HomeMy WebLinkAbout12139 ORD - 06/12/1974JRR- *h:6- 11 -74; 1st •
AN ORDINANCE
AUTHORIZING AND DIRECTING THE CITY MANAGER TO
EXECUTE A CONTRACT WITH MARGIE BENNETT DBA COLISEUM
CONCESSIONS, GRANTING THE RIGHTS OF CONCESSION AT THE
EXPOSITION HALL AND MEMORIAL COLISEUM ON SHORELINE
BOULEVARD IN THE CITY OF CORPUS CHRISTI, NUECES COUNTY,
TEXAS, TO THE SAID MARGIE BENNETT DBA COLISEUM CONCES-
SIONS, SAID CONCESSION RIGHTS TO BEGIN NOVEMBER 1, 1974
AND TO TERMINATE ON OCTOBER 31, 1977, SUBJECT TO THE
COVENANTS AND CONDITIONS PROVIDED IN SAID CONTRACT, A
COPY OF WHICH IS ATTACHED HERETO AND MADE A PART HEREOF,
MARRED EXHIBIT "A ".
BE IT ORDAINED BY THE CITY COUNCIL OF THE CITY OF CORPUS CHRISTI,
a
TEXAS:
SECTION 1. That the City Manager is hereby authorized and
9
directed, for and on behalf of the City of Corpus Christi, to execute a
contract with Margie Bennett dba Coliseum Concessions, granting the rights
of concession at the Exposition Hall and Memorial Coliseum on Shoreline
Boulevard, in the City of Corpus Christi, said concession rights to
commence on November 1, 1974 and terminate on October 31, 1977, subject
to the terms and conditions as set out in the contract, a copy of which
is attached hereto and made a part hereof, marked Exhibit "A ".
I-2_1139
AGREEMENT
THE STATE OF TEXAS X
X RNUd ALL MEN BY THESE PRESENTS:
COUM OF NDECES X
This contract made and entered into effective on the 1st day of November,
1974, by and between the City of Corpus Christi, a municipal corporation,
hereinafter called "City ", and Margie Bennett dba Coliseum Concessions, of
Corpus Christi, Nueces County, Texas, hereinafter called "Concessionaire ",
W I T N E S S T H•
The City hereby grants unto concessionaire the rights of concession,
as hereinafter defined, at the locations hereinafter specifically set out,
subject to the terms, conditions and covenants as follows, to -wit:
I
Terms of the Agreement. In consideration of the rent hereby provided
to be paid by the concessionaire and the covenants on her behalf herein
contained, the City hereby grants concessionaire rights to concession for
a term beginning November 1, 1974, and ending at 11:59 p.m., on October 31,
1977, (unless previously terminated under any provision herein contained)
the designated concession locations in the Coliseum, the Exposition Hall
and the Patio area for the sale and dispensing of food, beverages and other
merchandise as hereinafter provided.
II
Concession Rights Defined. The concession rights and privileges herein
granted are the exclusive right to make direct sales to the public of soft
drinks, beer, sandwiches, popcorn, candy floss, and other merchandise usually
and customarily handled by a concessionaire, except that the City retains
the right to:
(A) Handle catering separately and independently from the concession
contract.
(B) Grant permission for merchandise to be given away on the premises
and is in no way obligated to the concessionaire to force such
merchandise to be purchased through her.
(C) Use space designated for concessions (excepting office and in-
ventory storage) when the concessionaire is not using such space.
(D) Make final decision on matters which may arise not specifically
covered in the specifications including the interpretation thereof.
E
C:
(E) This concession does not include the right for Concessionaire
to sell space for either temporary or permanent signs. The
City especially reserves this right to itself.
(F) Approve the form of products to be sold and to require the
containers to be suitable for consumption of the product on
premises immediately after sale.
(G) To superintend sales to the extent that sales shall be only
at and for a reasonable length of time before and after the
time of the performance or function being served and so as to
insure that the sales will not interfere with the conduct of
the performance or function being served.
III
Location of Concession. The City will provide and make available to
the Concessionaire and except for the supervision of the City to be in the
exclusive control of the Concessionaire the following:
(1) Exposition Hall - One (1) enclosed stand 8' x 15'
with sink, counter and cupboards.
