by the assured contrary to law or any child employed under fourteen (14) years of age where no statu ́e restricts the age of employment; (3) any person by reason of collisions; (4) any passenger or passengers. 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 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 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 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, 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 de ires 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 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, and at the end of the period of the policy the assured sball 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 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 or the secretary of the company. 1. Name of assured, SCHEDULE. 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, 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 explosives are used or earried, except as follows: wages of the entire ship's crew, except as follows: except as follows: 8. The estimated compensation includes the 7. No 9. There is no similer insurance now carried, 10. Valid insurance in amounts not less than stated above will be carried during the period of this policy. 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 14. The minimum premium for this policy is $ the year ending December 31, last, was $ WORKMEN'S COLLECTIVE INSURANCE. Against bodily injuries sustained by any employee or employees of the assured through external, violent and accidental means, while actually engaged in the occupations and at the places mentioned in the schedule endorsed hereon, and resulting from the operation of the trade or business described in said schedule. SPECIAL AGREEMENTS. Clause A. If the death of any employee shall result within ninety days from such injuries, independent of all other causes, the company will pay to the assured a sum equal to weeks' wages, computed at the rate per week received by such injured employee at date of accident, but such sum shall not exceed one thousand five hundred dollars. Clause B. If any employee shall, within ninety days, as the result of such injuries, independent of all other causes, lose by actual separation, at or above the wrists or ankles, both hands or both feet, one hand and one foot, or shall irrecoverably lose the sight of both eyes, the company will pay to the assured the amount specified in Clause A. Clause C. If any employee shall, within ninety days, as the result of such injuries, independent of al other causes, lose by actual separation, at or above the wrist or ankle, one hand or one foot, the company will pay to the assured one-third the amount specified in Clause A. Clause D. If any employee shall, within ninety days, as the result of such injuries, independent of all other causes, irrecoverably lose the sight of one eye, the company will pay to the assured in satisfaction of all claims for such injury a sum equal to one-eighth the amount specified in Clause A, but not exceeding two hundred dollars. Clause E. If such injuries, independent of all other causes, shall immediately, continuously and wholly disable and prevent such employee from engaging in any work or occupation for wages, the company will pay to the assured an amount equal to one-half the usual weekly wages of the injured employee for the period of such disability, not exceeding twenty-six weeks in respect of any one accident, but such sum shall not exceed five hundred dollars in respect of any one injured person during the policy year. 1. Recovery may be had for the benefit of the same employee under one of the foregoing clauses only as respects the results of injuries caused by any one accident, and in no event shall the company's liability for a casualty, resulting in injuries to, or the death of, several persons, exceed ten thousand dollars. 2. The premium is based on the wages to be expended by the assured during the period of this policy. If the wages actually paid exceed the sum stated in said schedule, the assured shall pay the additional premium earned; if less than the sum stated, the company will return to the assured the unearned premium, pro rata; but the company shall first retain not less than dollars ($ ), it being understood and agreed that this sum shall be the minimum earned premium under this policy. Secretary Countersigned Issued by the company to 1. Name of assured President SCHEDULE. boilers. The maker's name 2. Address of assured (name street, town, county and State where office is located) 3. The locations of all factories, shops or yards are given below 4. Trade or business is (state what the business is, giving the rate-book classification, specifically including character of work, etc.) 5. The application of employees are those usual and necessary to the trade or kind of business described above. 6. No power is used except as follows: 7. There are Their type is Their age is 8. There are elevators. Their type is is 9. No chemicals are used, except as follows: 10. No explosives are used, except as follows: II. No stamping of sheet or other metal is done by power pressss, except as follows: (state number of power presses, if any) 12. The estimated pay-roll includes the wages of all executive officers, office men, piece-workers employed in the factories or shops, and all other employees, except as follows: 13. The employees whose wages are included in the following list do not make alterations or additions to buildings or plant. They make no repairs except as follows: 14. The following similar insurance is Name of company carried: Boiler, $ Name of company Employer's liability $ Name of company Elevator, $ 15. The insurances described in paragraph 14 cover the period for which this policy is written except as follows: 16. The estimated average number of employees in each class or occupation and the estimated average annual wages in each description or class are given in the following