight or other elevators on the premises, except as follows: 9. No power is used, except as follows: 10. No chemicals are used, except as follows: II. No explosives are used, except as follows: 12. The following insurances are now carried: Employers' Liability, $ name of company, Public Liability, $ name of company,

Workmen's Collective, $ , name of company, Boiler, $ name of company,

Elevator, $ of company, Teams, $ name of company,

13. Valid insurance in amounts not less than stated above will be carried during the period of this policy. 14. No company bas canceled er refused to issue liability, elevator or boiler insurance to the assured during the past three years, except as follows:

15. No company has insured this risk during the past two years, except as follows: . 16. The entire compensation earned by all employees during the year ending December 31 last, was $

17. The minimum premium for this policy is $ The insurance to begin on the

day of

, 19 at noon, and to expire on the day or , at noon, standard time, at the place where the policy is countersigned. Dated Broker or agent

Resident manager or general agent

name

,19

· 19

MANUFACTURERS' PUBLIC LIABILITY POLICY. The hereinafter called "the company,” in consideration of dollars ($ ) estimated premium and the statements hereinafter set forth in the schedule of statements, which statements the assured makes and warrants to be true by the acceptance of this policy, except the statements concerning the number of employees and their compensation, which are estimated, does hereby agree to indemnify

of
county of

State of , hereinafter called the assured, for a period of months, beginning on the day of 190 , noon, and ending on the

day of

190 , noon, standard time at the place where this policy has been countersigned : Against loss from the liability imposed by law upon the assured for damages on account of bodily injuries or death, accidentally suffered while this policy is in force, by any person or persons not employed by the assured while within the factory, shop or yard described in the schedule or upon the sidewalk or other ways immediately adjacent thereto provided for the use of employees or the public, during the operation of the trade or business described in the schedule, subject to the following conditions :

CONDITIONS. A. The company's liability for loss from an accident resulting in bodily injuries to or in the death of obe person is limited to dollars ($ ), and, subject to the same limit for each person, the company's total liability for loss from any one accident resulting in bodily injuries to or in the death of more than one person is limited to dollars ($

B. This policy does not cover loss from liability for injuries or death-(1) Caused by any person unless his compensation is included in the estimate set forih in the schedule (provided

that this exclusion shall not apply to loss from liability for injuries or death caused by the assured himself if an individual, nor if a firm by any member thereof, nor if a corporation by its president, vice-president, secretary or treasurer, provided such officer is not managing or superintending at the works); (2) Caused by any child employed by the assured contrary to law or any child employed under fourteen (14) years of age where no statute restricts the age of employment; (3) Caused by any convict employed by assured; (4) Suffered by any person while in or on any elevator or in any elevator well or hoistway, or wbile entering upon or álighting from any elevator ; (5) Caused by any

draught or driving animal or vehicle or any person in charge thereof; (6) To o caused by any person in connection with the making of additions to or alterations in or the construction of any building or structure or plant or in connecticn with the wrecking or de molition of any building or structure or plant or any part thereof. Ordinary repairs when made by the employees of the assured wnose compensation is included in the estimate set forth in the schedule are permited.

C. Upon the occurrence of an accident the assured shall give immediate written notice thereof, with the fullest information obtainable at the time, to the company's home office or to the agent who has countersigned this policy. If a claim is made on account of such accident the assured shall give like notice thereof with full particulars. The assured shall at all times render to the company all co-operation and assistance in his power.

D. If thereafter any suit is brought against the assured to enforce a claim for damages on account o an accident covered by this policy the assured shall immediately forward to the company's home office Every summons or other process as soon as the same shall have been served on him, and the company will, at its own cost, defend such suit in the name and on behalf of the assured unless the company shall elect to settle the same or to pay the assured the indemnity provided for in Condition A hereof. E. The

assured shall not voluntarily assume any liability, nor shall the assured, without the written consent of the company previously given, incur any expense or settle any claim, except at his own cost, or interfere in any negotiation for settlement or in any legal proceeding, except that the assured may provide at the time of the accident such immediate surgical relief as is imperative. Whenever requested by the company the assured shall aid in securing information and evidence and the attendance of witnesses and in effecting settlements and in prosecuting appeals.

F. No action shall lie against the company to recover or any loss under this policy unless it shall be brought by the assured for loss actually sustained and paid in money by the assured in satisfaction of a judgment after trial of the issue; nor unless such action is brought within ninety (90) days after final judg. ment against the assured has been so paid and satisfied. The company does not prejudice by this condition any defenses against such action that it may be entitled to make under this policy.

