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• MONEY AND SECURITIES BROAD FORM POLICY
POLICY PROVISIONS—PART 1 Form 5060
-THE HARTFORD
HA]CE GROUP - i-
HARTFORD.CONNECTICUT
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The company designated on the Declarations page as the Insurer
(a stock insurance company, herein called the company)
Agrees with the insured, named in the declarations made a part hereof, in consideration of the payment of the premium
and in reliance upon the statements in the declarations and subject to the limits of insurance,exclusions,conditions and other
terms of this policy:
INSURING AGREEMENTS
I. Coverage A — Loss Inside the Premises: To pay for loss of premises or attempt thereat, provided with respect to damage to the
money and securities by the actual destruction,disappearance or wrong- premises the insured is the owner thereof or is liable for such damage.
ful abstraction thereof within the premises or within any banking prem-
ises or similar recognized places of safe deposit. II. Coverage B—Loss Outside the Premises: To pay for loss of
money and securities by the actual destruction,disappearance or wrong-
To pay for loss of (a) other property by safe burglary or robbery ful abstraction thereof outside the premises while being conveyed by a
within the premises or attempt thereat, and (b) a locked cash drawer,
cash box or cash register by felonious entry into such container within messenger or any armored motor vehicle company, or while within the
g living quarters in the home of any messenger.
the premises or attempt thereat or by felonious abstraction of such con-
tainer from within the premises or attempt thereat. To pay for loss of other property by robbery or attempt thereat
outside the premises while being conveyed by a messenger or any
To pay for damage to the premises by such safe burglary, robbery armored motor vehicle company, or by theft while within the living
or felonious abstraction, or by or following burglarious entry into the quarters in the home of any messenger.
144
PART 2 Thi, net Poo Pow page, wide "POLICY PROVISIONS-- PART I /-,or +'t.2 (JO rl1 ,Men1, 1 uur. ',Ile d t fun„ a pa?) the,.of eompi,
the below numbered MONEY AND SE UTIES BROAD FORM POLICY.
. F CD Hartford Fire Insurance Company d,®Hartford Casualty Insurance Company
l a J Hartford Accident and Indemnity Company •1] Twin City Fire Insurance Company
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Hartford Plaza, Hartford,Connecticut 06115
� THE HARTFORD
22-- The INSURER shall be the Company C''Cad'
74 designated herein by Co.Code:— ' 5 POLICY NO. 83 MBO BJ7422
BJ DECLARATIONS Previous Policy No.
Items 83 MBO BJ7422 BOARD OF COUNTY COMMISSIONERS
I. Named Insured and Mail Address ). . OF THE COUNTY OF WELD
(No..Street,Town,County,State) GREELEY, CO 80631
83 2. Policy Period )From 01-15-83 To 01-15-84
Producer's Name and Address Agent Code I 12 noon, standard time at the address of the named insured as stated
herein.
The named insured is: MUNICIPALITY
ARTHUR J. GALLAGHER 550144 Individual _ Corporation _
Partnership _ Wholesaler
L_ J Manufacture _ Retailer
3. The insurance afforded is only with respect to such of the following coverages as are indicated by a specific limit of insurance applicable thereto,
subject to all the terms of this policy having reference thereto.