(2) Coliseum - Two (2) 62' x 5' stands with sinks, work areas
and approximately 300 square feet of enclosed space for
inventory storage and office.
IV
The City agrees to furnish the following:
(A) Utilities: Standard outlets and connections for gas, water and
electricity for service of concession activities only. Monthly utility bills
will be paid by the City.
(B) Equipment: Installation and major maintenance and repairs to the
following will be paid by the City:
On Premises:
1 Walk -ia Freezer
1 Reach -in Refrigerator
1 Walk -in Beer Cooler
1 Ice Machine and Storage Bin
2 Perlick Beer Dispensers
2 Candy Floss Machines
2 Central Poppers, 32 oz.
2 Sno -Cone Machines
2 Hot Dog Warmers
2 Electric Stoves
1 Large Safe
-2-
V
Obligations of Concessionaire. The Concessionaire will be responsible
to the City as follows:
(A) Compliance with all City health regulations and all ordinances of
the City of Corpus Christi as they affect the concession operation. Concessionaire
will secure at its sole expense all permits, licenses, etc., required by any
governmental agency.
(B) Insurance. The Concessionaire covenants that it will carry in-
surance as follows:
1. Before permitting any employees to begin working in any capacity.
Concessionaire shall cover all employees by Workmen's Compensation
Insurance, or other coverage approved by the State Industrial
Accident Board.
2. Before beginning or permitting the installation of any furnishings,
fixtures, equipment, etc., Concessionaire shall procure and keep
in full force and effect Public Liability and Property Dqmage
Insurance under which the City shall be co- insured.
3. Before opening up for business, Concessionaire shall procure
either by separate policy or by appropriate rider to its Public
Liability Insurance Products Liability coverage which is sometimes
referred to as Food Handlers or Restaurant Operators Protection
(protecting against claims for damages to persons claiming to
have been served unwholesome foods, etc.).
The policies referred to in 2 and 3 above, shall be in amounts pro-
vided for protection of not less than $50,000 against liability or damage to
property in any one accident and protection of not less than $50,000 for
injury to one person subject to a limit of not less than $100,000 protection
if injury to two or more persons in a single accident or other occurrence.
The originals of all of the policies referred to in 1, 2 and 3 above,
or copies thereof, certified by the agent issuing them, shall be deposited by
the Concessionaire with the Coliseum Manager who shall forward them to the
Director of Finance for custody. They shall include provisions that they
-3-
cannot be cancelled except after the expiration of fifteen days after delivery
of notice of the intention to cancel to the Director of Finance. Failure on the
part of the Concesionaire to furnish a new policy or certified copy before the
expiration date of such policy or failure to furnish a new policy before the date
so fixed for the cancellation of the existing policy so that the risk referred
to shall be continuously protected will constitute a default on the part of the
Concessionaire entitling the City to its option to terminate the entire agreement.
If either of the policies referred to in 2 and 3 above do not show
upon their face that they are a flat premium policy and the premium has been paid
in full, they must be accompanied by a rider or other appropriate certificate
or waiver sufficient to establish that the company or agency issuing the same
is entitled to look only to the Concessionaire for any premium payments and has
no right to recover any premiums from the City of Corpus Christi.
The Public Liability Policy or the policies referred to in 2 above
shall include provisions that the City is fully protected not only against
claims on behalf of the general public, but also against claims on the part of
any of the Concessionaire's employees, including claims based upon alleged
negligence an the part of the City, its officers, agents or employees. If
Concessionaire cannot procure such broad protection for the City as a part of
its Landlord - Tenant Public Liability Policy, it shall at its sole cost and
expense furnish other appropriate policies, approved by the City Insurance
Committee and City Attorney, which will also protect the City.
(C) Posting in a conspicuous place visible from every location where
merchandise is sold, a schedule of prices approved in writing by the Coliseum
Manager. Prices charged shall not be in excess of those charged under similar
conditions elsewhere in the City.
(D) Maintaining a clean, safe, orderly, and sanitary operation within
the concession locations and adjacent areas.
(E) Returning the premises and equipment to the City in the condition
received except for normal wear and tear.
(F) Collecting debris in the concession stands in covered containers
and placing same in designated trash areas outside the building at the conclusion
of each event served.