list: was $ The premium rate is 17. The total expenditure for wages for the last calendar year, ended December 31, 190 Surgeon's CLAUSE. In consideration of an additional premium of $ being at the rate of for every endu dred dollars ($100) of wages paid to the employees, this policy, subject to all its agreements and conditions, Is hereby extended so that the company will, at its own cost and expense, furnish to the injured employee, through its own surgeon, such medical attendance as may be considered by such surgeon necessary to the treatment of any injuries covered hereby. Dated , 190. Countersigned GENERAL EXPOSURE CLAUSE. In consideration of an additional premium of $ being at the rate of or every one hundred dollars ($100) of wages paid to employees, this policy, subject to all its benefits, agreements and conditions, is hereby extended to cover accidents to the employees of the assured insured hereunder, occurring at any time or place during the continuance of this policy. Dated , 190 Countersigned NON-CONFERENCE FORMS. The following policies are non-conference forms, and are issued by several, but not all, of the various liability companies. Only one form is given here of each kind of insurance, for the policies of the companies are substantially alike and differ only in minor conditions. STEAM BOILER INSURANCE. dollars hereby insures and steam In consideration of the receipt of legal representatives dollars against all immediate loss or damage, except by fire, to the property of the assured, or to property of others for which the assured may be liable, wherever located, caused by the explosion, collapse, or rupture of the boiler contained in the premises occupied and described in the application of the assured, No. ; also against loss or damage to the assured resulting from the loss of life or personal injury of any person or persons caused by the explosion, collapse, or rupture of said steam boiler or boilers, or any of them, and not contingent upon a judgment of liability against the assured; but the liability of the company for loss of life or injury of any one person shall not exceed the sum of five thousand dollars, nor exceed the amount of this policy, if it be for a less sum than five thousand dollars. It is further provided, that in case of loss under this policy, the loss or damage to property as described herein shall be the first claim for settlement, and that the portion of the policy then remaining shall be the only amount applicable to loss of life or injury to persons; but in no event shall the entire liability of the company exceed the sum insured by this policy, viz.: $ . From the nineteen hundred at day of nineteen hundred at 12 o'clock, noon; day of 12 o'clock, noon, unto the to be paid after notice and proof of loss by the assured, according to the requirements and in conformity to the provisions of this policy. CONDITIONS AND AGREEMENTS. Except as hereinafter provided, it being expressly covenanted and agreed, as conditions of this contract, that this company is not to be liable for any loss or damage resulting from any explosion caused by the burning of the building or steamer containing the boiler or boilers; nor for any loss or damage in case the load on the safety-valve approved by the company's inspector, viz.: pounds per square inch shall be exceeded; and if the title or possession of said property is transferred or changed, or if this policy is assigned without the written consent of this company endorsed hereon, this policy shall be void; and any change in the boilers, within the control of the assured, material to the risk, without the consent of this company, shall make void this policy. If there shall be any other similar insurance upon said property, or any other insurance covering loss of life and injury to persons or liability therefor, the assured shall in no event recover or demand of this company any greater proportion of the loss or damage to the property insured; or the loss or damage to the assured resulting from loss of life or injury in respect to any one person than the amount hereby insured bears to the whole amount of insurance applicable thereto. Prevention of steam boiler explosions being one of the objects of this company, it is hereby agreed that the inspectors of this company shall at all reasonable times have access to said boiler or boilers, and the machinery connected therewith, on which safety depends; and ample facilities shall be afforded to such inspectors, whenever this company shall desire it, for a thorough examination of said boiler or boilers; and should any inspector at any time discover any defect affecting the safety of said boi er or boilers or the apparatus connected therewith, he shall notify the assured and this policy shall thereupon become void, unless the use of the boiler or boilers so affected shall cease until such defect is thoroughly repaired by the assured; and this company reserves the right at any time to cancel this policy, in which case, after deducting the charges for inspection, the company will return to the assured a pro rata part of the remaining premium for the unexpired term of this policy. This policy may also be canceled at the request of the assured, but only in case of the sale, lease, transfer, or destruction of the boiler or boilers insured, or if the assured cease to use them for a period of more than three months; in which case the company, after deducting the charges for inspection and the customary short rates for the time the policy has been in force, will return to the assured the remaining portion of the premium. The assured in case of loss under this policy shall give immediate notice and render a particular account thereof to this company, with an affidavit stating the value and ownership of the property insured, the amount of the loss or damage resulting from the explosion, collapse, or rupture, other similar insurance, and other insurance covering loss of life or injury to persons