Classes of Property Limits of Insurance Premiums
A. Loss Inside the Premises S 1,000,000.00 $ 1,000.00
B. Loss Outside the Premises $ 1,000,000.00 $ 1,000.00
Form Numbers of Endorsements forming part of policy at issue: Premium for Endorsements $
8-1425-2, B-1203, B-1553-0, 8-1574-0, 8-1433-1
B-1528-0 TOTAL PREMIUM $ 2,000.00
If Policy Period more than one On effective date of Policy 1st Anniversary 2nd Anniversary
year,Premium is payable: $ $ $
4. (a) Business of the Insured conducted in the premises:
(b) The premises are located at the above address, unless otherwise GOVERNMENT (C1 1)
stated herein:
5. No other business is conducted in the premises, unless otherwise
stated herein:
6. Not more than one messenger will have custody of the insured prop-
erty outside the premises at any one time, unless otherwise stated 5 MESSENGERS
herein:
7. Each messenger while outside the premises will be accompanied by
how many guards. NONE
S. The insured property while outside the premises in the custody of a
messenger and his guard,if any,will be conveyed throughout the en-
tire trip by private conveyance employed for their exclusive use,un-
less otherwise stated herein:
9. The insured property will not be conveyed outside the premises by
any armored motor vehicles, unless otherwise stated herein: (enter
maximum number of such vehicles as of any one time). ONE
10. During the last five years the insured has not sustained or received
indemnity for any loss of the kind covered hereby, unless otherwise
stated herein: 03-26-73 1,250.00 (SAFE BURGLARY)
11. During the last five years no insurer has canceled insurance issued to
"- the insured against loss covered hereby, unless otherwise stated
herein:
12. No other insurance issued to the insured is in force which covers loss
covered hereby, unless otherwise stated herein:
LB/BQ OP: 01-15-82
Countersigned by
Form B-1541-3 Printed in U.S.A. (ISO: CR 00 05 10 58) Authorized Agent
BURGLARY (For attachm....t to Money and Securities Broad Form)
LIMITATION TO OR ADDITIONAL LIMIT FOR SECURITIES AND DAMAGE COVERAGE
AND LIMITATION FOR CHECKS, OTHER THAN PAYROLL CHECKS (B 610)
Named Insured and Address
This endorsement forms a part of Policy No 83 MBO BJ7422
issued by THE HARTFORD INSURANCE GROUP company or
companies designated therein,and takes effect as of the effective date
of said policy unless another effective date is stated herein.
Effective date 12 noon,standard time,at the address of the named in-
sured as stated herein.
It is agreed that with respect to loss at or in relation to the premises designated below,the insurance afforded by the policy(1) for money,securities
and other property,(2)for securities other than checks included in the following clause,and for physical damage to property other than money, and
(3) for checks, other than checks intended solely for the payroll of the insured, applies, subject to the amended limit of insurance stated in the
schedule as applicable thereto.
SCHEDULE
Limit of Insurance
(1) (2) (3)
Money, Securities Checks
Securities and Other
and Physical than
Other Damage Payroll
Location of Premises Coverage Property Coverage Checks Total
$ 5$
BLANKET A s1,000,000. 1,000,000.
WELD COUNTY, COLORADO B 1,000,000. 1,000,000.
"Insert total of columns(1), (2)and (3)
Nothing herein contained shall be held to vary,waive,alter,or extend any of the terms,conditions,agreements or declarations of the policy, other
than as herein stated.
This endorsement shall not be binding unless countersigned by a duly authorized agent of the company or companies; provided that if this endorse-
ment takes effect as of the effective date of the policy and,at issue of said policy,forms a part thereof,countersignature on the declarations page of
said policy by a duly authorized agent of the company or companies shall constitute valid countersignature of this endorsement.
THEHARTFORD Hanford Fire Insurance Company New York Underwriters Insurance Company
INSURANCE GROUP Hartford Accident and Indemnity Company Twin City Fire Insurance Company
-4 HARTFORD CONNECTICUT Citizens Insurance Company of New Jersey
Countersigned by
Authorized Agent
Form 8-1425.2 Printed in U.S.A. 8--'63
BURGLARY (For use with Money and Securities Broad Form)
•
BLANKET COVERAGE (B 807)
Named Insured and Address
This endorsement forms a part of Policy No
issued by the HARTFORD FIRE INSURANCE COMPANY GROUP com-
pany or companies designated therein,and takes effect as of the effective date of
said policy unless another effective date is stated herein.
Effective date 12 noon,standard time at the address of the named insured as
stated herein.
It is agreed that the policy applies,subject to the following provisions:
1. The definition of"premises"is amended to read: " 'Premises'means the interior of that portion of any building which is occupied by the insured in conducting
the business as stated in the declarations."
2. If,through consolidation or merger with,or purchase of assets of,some other concern,the insured shall thereby acquire the use and control of any additional premises,
the insurance afforded by the policy shall also apply as respects such premises, provided the insured shall give the company written notice thereof within thirty
days thereafter and shall pay the company an additional premium computed pro rata from the date of such consolidation,merger or purchase to the end of the current
premium period.
Nothing herein contained shall be held to vary,waive,alter,or extend any of the terms,conditions,agreements or declarations of the policy,other than as herein stated.
This endorsement shall not be binding unless countersigned by a duly authorized agent of the company or companies; provided that if this endorsement takes effect as
of the effective date of the policy and,at issue of said policy,forms a part thereof,countersignature on the declarations page of said policy by a duly authorized agent
of the company or companies shall constitute valid countersignature of this endorsement.