(G) Providing a detailed report at the conclusion of each event served
on forms to be provided by the City and reporting income from sub- contracts, if
any, as earned.
-4-
(H) Consulting with and receiving approval from the Coliseum Manager
on the quality, quantity and price schedule of all concession merchandise.
(I) Requiring employees to wear appropriate uniforms to indicate the
fact and nature of such employment and to present themselves to the public in a
clean and neat condition and in polite and courteous manner. Drinking on duty,
showing up in a condition unfit for work, or objectionable conduct, will give the
City the right to demand immediate dismissal of concession help, and, if manage-
ment or the Concessionaire is the party involved, immediate cancellation of the
contract.
(S) Being prepared to furnish additional equipment (other than that
provided by the City) and personnel sufficient to serve up to 6,000 people in
the Coliseum during a 20- minute intermission upon reasonable notice from the
Coliseum Office.
(The term "sufficient" as used in the foregoing paragraph
means that Concessionaire will have on hand equipment and
personnel adequate to serve all persons attending the
particular event.)
VI
General Provisions:
(A) It is a condition of the concession rights herein offered that
the City will not be responsible to the Concessionaire in any manner for
merchandise, equipment, etc., belonging to the Concessionaire if such are not
removed from the concession locations by the Concessionaire during periods
when concession locations may be otherwise occupied. It is likewise a condition
that equipment and merchandise which is not in the sole possession of the Concession-
aire may not be removed. It is further a condition that the Concessionaire is
entitled to use any and all equipment in the concession locations during
occupancy.
(B) When temporary concession stands are required at locations other
than those already specified the City will provide the space and standard utilities
and the Concessionaire will be responsible for setting up and taking down such
temporary concession stands.
(C) Operation of the concession will at all times be in keeping with the
activity using the facilities and restraint shall be exercised in the handling of any
equipment to minimize interference with the served event caused by resulting noise.
-5-
The Coliseum Manager shall have the right to instruct the Concessionaire to
cease those operations which produce disturbing noises during those periods when
the resulting noise will interfere with the enjoyment of the event in process.
Such instruction shall be immediately complied with. Beer sales will be allowed
only after the activity using the building first obtains permission in writing
from the City for such sales as set forth in Ordinance No. 5918.
(D) Subcontracts:
(1) Concession items such as programs, novelties, song
books, autographed pictures, etc., usually carried by traveling
shows and not normally stocked by the Concessionaire, and addi-
tional stands set up on a temporary basis with equipment not
owned by the City or the Concessionaire are considered as
subcontracts. Privilege agreements between the Concessionaire
and the subcontractor for such items must be approved by the
Coliseum Manager and, in case of a dispute, the decision of the
Coliseum Manager shall be final.
(2) Arrangements for vending machines will be made by
the Coliseum Manager but supervision of the machines to
see they are stocked and moved according to the event is the
responsibility of the Concessionaire. Vending machines are
considered to be subcontracts.
(3) When the Concessionaire does not operate as a retailer
but supplies concessions as defined in Section II herein on a
per-person basis, such service will be considered a subcontract.
(4) A flat 50% of net receipts from subcontracts will
be paid to the City by the Concessionaire, except as shown in
paragraph (5) under (D), Article VI.
(5) When the Concessionaire operates as a caterer
supplying food on a per - person basis, such service will be
considered 'a food subcontract payable to the City at 252 of
ne t.
(E) Maintenance of City -owned equipment will be the responsibility
of the Concessionaire and City employees will not service the equipment unless
a request for major repairs or maintenance is reported to the Coliseum Office.
-6-
In the event an outside caterer wishes to buy ice, arrangements will be handled
through the Concessionaire so his stock of ice will not be depleted without his
knowledge and such sales will be considered as part of the gross sales of
Concessionaire.
(P) The Concessionaire shall acquaint himself with the regulations and
rules of the Liquor Control Board and comply with the qualifications to obtain
and keep a beer license.
VII
Consideration To Be Paid By Concessionaire:
In addition to payments to be made under the provisions of Article VI,
Concessionaire shall made the following payments:
(A) 43% of gross sales on all basic concession items sold, including
all drinks, ice, peanuts, popcorn, cotton candy and sno- cones. Those items
listed in (B), (C) and (D) below, shall carry the respective percentages shown.
