at insurance to the assured during the past three years, except as follows: 16. No company has insured this risk during the past two years, except as follows: 17. Inspection reports and other notices and correspondence are to be mailed to the assured at address given above, or to (If to the latter it is by request of the assured, who acknowledges such person as the proper agent for this purpose.) 18. The premises are leased entire to one tenant, except as follows: 19. There is no other elevator or general liability insurance carried by the assured on the premises, except as follows: OWNERS' CONTINGENT POLICY FORM. 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, the , hereinafter called the company, hereby agrees to indemnify hereinafter called the assured, for a period of months, beginning on the noon, and ending on the of of day of county of , State of day , 190 , 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 during the continuance of the work described in the schedule, and resulting from the negligence of any contractor or sub-contractor engaged in such work, 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, 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. It is agreed that all work mentioned in the schedule is to be done by written contract at the risk of the contractor or contractors, and that the assured has not and will not by contract or otherwise voluntarily assume any liability for loss on account of injuries or death suffered by any person or persons. It is agreed that no employee of the assured shall be engaged in work on the premises herein described, nor shall the assured furnish any material or appliances or assume any supervision or control of the work herein described. It is agreed that the company shall not be responsible for any loss from liability for injuries or death resulting from faulty work, as distinguished from injuries due to acts of negligence in the immediate doing of the work of construction. Č. If a claim is made on account of an accident the assured shall give immediate written notice thereot 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, 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, nor interfere in any negotiation for settlement, or in any legal proceeding. 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 to this action 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 to the amount of such payment of the assured, against any person or corporation, as respects such loss, 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. 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 or its secretary. J. The estimated premium of this policy is based on the total cost of the work described in the schedule. If such cost exceeds the sum set forth in the schedule the assured shall immediately pay the company the additional premium earned; if such cost is less than the sum set forth in the schedule the company will return the unearned premium when determined; but the company shall retain not less than ($ ), it being agreed that this sum shall be the minimum earned premium. dollars K. This policy may be canceled by the company at any time by written notice to the assured 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, the company shall be entitled to the earned premium calculated at short rates in accordance with the table printed hereon. In either case the earned premium shall be computed on the cost of the work during the time the policy shall have been in force. In any case the minimum earned premium stated in condition J shall be retained by the company. 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 cost of the work 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 work designated in the schedule. 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 the cost of the work designated in the schedule, and the assured shall render reasonable assistance; but the company waives no right by falling to make such examination. The assured shall, whenever the company so requests, furnish the company with a written statement of the cost of the work during any part of the period of the policy, and at the end of the period of the policy or upon the completion of the work the assured shall furnish the company with such statement. 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 or the secretary 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. 0. No person shall be deemed an agent of the company unless such person is authorized in writing as such agent by the president or the secretary of the company. SCHEDULE. 2. Address of assured, 1. Name of assured, (name street, town, county and State where office is located). 3. The assured has no interest in the work covered by this policy except that of owner. 4 The location of the work is (name street, town, county and State where work is located). 5. Description of work: (If a building state materials used in construction and for what purpose building is to be used.) 6. If a building its dimensions will be: Frontage, feet; depth, feet; height, teet; stories, 7. No employee of the owner is engaged in any work on the premises herein described, except as follows. 8. The owner will not furnish any material or appliances or assume any supervision or control of the work herein described, except as follows: 9. The contract price for the work is $ 10. No wrecking or demolition is done, except as follows: CONTRACTORS' CONTINGENT FORM. 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, the hereinafter called the comcounty of , State of months, beginning on the day of 190, 190 noon, standard time at the place where of day of hereinafter pany, hereby agrees to inde...nify called the assured, for a period of noon, and ending on the 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 during the continuance of the work described in the schedule, and resulting from the negligence of any sub-contractor engaged in such work, 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 ore 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. It is agreed that the assured will, until expiration of this policy, carry insurance in this company under its Employers' Liability and Public Liability forms, covering loss from liability for injuries resulting from his own negligence in the work mentioned in the schedule, and that he has not and will not, by con. tract or otherwise, voluntarily assume any liability for loss on account of bodily injuries or death suffered by any person or persons by reason of the negligence of any sub-contractor. It is agreed that the company shall not be responsible for any loss from liability for injuries or death resulting from faulty work as distinguished from injuries due to acts of negligence in the immediate doing of the work of construction. C. It is understood that the term "sub-contractor" wherever used in this policy means any person or persons, firm or corporation, who at any time prior to the expiration of this policy, contract with the assured relating to or affecting any work designated in the schedule or any part thereof. D. 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 company's authorized agent. If a clain 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. E. 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, 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. F. 