HARTFORD FIRE INSURANCE COMPANY GROUP
Hartford Fire Insurance Company New York Underwriters Insurance Company
Hartford Accident and Indemnity Company
Citizens Insurance Company of New Jersey Twin City Fire Insurance Company
Countersigned by
Form B-1303 6th Rev. Printed in U.S.A. 10-'59
Authorized Agent
.'yrTygr•sP-..
1
BURGLARY
(For attachmentto Money and
Broad Fo
rm)
Broad Form)
Exclusion of "Extortion"
Endorsement IA THE HARTFORD
Named Insured and Address
This endorsement forms a part of Policy No
issued by THE HARTFORD INSURANCE GROUP company desig-
nated therein,and takes effect as of the effective date of said policy
unless another effective date is stated herein.
Effective date 12 noon, standard
time at the address of the named insured as stated herein.
It is agreed that this policy does not apply to loss due to the surrender of money, securities or other property away from the premises as a
result of a threat to do
(1) bodily harm to any person,or
(2) damage to the premises or property owned by the insured or held by the insured in any capacity;
provided, however,these exclusions do not apply under Coverage B if coverage is afforded thereunder,to loss of money,securities or other
property while being conveyed by a messenger when there was no knowledge by the insured of any such threat at the time the conveyance
was initiated.
Nothing herein contained shall be held to vary,waive,alter,or extend any of the terms,conditions,agreements or declarations of the policy,
— other than as herein stated.
This endorsement shall not be binding unless countersigned by a duly authorized agent of the company; provided that if this endorsement
takes effect as of the effective date of the policy and,at issue of said policy,forms a part thereof,countersignature on the declarations page
of said policy by a duly authorized agent of the company shall constitute valid countersignature of this endorsement.
-Rd ea f-0/
DeRoy C. Thomas, President
Countersigned by
Authorized Agent
B-155341 Printed in U.S.A. ISO 1243
Effective Time Endorsement THE HARTFORD
The time of inception and the time of expiration of this policy and of any schedule or endorsement attached shall be 12:01 a.m. standard time.
To the extent that coverage in this policy replaces coverage in other policies terminating noon standard time on the inception date of this policy,
coverage under this policy shall not become effective until such other coverage has terminated.
Hartford Fire Insurance Company New York Underwriters Insurance Company
Hartford Accident and Indemnity Company Twin City Fire Insurance Company
Hartford Casualty Insurance Company
cf. -c--Qacae-nte-4-
DeRoy C. Thomas, President
Countersigned by
Form II-1574-0 Printed in U.S.A. ISO-105 (Ed. 1-77)
BURGLARY For use with Money and Securities Broad Form
or Robbery Form or Safe Burglary Form or_
Storekeeper's Burglary and Robbery Form.
RECORD OF CHECKS ENDORSEMENT
Named Insured and Address
This endorsement forms a part of Policy No.
issued by THE HARTFORD INSURANCE GROUP company desig- —
nated therein, and takes effect as of the effective date of said policy
unless another effective date is stated herein.
Effective date 12 noon,standard time at the address of the named insured
as stated herein.
It is agreed that the requirement of the policy as to the keeping of records by the insured is amended by the addition of the following provision:
As respects checks negotiated to the insured, the record shall:
(a) be made immediately upon the negotiation; (b) include the names of the maker, payee and drawee bank,and the date and amount of
the check; (c) be maintained in a receptacle other than that used for money and securities.
Nothing herein contained shall he held to vary,waive,alter,or extend any of the terms,conditions,agreements or declarations of the policy, other than
as herein stated.
This endorsement shall not be binding unless countersigned by a duly authorized agent of the company; provided that if this endorsement takes effect
as of the effective date of the policy and,at issue of said policy,forms a part thereof,countersignature on the declarations page of said policy by a duly
authorized agent of the company shall constitute valid countersignature of this endorsement.
THEHARTFORD Countersigned by
INSURANCE GROUP Authorized Agent
HARTFORD.CONNECTICUT
Form 8-1433-t Printed in U.S.A. 3259 (8-811≥)
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BURGLARY •
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EXCESS OF LOSS OVER DEDUCTIBLE AMOUNT
Named Insured and Address
83 MBO BJ7422
This endorsement forms a part of Policy No
issued by THE HARTFORD INSURANCE GROUP company desig-
nated therein, and takes effect as of the effective date of said policy
unless another effective date is stated herein.