(B) 50% of net income from subcontracts and vending, except food
subcontracts under (D) (5), Article VI.
(C) 23% of gross sales on food items including: chipos, do -nuts,
potato chips, pretzels, sandwiches, hot dogs, french fries, chili dogs, tamales,
coffee, barbecue, salted peanuts and pizza.
(D) 23% of all gross sales of items listed below:
Souvenirs Postcards
Novelties Toiletries
VIII
Accounting Procedure: All payments due the City shall be due and,
payable without demand at the office of the Coliseum Manager.
At the conclusion of each event a report of the gross sales shall be
provided to the Coliseum Manager on forms approved by the City. Payments from
any calendar month shall be due an the 20th day of the following month and such
-7-
day shall be considered the due date for all intents and purposes. Any payment
which is not made within ten days after the date it is due shall bear interest at
the rate of 10% per annum from the date it became due until the date it is paid.
In the event any amount or sum owing by the Concessionaire to the City under this
agreement remains unpaid after the demand for payment thereof and is thereafter
collected by suit, 10% in addition computed on the amount otherwise recovered
therein by the City as attorney's fees and cost of the expense of collection
shall be paid,
The Concessionaire's cash register and all records relating to the
operation of the concession shall be subject to the examination and audit by
the City at any time. If Concessionaire shall knowingly furnish any incorrect
statement of the - amount of gross sales -, this will constitute a default entitling
the City at its option to declare this concession terminated. Any such report
which shall understate the gross sale for any month by as much as 10% of the true
amount thereof shall be conclusively deemed to have been knowingly and falsely
furnished by Concessionaire and the City, in order to exercise its option of
termination, shall only be required to establish such falsity and shall not be
required to establish actual knowledge on the part of the lessee of such facility.
In the event of default on the part of the Concessionaire in payment
of any rental or in the performance of any of the covenants and obligations here-
in described within ten days after the date the same is due, the City of Corpus
Christi may at its option, after ten days written notice of intention to do so,
declare this agreement terminated.
Ix
Termination: If at any time the City is of the opinion that the
Concessionaire is not in performance of the terms of this agreement, the City
shall have the option to terminate this agreement by notifying the Concessionaire
in writing that a violation of a condition of the contract has occurred.and
setting forth the nature of such violation. In the event such violation is not
discontinued, and a correction made on or before the next event for which con-
cessions are to be provided by Concessionaire, or within 10 days of such notice,
whichever date first occurs, then this agreement shall be terminated except for
the right of the City to recover any and all sums payable by the Concessionaire.
c8c
Concessionaire may appeal from such notice within five (5) days of the receipt
of same from the Coliseum Manager and such appeal shall be in writing to the
Director of Inspections and Operations and then to the City Manager whose deci-
sion shall be final.
WITNESS our hand at Corpus Christi, Texas, this the
day of' 1974, in duplicate, each of which shall be considered an
original.
CITY OF CORPUS CHRISTI
ATTEST:
R. Marvin Townsend
City Secretary. City Manager
APPROVED:
DAY OF
City Attorney
Margie Bennett DBA Coliseum Concessions
That the foregoing ordinance was read for tie first time and passed
to its second reading on this the day of 19_24, by the
following vote:
Jason Luby
James T. Acuff
Rev. Harold T. Branch
Thomas V. Gonzales
Ricardo Gonzalez
Gabe Lozano, Sr.
J. Howard Stark.
That the foregoing ordinance was read fo the second time and passed
to its third reading on this the 4q Wday of ,19 by the
following vote:
Jason Luby
James T. Acuff
Rev. Harold T. Branch
Thomas V. Gonzales
Ricardo Gonzalez
Gabe Lozano, Sr.
J. Howard Stark
That the fore of}ngg ordinanc was read for th third time and passed
finally on this the Tay of 19, by the following vote:
Jason Luby
James T. Acuff �
Rev. Harold T. Branch
Thomas V. Gonzales
Ricardo Gonzalez
• Gabe Lozano, Sr.