or liability therefor, if any, with copies of all policies, and shall, whenever and as often as required, be examined under oath by some officer or attorney of this company touching all questions relating to the claim, and until such proofs are rendered to the company the loss shall not become payable. In no case shall the claim be for more than the actual and immediate damage insured against, estimated according to the true cash value of the property at the time of the explosion, and the loss or damage to the assured resulting from loss of life and personal injury as insured against. Claims on account of personal injury may be settled by the assured on the basis of loss of wages of the injured person for the time of total disability, and reasonable expenses for nursing and medical attendance, without prejudice to the rights of the assured under this policy; and in case suit is brought against the assured for loss of life or injury to person, or for other loss or damage insured against by this policy the company will co-operate with the assured and render every practicable assistance in the defense of the same, the cost of such defense to be paid by the company as part of the loss or damage insured against. In case of explosion, colapse, or rupture, the company shall have reasonable time and opportunity to examine thoroughly said boiler or boilers and the machinery and premises connected therewith before any repairs are commenced; and this company may repair, restore, or replace the property damaged or lost and hereby insured, upon giving notice of such intention after said examination shall have been made and proofs of loss shall have been rendered as above. In event of disagreement as to the amount of loss, the same shall be ascertained by two competent and disinterested appraisers, one to be chosen by the assured and one by this company; the two so chosen to select a third person to act as umpire and decide upon items upon which the two may disagree, and the award of any two of them shal. determine the amount of loss. The assured and the company to pay the appraisers respectively chosen by each and share and pay equally for the umpire and expenses of appraisal. It is expressly covenanted by the parties hereto that no suit or action shall be brought against the company for the recovery of any claim for loss or damage under this policy unless commenced within one year, or within the statutory limit of time if same is more than one year, next after such loss or damage shall occur; and it is further covenanted that by the terms "explosion, collapse, or rupture of the boiler," as used in this policy, is to be understood a sudden and substantial collapse or rupture of the shell or flues of the boiler, or the safety-valve, steam pipe, feed pipe, blow-off pipe, and pipes of water column and steam gauge, up to and including the stop-valve nearest the boiler in each of same, caused by the pressure of steam; it being agreed that this company is not l'able under this policy for any loss or damage from any other accident, and that the company assumes no liability from loss or damage by fire, resulting from any cause whatever. No change, modification, or waiver of any provision or condition of this contract shall be made except by the president, vice-president, or secretary of the company, in writing indorsed hereon. In witness whereof, have caused these presents to be signed by their President, attested by their Secretary, and delivered at the Home Office, in the City of but the same shall not be binding upon the company until countersigned by Secretary President. Countersigned at this day of 190 AUTOMATIC SPRINKLER INSURANCE Against all direct loss or damage caused by the accidental discharge or leakage of water from the Automatic Sprinkler System erected in or upon the building, any portion of which is occupied by assured, situate on that part of the premises occupied by the assured as described in this application, whenever such discharge or leakage is occasioned by any accidental cause, except that caused by fire (thereby meaning conflagration). This insurance covers property real and personal, owned by the assured, or held in trust or on commission, or sold but not delivered or removed, and on property of others for which the assured may be liable. It is understood and agreed, that the entire liability of this company under this contract shall under no circumstances exceed the sum of dollars (for all losses, claims and damages whatsoever.) This company shall not be liable for any loss unless amounting to twenty-five dollars ($25.00) or more. GENERAL CONDITIONS. Subject to the following conditions and agreements: It is expressly warranted and agreed, that the company shall not be held responsible for any damage caused by any wifil act of the assured, or those in the employ of the assured. That the company shall not be held responsible for damages which may occur during repairs to the sprinkler plant, or from freezing if the premises herein described shall become vacant or unoccupied. That the company shall not be held responsible for loss or damage which might occur after due notice had been furnished to the assured that the sprinkler plant is not in good condition or is liable to cause loss, owing to defective construction, nor if the assured is himself aware of any defective construction or condition. That the company shall not be held responsible for any loss or damage as the result of repairs to the building or any part of the premises, or by earthquake, blowing up of premises or blasting in the vicinity, which may cause damage to said plant and thus cause loss. That the company shall not be held responsible for damage or loss of books, by which it is understood books of account, for bills, currency, deeds, evidence of indebtedness, money, notes, securities, curiosities, drawings, paintings, jewels, manuscripts, medals, models or any work of art, unless same shall be specially enumerated in