Effective date 12:01 A.M.,standard time at the address of the named insured as
stated herein.
It is agreed that the policy applies, subject to the following provisions:
The company shall not be liable under THIS POLICY
(designation of The appropriate coverage)
100 000.00 with the insurance then applying to such excess only,
account of any loss, except to the extent such loss is in excess of$ °
subject otherwise to the applicable limit of the company's liability.
Nothing herein contained shall be held to vary, waive, alter, or extend any of the terms, conditions, agreements or declarations of the policy, other
than as herein stated.
This endorsement shall not be binding unless countersigned by a duly authorized agent of the company; provided that if this endorsement takes
effect as of the effective date of the policy and, at issue of said policy, forms a part thereof, countersignature on the declarations page of said policy
by a duly authorized agent of the company shall constitute valid countersignature of this endorsement.
f Countersigned by
THE HARTFORDAuthorised Aeon,
Form B-1528-0 Printed in U.S.A. 12-'68 (B-805)
1
C
EXCLUSIONS
This policy does not apply: (d) under coverage A, to loss of money contained in coin operated
amusement devices or vending machines, unless the amount of money
(a) to loss due to any fraudulent, dishonest or criminal act by any deposited within the device or machine is recorded by a continuous
insured, a partner therein, or an officer, employee, director, trustee or recording instrument therein;
authorized representative thereof, while working or otherwise and (e) to loss due to war, whether or not declared, civil war, insurrec- --
whether acting alone or in collusion with others; provided,this exclusion tion, rebellion or revolution, or to any act or condition incident to any
does not apply to safe burglary or robbery or attempt thereat by other of the foregoing;
than an insured or a partner therein; (f) to loss due to nuclear reaction, nuclear radiation or radioactive
(b) to loss due to(1)the giving or surrendering of money or securi- contamination, or to any act or condition incident to any of the fore-
ties in any exchange or purchase, or (2) accounting or arithmetical going;
errors or omissions; (g) under Coverage A,to loss,other than to money,securities,a safe
or vault,by fire whether or not such fire is caused by,contributed to by
(c) to loss of manuscripts,books of account or records; or arises out of the occurrence of a hazard insured against.
CONDITIONS
1. Policy Period, Territory, Discovery: This policy applies only 3. Ownership of Property; Interests Covered: The insured
to loss which occurs during the policy period within any of the States property may be owned by the insured, or held by the insured in any
of the United States of America, the District of Columbia, Hawaii, capacity whether or not the insured is liable for the loss thereof,or may
Virgin Islands, Puerto Rico, Canal Zone or Canada, and is discovered be property as respects which the insured is legally liable; provided,
not later than one year from the end of the policy period. the insurance applies only to the interest of the insured in such property,
including the insured's liability to others, and does not apply to the
interest of any other person or organization in any of said property
2. Definitions.
"Money" means currency, coins, bank notes and bullion; and unless included in the insured's proof of loss.
travelers checks, register checks and money orders held for sale
to the public. 4. Joint Insured: If more than one insured is named in the declara-
"Securities" means all negotiable and non-negotiable instru- tions, the insured first named shall act for every insured for all purposes
ments or contracts representing either money or other property of this policy. Knowledge possessed or discovery made by any insured
and includes revenue and other stamps in current use,tokens and shall constitute knowledge possessed or discovery made by every
tickets, but does not include money. insured.
The unqualified word "premises" means the interior of that
portion of any building at a location designated in the declare- b. Books and Records: The insured shall keep records of all the
tions which is occupied by the insured in conducting his business insured property in such manner that the company can accurately
as stated therein. determine therefrom the amount of loss.