J. Howard Stark
PASSED AND APPROVED, this the --46da of .ur+RJ 19*
ATTEST:
. - ee�
•SST. City Secretary
APPROVED: e�
DAY OF,� 19 1 �] 1 :
A951 City Attorney �1
MAYO 4%- 0 i � �— rm) �
CITY OF CORPUS CUR 40, TEXAS
juPi 1974
APPROVRO
By COUNCIL
LUMRERMENS MUTUAL
CASUALTY COMPANY
(A Mutual Insurance Company, herein called the Company)
Home Office: Long Grove, Illinois 60049
AMERICAN MANUFACTURERS
MUTUAL INSURANCE COMPANY
IA Mutual Insurance Company, heraln called the Company)
Home Office: 90 William Street, New York 10038
Executive Offices: Long Grove, Illinois 60949
r
AMERICAN MOTORISTS
INSURANCE COMPANY
(A Stock Insurance Company, heraln called the Company)
Home Office: Long Grove, Illinois 60049
FEDERAL MUTUAL
INSURANCE COMPANY
(A Mutual Insurance Company, herein called the Company)
Home Office: Long Grove, Illinois 60049
Executive Offices: 2001 East Mound Road, Decatur, Illinois 62626
The company providing the insurance afforded by this policy is designated on the Declarations Page
The annual meeting of the Lumbermen& Mu-
tual Casualty Company Is held at its home
office In Long Grove, III., on the third Tuesday
In May of each year at eleven o'clock A.M.
ALL FORMS OF INSURANCE
BILL CURRAN AGENCY
Box 2727 853.9601
Corpus Christi, Texas 78403
LIFE • FIRE • AUTO • ACCIDENT • LUUIILITY
The annual meeting of the American Manu� The annual meeting of the Federal Mutual
facturers Mutual Insurance Company is held Insurance Company Is held at he home office
at its home office in New York, New York, In Long Grove, Illinois, on the Wednesday
on the Thursday following the first Tuesday following the fourth Tuesday In May of
in June of each year at eleven o'clock A.M. each year at eleven o'clock A.M.
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 liability, exclusions, conditions and other terms of
this policy:
INSURING AGREEMENTS
I. Coverage A— Workmen's Compensation
To pay promptly when due all compensation and other benefits
required of the insured by the workmen's compensation law.
Coverage B— Employers' Liability
To pay on behalf of the insured all sums which the insured
shall become legally obligated to pay as damages because of bodily
injury by accident or disease, including death at any time resulting
therefrom,
(a) sustained in the United States of America, its territories or
possessions, or Canada by any employee of the insured arising out
of and in the course of his employment by the insured either in
operations in a state designated in Item 3 of the declarations or in
operations necessary or incidental thereto, or
(b) sustained while temporarily outside the United States of
America, its territories or possessions, or Canada by any employee
of the insured who is a citizen or resident of the United States or
Canada arising out of and in the course of his employment by the
insured in connection with operations in a state designated in
Item 3 of the declarations; but this insurance does not apply to
any suit brought in or any judgment rendered by any court outside
the United States of America, its territories or possessions, or
Canada or to an action on such judgment wherever brought.
IL Defense, Settlement, Supplementary Payments
As respects the insurance afforded by the other terms of this
policy the company shall:
(a) defend any proceeding against the insured seeking such
benefits and any suit against the insured alleging such injury and
seeking damages on account thereof, even if such proceeding or
suit is groundless, false or fraudulent; but the company may make
such investigation, negotiation and settlement of any claim or suit
as it deems expedient;
(c) pay all expenses incurred by the company, all costs taxed
against the insured in any such proceeding or suit and all interest
accruing after entry of judgment until the company has paid or
tendered or deposited in court such part of such judgment as does
not exceed the limit of the company's liability thereon;
(d) reimburse the insured for all reasonable expense4 other
than loss of earnings, incurred at the company's request.
The amounts incurred under this insuring agreement, except
settlements of claims and suits, are payable by the company to
addition to the amounts payablo under coverage A or the appli-
cable limit of liability under coverage B.
III. Definitions
(a) Workmen's Compensation Law. The unjustified term "work-
men's compensation law' means the workmen s compensation law
and any occupational disease law of a state designated in Item 3
of the declarations, but does not include those provisions of any
such late which provide non - occupational disability benefits.
(b) State. The word "state" means any State or Territory of
the United States of America and the District of Columbia.