G. In case of payment of loss under this policy the company shall be subrogated to all rights of the assured against any person or corporation, as respects such loss, to the amount of such payment, and the assured shall execute all papers required and shall co-operate with the company to secure to the company such rights.

H. If the assured carry a policy of another insurer, whether valid or not, against a loss covered by this policy, the assured shall not be entitled to recover from the company a larger proportion of the entire loss than the amount hereby insured bears to the total amount of his insurance.

1. If the business of the assured is placed in the hands of a receiver, assignee or trustee, wbether by the voluntary act of the assured or otherwise, this policy shall immediately terminate, but such termination shall not affect the liability of the company as to any accidents theretofore occurring. If the assured is a corporation, a change of title, or if a firm or individual, a change of title or of ownership, shall in like manner terminate this policy, unless such change is consented to by the company, by an endorsement hereon, signed by its president, vice-president or one of its secretaries.

J. The premium is based on the entire compensation, whether for salaries, wages, piecework, overtime or allowances earned by the employees of the assured during the period of this policy; whenever employees are compensated, in whole or in part, by store certificates, board, merchandise, credits or any other substitute for cash, the amount of compensation covered by such substitutes shall be included in the entire compensation on which the premium is based. If such entire compensation exceeds the sum set forth in the schedule the assured shall immediately pay the company the additional premium earned; if such compensation is less than the sum set forth in the schedule the company will return the unearned premium, when determined; but the company shall receive or retain not less than dollars ($ ), it being agreed that this sum shall be the minimum earned premium.

K. This policy may be canceled by the company at any time by written notice, served on or sent by registered letier to the assured at the address given herein, stating when the cancellation shall be effective. It may be canceled by the assured by like notice to the company. If canceled by the company, the company shall be entitled to the earned premium, pro rata, when determined. If canceled by the assured, unless the assured has retired from business, the company shall receive or retain the customary short-rate premium. (In either case the earned premium shall be computed on the compensation for the year as indicated by the actual compensation earned by the employees of the assured during the time the policy shall have been in force.) In any case the company shall receive or retain the minimum earned premium stated in Condition J. The company's check mailed to the address of the assured as given herein shall be a sufficient tender, but no return premium shall be payable until a statement of the actual compensation earned by the employees of the assured during the period the policy was in force shall have been furnished to the company by the assured.

L. Any of the company's authorized inspectors shall have the right and opportunity, whenever the company so desires, to inspect the plant, works, machinery and appliances of the assured; and the company or any of its inspectors may suspeod this insurance, so far as any boiler is concerned, because of any defect or dangerous condition found in the same. Notice of such suspension and the reason therefor and of the reinstatement of the insurance must be in writing.

M. Any of the company's authorized auditors shall have the right and opportunity, whenever the company so desires, to examine the books and records of the assured as respects compensation earned by the employees of the assured, and the assured shall render reasonable assistance; but the company waives no right by failing to make such examination. The assured shall, whenever the company so requests, furnish the company with a written statement of the amount of compensation earned by his employees during any part of the period of the policy. The rendering of any estimate or statement or any settlement shall not bar the examination herein provided for nor the company's right to additional premiums.

N. No erasure or change appearing on the face of this policy as originally printed and no change or waiver of any of its terms or conditions or statements shall be valid unless endorsed hereon and signed by the president, the vice-president or one of the secretaries of the company. Notice to or knowledge by any agent or any other person shall not be beld to waive any of the terms, conditions or statements hereof.

0. No person shall be deemed an agent of the company unless such person is authorized in writing as such agent by the president, the vice-president or one of the secretaries of the company.

SCHEDULE. 1. Name of assured 2. Address of assured (state street, town, county and State where head office is located.) 3. The assured is (state whether individual, co-partnership, corporation, receiver or other trustee.) 4. The places where the factories, shops and yards are located, the kind of trade or business carried on at each such location, and the estimated number of employees, and the estimated compensation of employees at each such location, are as follows:

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The estimated compensation covers the wages or salaries of all persons to whom compensation is paid in the business or trade carried on by the assured at the locations mentioned and described in this schedule, including regular time and overtime, and all allowances, whether paid

in cash, or board, or store certificates, or merchandise, or credits, or in any other way, including the compensation, of whatever kind, paid to piece workers, also the wages or other compensation paid to drivers when there IS DO concurrent teams policy, and including the salaries or other compensation of president, vicepresident, secretary, treasurer, clerks and office men, except as follows:

The total number of hand-fed cutting, embossing, pressing, punching and stamping machines at all the ocations mentioned above, whether in use or not, is as follows: (state number and kind of ach.) 6. The operations carried on are those usual to the kind of trade or business described herein. 7. There are no steam-power boilers on the premises, except as follows: 8. There are no passenger or freight or other elevators on the premises, except as follows: 9. No power is ased, except as follows: 10. No chemicals are used, except as follows: 11. No explosives are lised, except as follows: 12. The following insurances are now carried : Employers' liability, $ Name of company Boiler, $ Name of company

Public liability, $ Name of company Elevator, $

Name of company

Workmen's collective, $ Name of company Teams, $ Name of company 13. Valid insurance in amounts not less than stated above will be carried during the period of this policy. 14. No company has canceled or refused to issue liability, elevator or boiler insurance to the assured during the past three years, except as follows: 15. No company has insured this risk during the past two years, except as follows: 16. The entire compensation earned by all employees during the year ending December 31, last, was $ minimum premium for this policy is $ The insurance to begin on the

day of

19 at noon, and to expire on the

day of

19 at noon, standard time, at the place where the policy is countersigned Dated

19
Broker or agent

Resident manager or general agent

17. The

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CONTRACTORS' EMPLOYERS' LIABILITY POLICY. The hereinafter called the company, in consideration of dollars ($ mated premium and the statements hereinafter set forth in the schedule of statements, which statements the assured makes and warrants to be true by the acceptance of this policy, except the statement concerning the number of employees and their compensation which are estimated, does hereby agree to indemnify of , county of State of , hereinafter called the assured, for a period of months, beginning on the day of , 190, noon, and ending on the day of

, 190, noon, standard time, at the place where this policy has been countersigned: Against loss from the liability imposed by law upon the assured for damages on account of

bodily injuries or death, accidentally suffered while this policy is in force, by any employee or employees of the assured while at the places described in the schedule, in and during the prosecution of the work described in the schedule, including, however, drivers mentioned in the schedule when on duty in the vicinity of the locations designated in the schedule, subject to the following conditions :

A. The company's liability for loss from an accident resulting in bodily injuries to or in the death of one person is limited to dollars ($ ), and, suhject to the same limit for each person, the company's total liability for loss from any one accident resulting in bodily injuries to or in the death of more than one person is limited to dollars ($ ).

B. This policy does not cover loss from liability for injuries or death to or caused by—(1) Any person unless his compensation is included in the estimate set forth in the schedule (provided that this exclusion shall not apply to loss from liability for injuries or death (a) caused by the assured himself if an individual, nor if a firm by any member thereof, nor if a corporation by its president, vice-president, secretary or treasurer, provided such officer is not managing or superintending the work; or (6) to or caused by drivers of teams for which the assured carries concurrent teams insurance in this company); (2) Any child employed by the assured contrary to law or any child employed under tourteen (14) years of age where no statute restricts the age of employment; (3) Any convict. This policy does not cover loss from liability for injuries or death occasioned by reason of the failure of the assured to observe any statute affecting the safety of persons; nor for injuries occasioned by reason of the failure of the assured to observe any local ordinance of which he has knowledge.

C. Upon the occurrence of an accident the assured shall give immediate written notice thereof, with the fullest information obtair able at the time, to the company's home office or to the agent who has countersigned this policy. If a claim is made on account of such accident the assured shall give like notice thereof with full particulars. The

assured shall at all times render to the company all co-operation and assistance D. If thereafter any suit is brought against the assured to enforce a claim for damages on account of an accident covered by this policy, the assured shall immediatly forward to the company's home office every summons or other process as soon as the same shall have been served on him, and the company will, at its own cost, defend such suit in the name and on behalf of the assured unless the company shall elect to settle the same or to pay the assured the indemnity provided for in condition A hereof.

E. The assured shall not voluntarily assume any liability, nor shall the assured, without the written consent of the company previously given, incur any expense or settle any claim, except at his own cost, or interfere in any negotiation for settlement or in any legal proceeding; except that the assured may provide at the time of the accident such immediate surgical relief as is imperative. Whenever requested by the company, the assured shall aid in securing information and evidence and the attendance of witnesses and in effecting settlements and in prosecuting appeals.

F. No action shall lie against the company to recover for any loss under this policy unless it shall be brought by the assured for loss actually sustained and paid in money by the assured in satisfaction of a

in his power.

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