"Banking premises"means the interior of that portion of any
building which is occupied by a banking institution in conduct-
ing its business. 6. Limits of Liability; Settlement Options: The limit of the
company's liability for loss shall not exceed the applicable limit of
"Messenger"means the insured, a partner therein or an officer
insurance stated in the declarations, nor what it would cost at the time
thereof, or any employee thereof who is in the regular service of
of loss to repair or replace the property with other of like kind and
and duly authorized by the insured to have the care and custody
of the insured property outside the premises. quality, nor as respects securities the actual cash value thereof at the
close of business on the business day next preceding the day on which
"Custodian" means the insured,a partner therein or an officer the loss was discovered, nor as respects other property the actual cash
thereof,or any employee thereof who is in the regular service of value thereof at the time of loss; provided, however, the actual cash
and duly authorized by the insured to have the care and custody value of such other property held by the insured as a pledge, or as
of the insured property within the premises,excluding any person collateral for an advance or a loan, shall be deemed not to exceed the
while acting as a watchman, porter or janitor. value of the property as determined and recorded by the insured when
making the advance or loan, nor, in the absence of such record, the
"Guard" means any male person not less than seventeen nor
more than sixty-five years of age who accompanies a messenger unpaid portion of the advance or loan plus accrued interest thereon at
legal rates.
by direction of the insured, but who is not a driver of a public
conveyance. The applicable limit of insurance stated in the declarations is the
"Robbery"means the taking of insured property(1)by violence total limit of the company's liability with respect to all loss of property
inflicted upon a messenger or a custodian; (2) by putting him of one or more persons or organizations arising out of any one occurrence.
in fear of violence; (3)by any other overt felonious act committed All loss incidental to an actual or attempted fraudulent, dishonest or
in his presence and of which he was actually cognizant,provided criminal act or series of related acts at the premises,whether committed
such other act is not committed by an officer, partner or em- by one or more persons, shall be deemed to arise out of one occurrence.
ployee of the insured; (4) from the person or direct care and The company may pay for the loss in money or may repair or replace
custody of a messenger or custodian who has been killed or the property and may settle any claim for loss of property either with
rendered unconscious; or (5)under coverage A, (a)from within the insured or the owner thereof. Any property so paid for or replaced
the premises by means of compelling a messenger or custodian
shall become the property of the company. Any property recovered
by violence or threat of violence while outside the premises to after settlement of a loss shall be applied first to the expense of the
admit a person into the premises or to furnish him with means of parties in making such recovery, with any balance applied as if the
ingress into the premises,or(b)from a showcase or show window recovery had been made prior to said settlement, and loss readjusted
within the premises while regularly open for business,by a person accordingly. The insured or the company, upon recovery of any such
who has broken the glass thereof from outside the premises. property, shall give notice thereof as soon as practicable to the other.
"Safe burglary" means(1)the felonious abstraction of insured
property from within a vault or safe,the door of which is equipped
with a combination lock, located within the premises by a person 7. Insured's Duties When Loss Occurs: Upon knowledge or
making felonious entry into such vault or such safe and any vault discovery of loss or of an occurrence which may give rise to a claim for
containing the safe, when all doors thereof are duly closed and loss, the insured shall: (a) give notice thereof as soon as practicable
locked by all combination locks thereon, provided such entry to the company or any of its authorized agents and also to the police
shall be made by actual force and violence, of which force and if the loss is due to a violation of law; (b)file detailed proof of loss,duly
violence there are visible marks made by tools, explosives, sworn to, with the company within lour months after the discovery
electricity or chemicals upon the exterior of(a)all of said doors of loss.
of such vault or such safe and any vault containing the safe, if Upon the company's request, the insured and every claimant here-
entry is made through such doors,or(b)the top,bottom or walls under shall submit to examination by the company,subscribe the same,
of such vault or such safe and any vault containing the safe under oath if required,and produce for the company's examination all
through which entry is made,if not made through such doors,or pertinent records, all at such reasonable times and places as the com-
(2)the felonious abstraction of such safe from within the premises. pany shall designate, and shall cooperate with the company in all
"Loss"includes damage. matters pertaining to loss or claims with respect thereto.
Form 5060 Page 2
(CONDITIONS—continued from right column of Page 2)
8. Superseded Insurance: If similar insurance of the insured, fixed by agreement under any statute controlling the construction of
consisting of one or more policies affording continuous coverage, this policy, the shortest permissible statutory limitation of time shall
terminated with the beginning of the policy period, loss, to the extent govern and shall supersede the time limitation herein stated.
that it is not insured under such prior insurance solely because of late
discovery, shall be deemed to have occurred on the first day of the 13. Subrogation: In the event of any payment under this policy,
policy period. the company shall be subrogated to all the insured's rights of recovery
therefor against any person or organization and the insured shall
9. Other Insurance: As respects loss of insured property while in execute and deliver instruments and papers and do whatever else is
the custody of any armored motor vehicle company, the company shall necessary to secure such rights. The insured shall do nothing after
be liable hereunder only for that part of such loss which is in excess of loss to prejudice such rights.