(c) Bodily Injury by Accident; Bodily Injury by Disease. The
contraction of disease is not an accident within the meaning of the
word "accident" in the term "bodily injury by accident" and only
such disease as results directly from a bodily injury by accident
is included within the term "bodily injury by accident" The term
"bodily injury by disease" includes only such disease as is not
included within the term "bodily injury by accident"
(d) Assault and Battery. Under coverage B, assault and battery
shall be deemed an accident unless committed by or at the direction
of the insured.
IV. Application of Policy
(b) pay all premiums on bonds to release attachments for an This policy applies only to injury (1) by accident occurring
amount not in excess of the applicable limit of liability of this during the policy period, or (2) by disease caused or aggravated
policy, all premiums on appeal bonds required in any such defended by exposure of which the last day of the last exposure, in the
proceeding or suit, but without any obligation to apply for or employment of the insured, to conditions causing the disease
fumish any such bonds; occurs during the policy period.
EXCLUSIONS
This policy does not apply:
(a) under coverages A and B, to operations conducted at or
from any workplace not described in Item 1 or 4 of the declara-
tions if the insured has, under the workmen's compensation law,
other insurance for such operations or is a qualified self - insurer
therefor;
(b) under coverages A and B, unless required by law or de-
scribed in the declarations, to domestic employment or to farm
or agricultural employment;
(c) under coverage B, to liability assumed by the insured under
any contract or agreement, but this exclusion does not apply to a
warranty that work performed by or on behalf of the insured will
be done in a workmanlike manner;
((I) under coverage B, (1) to punitive or exemplary damages
on account of bodily injury to or death of any employee employed
in violation of law, or (2) with respect to any employee employed
in violation of law with the knowledge or acquiescence of the
insured or any executive officer thereof;
(e) under coverage B, to bodily injury by disease unless prior
to thirty -six months after the end of the policy period written
claim is made or suit is brought against the insured for damages
because of such injury or death resulting therefrom;
(f) under coverage B, to any obligation for which the insured
or any carrier as his insurer may be held liable under the work-
men's compensation or occupational disease law of a state desig-
nated in Item 3 of the declarations, any other workmen's com-
pensation or occupational disease law, any unemployment com-
pensation or disability benefits law, or under any similar law.
CONDITIONS
(Unless otherwise noted, conditions apply to all Coverages.)
1. Premium. The premium bases and rates for the classifications
of operations described in the declarations are as stated therein
and for classifications not so described are those applicable in
accordance with the manuals in use by the company. This policy
is issued by the company and accepted by the insured with the
agreement that if any change in classifications, rates or rating
plans is or becomes applicable to this policy under any law regu-
Iatm this insurance or because of any amendments affecting the
benefits provided by the workmen's compensation law, such change
with the effective date thereof shall be stated in an endorsement
issued to form a part of this policy.
When used as a premium basis, "remuneration" means the
entire remuneration, computed in accordance with tdhe annals in
use by the company, earned during the policy period by (a) all
executive officers and other employees of the insured engaged in
operations covered by this policy, and (b) any other person per-
forming work which may render the company liable under this
policy for in+ury to or death of such person in accordance with
the workmen s compensation law. "Remuneration" shall not include
the remuneration of any person within division (b) foregoing if
the insured maintains evidence satisfactory to the company that
the payment of compensaton and other benefits under such law to
JACKET PAGE 1
Bonn TX -14.1
Workmen's Compensation and Employers' Liability Policy
PREMIUM DISCOUNT ENDORSEMENT -TEXAS
It is agreed that:
1. Standard Premium. The Premium computed in accordance with the provisions of the policy, other than
this endorsement, shall be known as the Standard Premium.
2. ,Computation of Premium Discount.
(a) If none of the Standard Premium is subject to retrospective rating, the premium shall be subject
to the applicable discount stated in the Table of Premium Discount Percentages.
.(b) So much of the Total Standard Premium as is subject to retrospective rating shall not be subject
to discount. If a portion of the Standard Premium is subject to a retrospective rating plan, the
discount on that portion of such premiums not subject to retrospective rating shall be the difference
between ( I ) the discount which would be obtained if none of the Total Standard Premiums were
subject to retrospective rating and (2) the discount which would be obtained if only premium sub-
ject to retrospective rating were included in the computation.