the application herefor. The company shall not be liable for more than the actual market value of the property at the time any loss or damage occurs, and the loss or damage shall be ascertained or estimated according to such actual market value, with the proper deduction for depreciation, however caused, and shall in no event exceed what it would cost the assured to repair or replace the same with material of the like kind and quality; said ascertainment or estimate shall be made by the assured and this company, or if they differ, then by appraisers as hereinafter provided. The company shall be subrogated to the extent of its interests to all claims or rights of the assured against any third party in respect to any loss that may occur hereunder, and the assured shall execute all papers necessary for this purpose. The company shall have permission to examine the premises for the purpose of inspection at any reasonable time. That should the assured, under this contract, cause to be made any change or repairs of the sprinkler system herein enumerated, notice in writing shall be furnished beforehand to the company. That loss or damage under this contract shall be held to apply to such loss or damage occasioned by the direct act of the plant described ther-in, and no loss or damage caused by theft or neglect, or by the failure of the assured to use all reasonable means to preserve the property insured under this contract shall be claimed under same, but no loss sustained to the sprinkler plant itself shall be covered under this contract. This policy does not cover loss or damage resulting from the explosion, rupture, collapse or leakage of steam boilers or steam pipes, nor the fall or collapse of any building or buildings. That in the event of losses the assured shall give immediate notice thereof in writing to the company, either at its head office direct, or through or to any of its duly authorized agents, and shall further cause the property to be protected from damage forthwith, and separate damaged and undamaged property, placing it in the best order, making a complete inventory of same, stating quantity, and furnishing evidence of cost of such articles as may be damaged, and file a full and complete claim therefor, and that within thirty days after the loss a statement shall be furnished to the company and property verified, showing the relative interests of the assured and any others in the property, also containing the value at the time of loss of each item thereof and the amount of loss thereon, also evidence of any similar insurance carried upon same, and, further, a copy and description and schedules of such policies, and shall further furnish, if required, specification or evidence of the cost of the machinery or fixtures destroyed, damaged or injured. That the assured, if required, shall exhibit to any properly designated representative of this company all that remains of any property damaged under this contract, and submit an affidavit, and, if required, produce for examination books of account, invoices, and such vouchers or certified copies thereof as may be required, at such reasonable place as 'may be designated by the company or its representatives. In the event of disagreement as to the amount of damage or loss, the same shall be submitted to the appraisement of two competent and disinterested appraisers, the assured and company each represented by one such appraiser, having first mutually agreed upon an umpire to whom shall be submitted their decision. The three shall then estimate and arrive at the loss that the company shall pay. The assured and the company each shall pay the representative appraiser selected by them, and equally bear the expense of the appraisement and umpire; but the company shall not be held to waive any condition of this contract, or to forfeit any rights thereunder, or any act or proceeding on their part relative to said appraiser or examination here provided for, and such loss shall become payable ten days after notice, estimate and satisfactory deter nination and appraising of loss. No suit or action under this contract for recovery of loss shall be sustained in any court of law or equity until all conditions of this contract have been complied in by the assured, including all foregoing requirements, and any suit and all claim for loss shall be barred, unless entered within twelve months of the loss. In case of any other like insurance, the company having been notified by the assured, any loss occurring shall be only borne in its pro rata share by the company, under this contract. This contract may be canceled by the assured, provided the premium has been paid, by giving thirty days' notice to the company at the head office, or to any representative; at the expiration of which time the company, having first retained 30 per cent. of the premium for inspection charges and the customary short rate, to be computed upon the balance of the premium for the time said contract has been in force, shall return the unearned premium; provided this cancellation shall not be for the interest of any similar company. The contract may also be canceled by the company by giving written notice to the assured; in which case the company shall retain a pro rata portion of the premium for the time the contract has been in force. No agent has any authority to change this policy or waive any of its provisions or conditions, nor shall notice to any agent or knowledge of his or any other person be held to effect a waiver or change in this contract or in part of it. No change whatever in this policy nor waiver of any of its provisions or conditions shall be valid unless an endorsement is added hereto signed by the president or secretary of the company, expressing such waiver or change. APPLICATION FOR AUTOMATIC SPRINKLER INSURANCE. Application is hereby made for a Sprinkler Insurance Contract to be issued upon the following repreentations, which are to be considered as warranties: |