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, nor interfere in any negotiation for settlement or in any legal proceeding. 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. G. 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 to such action it may be entitied to make under this policy. H. In case of payment of loss under this pollcy the company shall be snbrogated to all rights, to the amount of such payment, of the assured against any person or corporation, as respects such loss, and the assured shall execute all papers required and shall co-operate with the company to secure to the company such rights. I. 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. J. 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 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 or one of its secretaries. K. The premium is based upon one-third of the total cost of the work described in the schedule less the compensation paid the employees of the assured. If such cost exceeds the sum set forth in the schedule the assured shall immediately pay the company the additional premium earned; if such cost is less than the sum set forth in the schedule the company will return the unearned premium when determined; but the company shall retain not less than dollars ($ ), it being agreed that this sum shall be the mini mum earned premium. L. This policy may be canceled by the company at any time by written notice to the assured 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 be entitled to the earned premium calculated at short rates in accordance with the table printed hereon. In either case the earned premium shall be computed on the entire cost of the work during the time the policy shall have been in force. In any case the minimum earned premium stated in condition K shall be retained by the company. 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 cost of the work during the period the policy was in force shall have been furnished to the company by the assured. M. Any of the company's authorized inspectors shall have the right and opportunity whenever the company so desires to inspect the work designed in the schedule. N. 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 the cost of the work designated in the schedule 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 cost of the work during any part of the period of the policy, and at the end of the period of the policy, or upon the completion of the work of the assured, shall furnish the company with such statement. The rendering of any estimate or statement shall not bar the examination herein provided for nor the company's rights to additional premiums. O. 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 secretary or the assistant secretary 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. P. No person shall be deemed an agent of the company unless such person is authorized in writing as such agent by the president, the secretary, or the assistant secretary of the company. SCHEDULE. 2. Address of assured, 1. Name of assured, (name street, town, county and State where office is located.) 3. The assured has no other interest in the work than that of general contractor, except as follows: 4. dollars ($ In consideration of ), 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, the called the company, hereby agrees to indemnify of of county of hereinafter State , hereinafter called the assured, for a period of months, beginning on the day of 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 ihan 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 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 on or about the vessels); (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 person by reason of collision. 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 company's authorized agent. 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, 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 its 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 renef 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 to such action 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, to the amount of such payment, of the assured against any person or corporation, as respects such loss, 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. 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 or its secretary. 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 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 to the assured 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 be entitled to the earned premium calculated at short rates in accordance with the table printed hereon. 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 minimum earned premium stated in condition J shall be retained by the company. 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 vessel or vessels, machinery and appliances of the assured; and the company or any of its inspectors may suspend 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 conpany 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, 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 or the secretary of the company. Notice to or knowledge by any agent or any other person shall not be held to waive any of the terins, 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 or the secretary of the company. SCHEDULE. 2. Address of assured, 1. Name of assured, (state street, town, county and State where head office is located). 3. The assured is (state whether individual, co-partnership, corporation, estate or receivership). 4. The names of the vessels, the estimated number of employees and the estimated compensation of employees on said vessels are as follows: 5. Boats are plying on waters of Total Prem. 6. Kind of business for which vessels are used 7. No explosives 8. The estimated compensation includes the wages of the 9. There is no similar insurance now carried, except as 10. Valid insurance in amounts not less than stated above will be carried during the period II. No company has canceled or refused to issue liability insurance to the assured during the past three years, except as follows: 12. No company has insured this risk during the past two years, except as follows: 13. The entire compensation earned by all employees during the year ending December 31 last, was $ 14. The minimum premium for this policy is $ of this policy. MARINE EMPLOYERS' AND PUBLIC POLICY. In consideration of dollars ($ , hereinafter ) 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, the called the company, hereby agrees to indemnify , county of , State hereinafter called the assured, for a period of months, beginning on the 190, noon, and ending on the day of of of , 190, noon, standard day of 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—(1) Any employee or employees of the assured, while on duty on or about the vessels, and in and during the operations of the trade or business described in the schedule; (2) By any person or persons not employed by the assured on or about the vessels of the assured described in the schedule, and resulting from the operations of the trade or business described 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, 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 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 on or about the vessels); (2) any child employed |