TABLE of PREMIUM DISCOUNTS -TEXAS
Premium
Discount
Premium
NUMBER�9
Discount
Interval
%
Interval
I
%
1 -
1,005-..
0.0%
1,348 -
1,366_
2.5%
1,006-
1,015 --
0.1
1,367 -
1,386_
2.6
1,016 -
1,026
- 02
1,387 -
1,406 -.. -_
27
1,027 -
1,037._._....
--- 0.3
1,407 -
1,428
2.8
1,038-
1,049-
0.4
1,429-
1,449_
29
1,050 -
1,060_.- _..__.
0.5
1,450-
1,4n
3.0
1,061 -
1,072 --
0.6
1,473 -
1,495-
3.1
1,073-
1,085-
0.7
1,496 -
1,519 -.___
32
1,086 -
1,097
0.8
1,520 -
1,544-
3.3
1,098 -
1,110 -_
-_ 0.9
1,545 -
1,569.3.4
1,111 -
1,123 - -- -------
1.0
1,570 -
1,596_
3S
1,124 -
1,137 ----
____ 1.1
1,597 -
1,623
.3.6
1,138 -
1,151-
12
1,624-
1,651._
-__ 3.7
1,152-
1,165 -
-__ 1.3
1,652 -
1,680
3.8
1,166 -
1,179._ -_
-__ 1.4
1,681 -
1,711-
3.9
1,180-
1,194_ -_.___
1.5
1,712 -
1,742.4.0
1,195 -
1,7A9- ___.:_
1.6
1,743 -
1,775-
4.1
1,210 -
1,225____
1.7
1,776 -
1,809 -._
-__ 42
1,226 -
1,241 -_.._
1.8
1,810 -
1,844-4.3
1,242-
1,257 -_
-_ 19
1,845 -
1,880--4.4
1,258 -
l,274______
- 2.0
1,881 -
1,918-
4.5
1,275 -
1,292___
2.1
1,919-
1,958--..
4.6
1,293 -
1,309__
22
1,959 -
1,999-
4.7
1,310 -
1,328 - -____
2.3
2,000 -
2,042
4.8
1,329 -
1,347_ -
- -... 2.4
2,043 -
2,087--__
4.9
(Table =tinned on reverse side)
Effective Dale: Unleo; an effective date is entered below, this endorsement shall be effective as of the beginning of the polity period slated
In the declarations of the policy.
This endorsement shall form a part of the policy to which it is attached.
LUM>O�MIDNS MUTUAL AMERICAN nOTOE197'S'j
CASUALTY COMPANY INSURA -N OMOR.'
NAAAyyMED--�A INSURED
N'ougeim VSS�i
NUMBER�9
ENO�T' ND.
4CH
I
8-3-"
•Completion necesmry only when (sued sabsequeot to policy preparation.
AMERICAN AMERICAN MANUFACTURERS FEDERAL MUTUAL
MUTUAL INSURANCE COMPANY INSURANCE COMPANY
Farm TX -14.I
(12 -1 -67) � 17 -73 5M PRINTED IN U.S.A.
CK 67.3 DOURANCE
TABLE of PREMIUM DISCOUNTS -TEXAS (Coned)
h Pre -;-
Discount
Preatium -
Discount
Premitun
Discount
Interval
%
Interval
%
Interval
%
2,088 -
2,135 -
2,134_-
2,183_ --
SA%
5.1
6,134-
6,239 -
6238.__ -__
6,347._.__.._
9.0%
9¢
18718 - 19,729__. - - 13.0%
19,730- 20,856T_ -13.1- -
• 2,184-
2234 - ----
52
6,348 -
6,459 -.._..
92
20,857 - 22,120._,_..132
,
2,235 -
2288 - -
-_ 5.3
6,460-
6576 --
9.3
22,121 - 73,547__._.13.3
2,289 -
2,345._
- 5.4
6,577 -
6,696_...____
9.4
23,548 - 25,171._-.13.4
2,346 -
2,404- _ -
--- 5.5
6,697-
6,821 - -___
M
25,172 - 27,036 ____
2,405-
2,467 -..._
5.6
6,822-
6,951 - --
%6
27.037- 29,199 -__
.
13.6
- - 2,468 -
2532 --
- 57
6,952 -
7,086_- _-..
