|
<br />COVERAGE PART MANUFACTURERS' AND CONTRACTORS' LIABILITY INSURANCE
<br />C(l\I~RAGE FOR PREMISES AND FOR OPERA nONS IN PROGRESS INCLUDING OPERATIONS OF INDEPENDENT CONTRACTORS
<br />..,
<br />
<br />~ ..
<br />
<br />Fa; altaCh~ent to Policy No, OLJ\ 5 22 e S
<br />
<br />L 84tO'
<br />(Ed. 1.73)
<br />
<br />. to complete said policy,
<br />AODITIONAL DECLARA TrONS
<br />Location ~&emlses owned by. rented to or controlled by t~e named Ins~red "NT" ......... .. ..... LOC'TION., 'ODU.. '''OWN'N .u.. '0. OOCL..."ON.:
<br />,
<br />
<br />Interest of nlmed Insured in such premises 'C"OCK ULOW,
<br />~ OWNI''' 0 OIlNl'ftAL LII..... 0
<br />
<br />"J.'~
<br />'.
<br />
<br />TENANT
<br />
<br />D Other
<br />
<br />Parl occupied by nlmed Insured ,ONT.. ULOWI
<br />
<br />ENTIRE
<br />
<br />SCHEDULE
<br />
<br />The Insurance afforded Is only with respect to such of the following Coverages as are indicated by specific premium charge or charges. The limit of the company's
<br />liability against each such Coverage shall be as stated herein, subject to all the terms of this policy having reference thereto,
<br />
<br />A Bodily Injury liability
<br />B-Properly Damage liability
<br />Form numbers of endorsements attached at Issue
<br />
<br />$
<br />$
<br />$
<br />" $
<br />
<br />
<br />AdYlnce
<br />Premiums
<br />
<br />Total AdYlnce Premium
<br />
<br />General liability Hazards
<br />
<br />Advance Premiums
<br />Bedily Injury Property Dlm"e
<br />
<br />Rates
<br />B.I. P,O,
<br />
<br />Premium Bases
<br />
<br />110.00
<br />
<br />130.00
<br />
<br />.661
<br />
<br />.781 C
<br />
<br />1()700
<br />
<br />23.00
<br />
<br />28.00
<br />
<br />COYerale.
<br />
<br />Code
<br />No,
<br />
<br />Description of Hazards
<br />
<br />Premises, Operations
<br />17315 ELECTRICAL WIRHG
<br />WITHIN BUILDINGS,
<br />INCLUDING INSTALLATION
<br />OR REPAIR OF FIXTURES
<br />OR APPLIANCES.
<br />
<br />SURCHARGE
<br />
<br /> I
<br />.~ I ';' , , I
<br />...;: , f
<br />t\ y' ~ , , I
<br />
<br />(a) Per 100 Sq, FI. 01 Are8
<br />(bl Per lInear Foot
<br />(c Per $100 of Remun"a!lr, ,
<br />(d) Pe' $100 of R""eir" '
<br />fel Per Unil
<br />Per tanding
<br />
<br />
<br />- _l___
<br />
<br />(a) Are. (Sq, 't,)
<br />(h) rront,'~e
<br />(el R''l1unCI3tlon
<br />(d) r,"ftiot5
<br />(e) Units
<br />
<br />Numb"-' Illsurtd
<br />
<br />E~I' a!;,:nrs ("umbryr al Preml~~~)
<br />
<br />
<br />I
<br />J
<br />
<br />,.;.; .,nn rif ~,.,.t
<br />
<br /><'-~._._..--c;;;;----- '!'\"~ren-!et1' e~~traetors
<br />
<br />I
<br />I
<br />I
<br />I
<br />T.t-' .~Y~"r. 'I' '"~ " ;; ~~, _! ;::-.:-., T ----~-- --
<br />-:....':..._._--...:"'~,___ _" I
<br />
<br />'" {.~
<br />
<br />s 133.00 s
<br />
<br />158.00
<br />
<br />When used as a premium basis:
<br />
<br />1. "cosl" means the lotal cosl fa the "~"1r.~ i'~tlr~1 VJi:h ""r-' , >',
<br />contractors of all work let or sub,lct in cr~:1ccli0n wi::, ,,'
<br />or delivered for use in the execulicn of sl1ch \'I~r~, VI!' 00,
<br />commissions made. paid or due;
<br />
<br />._. f, "1 ,f I... !t,.~ ... '"1"
<br />
<br />.. ~ Ih~ po' icy rcriarl hy inder~ndcnl
<br />',' : lah Jnd r.quiprnent lurnishr.d, l1sp.d
<br />c';r'S~n f~~Sr ni!o\":':~,;r.'i, !JOllUSCS or
<br />
<br />2, "reeelph" met". th. IIr",. amnunl nl Inn",,, th"~MII...' .'", ""' '. ~, "y ..!I'e" dllrlng t~e ",,"ey "erlnd
<br />as are rated on a receipts basi,. other Ih,:l1icC-'-' , , "', oL'or t~:: laxc":ich th:' "~med
<br />Insured collects as a separate item ~n" ::':;:~ ":'"." ,:, ".. "'''''1
<br />
<br />3. "fCmuIlZfltlDiI" m~ails Ik~ enUre reiliUMralion earned during the policy period by proprieto' ~nd by all employees of the named Insured, other than
<br />chauffeurs (except operators of mobile equipment) ,n,l "",," .:'" 'lIots, su~ ' "~ime earnings or limitalion of relllul1crati~n rule
<br />applicable in accordance with the manuals in use ~;
<br />
<br />(cv~r)
<br />
<br />.' I~~~..
<br />
<br />,[
<br />I
<br />I
<br />~
<br />~'
<br />1
<br />I
<br />l
<br />t
<br />I
<br />
|