the amount recovered or received by the insured under(1)the insured's
contract with said armored motor vehicle company, (2) insurance 14. Changes: Notice to any agent or knowledge possessed by any
carried by said armored motor vehicle company for the benefit of users agent or by any other person shall not effect a waiver or a change in
of its service, and (3) all other insurance and indemnity in force in any part of this policy or estop the company from asserting any right
whatsoever form carried by or for the benefit of users of said armored under the terms of this policy; nor shall the terms of this policy be
motor vehicle company's service. waived or changed, except by endorsement issued to form a part of
Subject to the preceding paragraph, if there is any other valid and this policy,signed by an authorized representative of the company.
collectible insurance which would apply in the absence of this policy,
the insurance under this policy shall apply only as excess insurance over IS. Cancelation: This policy may be canceled by the insured by
such other insurance; provided, the insurance shall not apply (a) to surrender thereof to the company or any of its authorized agents or by
property which is separately described and enumerated and specifically mailing to the company written notice stating when thereafter the
insured in whole or in part by any other insurance; or(b)to property cancelation shall be effective. This policy may be canceled by the
otherwise insured unless such property is owned by the insured. company by mailing to the insured at the address shown in this policy
written notice stating when not less than ten days thereafter such
10. No Benefit to Bailee: The insurance afforded by this policy cancelation shall be effective. The mailing of notice as aforesaid shall
shall not inure directly or indirectly to the benefit of any carrier or other be sufficient proof of notice. The time of the surrender or the effective
bailee for hire. date and hour of cancelation stated in the notice shall become the end
of the policy period. Delivery of such written notice either by the
insured or by the company shall be equivalent to mailing.
11. Appraisal: If the insured and the company fail to agree as to It the insured cancels,earned premium shall be computed in accord-
the amount of loss, each shall, on the written demand of either, made ance with the customary short rate table and procedure. If the com-
within sixty days after receipt of proof of loss by the company, select a pany cancels, earned premium shall be computed pro rata. Premium
competent and disinterested appraiser,and the appraisal shall be made adjustment may be made either at the time cancelation is effected or
at a reasonable time and place. The appraisers shall first select a as soon as practicable after cancelation becomes effective, but payment
com
petent and disinterested umpire, and failing for fifteen days to or tender of unearned premium is not a condition of cancelation.
agree upon such umpire, then, on the request of the insured or the
company, such umpire shall be selected by a judge of a court of record
in the county and state in which such appraisal is pending. The ap- 16. Assignment: Assignment of interest under this policy shall not
praisers shall then appraise the loss, stating separately the actual cash bind the company until its consent is endorsed hereon; if,however, the
value at time of loss and the amount of the loss, and failing to agree insured shall die, this policy shall cover the insured's legal representa-
shall submit their differences to the umpire. An award in writing of tive as insured; provided that notice of cancelation addressed to the
any two shall determine the amount of loss. The insured and the com- insured named in the declarations and mailed to the address shown in
pany shall each pay its chosen appraiser and shall bear equally the this policy shall be sufficient notice to effect cancelation of this policy.
expenses of the umpire and the other expenses of appraisal.
The company shall not be held to have waived any of its rights by 17. Terms of Policy Conformed to Statute: Terms of this policy
any act relating to appraisal. which are in conflict with the statutes of the State wherein this policy
is issued are hereby amended to conform to such statutes.
12. Action Against Company: No action shall lie against the
company unless as a condition precedent thereto, there shall have been 18. Declarations: By acceptance of this policy the insured agrees
full compliance with all the terms of this policy, nor until ninety days that the statements in the declarations are the agreements and represen-
after the required proofs of loss have been filed with the company, nor tations of the insured, that this policy is issued in reliance upon the
at all unless commenced within two years from the date when the insured truth of such representations and that this policy embodies all agree-
discovers the loss. If any limitation of time for notice of loss or any ments existing between the insured and the company or any of its agents
legal proceeding herein contained is shorter than that permitted to be relating to this insurance.
In Witness Whereof, the Company has caused this policy to be signed by its President and a Secretary, but the same
shall not be binding unless countersigned on the declarations page by a duly authorized agent of the company.
�� Secretary .
President
Form 5060 Printed in U.S.A. t-'72 Page 3
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