- -- 9{7
29200 - 31,738
- -13.7
2533 --
2,602 - --
5.8
7.087 -
7,227 -_
9.8
31.739 -- 34,761 -__132
-2,603 -
2,675
_ 5.9
7,228 -
7573- -___
-. 9.9
34762 - - 38,420._-_-13.9
• - 2,676 -
2,753 - -----
_ 6.0
7,374-
7,52510{
38,421 - 42,940 --
....14.0
_ - 2,754 -
2)W --
6.1
7,526 -
7,683 -. --------
104
42,941-- 48,666
14.1 ;
2,836 --
2,922 -
62
7,684 -
7,848- _____10.2
- 48,667 = 56,153 __142
2,923 -
3,015 -_-
6.3
7,849 -
8,021 - -_
-10.3
56,154 - 66,363_____14.3
3,016-
3,114____.
-_ 6.4
8,022 -
8,201_.__
-- 10.4
66,364 - 81,110_
-14.4
3,115 -
3,219___
-_ 6.5
8,202 -
8,390...._. --
._..10.5
81,111 - 100768 -
___14.5
3,220 -
3.332 -____
6.6
8,391- -
8,587_ -10.6
100,769 - 106,215 __-
__14.6
3,333 -
3,454 - -.._
6.7
8588 -
8,794_... -_.._
-10.7
106,216 - 112,285__
-.- _.14.7
3,455 - -
3,584_.__._..
6.8
8,795 -
9,011.: -.._ -_.102
112,286 -
3,585 -,
3724__
_._ 6.9
9,012 -
9,240_..__.:..10,9
119,091 - 126,773__._.._14.9
3,725 -
3,877___.
-__ 7.0
9,241 -
9,480-___..11,0
126,774 - 135516
--- . 15.0
3,878 -
4,042-7.1.
- - 9,481 -
9,732 - -,-.11.1
.135,517 - 145555.___15.1
4,043_-
4221__ -
-__ 72
9,733 -
9,999.___..._.'11.2,
145556 - 157,199 -
152
4222-
4,418_ --
7.3
10,000 -
10281 --
__11.3
157200 - 170,869 _ --
4,419-
4,633 - --
- 7.4
10282 -
10,579------11.4
170,870 - 187,142 _-
-15.4
.4,634 --
4,871 - -__
7.5
10,580 -
10,895.. - .__..__11.5
187,143 - 206;841 --
-15.5
4.872-
5,033._ -_
-._ 7.6
10,896 -
11,230__- _..__11;6
206,842 -- -- 231,175 -_
-15.6
5,034 -
5,104___...
77
11,231 -
11,586 -_11.7
231,176 - ,'261,999 -_
-_ -15.7
5,105 -
5.176 - -__
7.8
11,587 -
11,966._. -
___11.8
2627.000- 302307-.
-152
5,177 -
5251 - -_._.
7.9
11,967-
12,372__ -.- .:._11.9
302,308 - 357.272
5252-
5,327___
- -- 8.0
12,373 -
12,806- ....._
..12,0
357,273 - 436,666_-
16.0
5,328 -
5.406_ -____
8.1
12,807 -
13,272----
- 12,1
436,667 - %1,428 __
_.._ 161
5.407 -
5,488- -
82
13273 -
13.773 __
122
561,429 - 785,999 -.__
162
5,489 -
5_572_______
83
13.774 -
14,313._. -_._..
113
786,000 - 1,309,999_...
-_... 16.3
5573 -
5,658 -
-__ 8.4
14.314 -
14,897.__
12.4
1,310,000 - 3,929,999_._.
-_ -16.4
5,659 -
5,747_. _
-- _ 8.5
14,898 -
15531._. -. -...
12.5
3,930,000 and over_.____._l6S
5,748 -
5.839_ _._:_'8.6
15.532 -
16221_. -.._
12.6
5.840 -
5.934____`
87
16-M -
16.976 ----------
12.7
5.935 -
6.032._ ___-
8.8
16,977 -
17.804....
.12,8
6.033 - -
6-133---
8.9
17.805 -
18,717...
_ 12.9
TX 3.2 EXECUTIVE OFFICERS, PARTNERS AND SOLE PROPRIETORS ENDORSEMENT • TEXAS
Tliis endorsement Issued to causem comes /Lon Standard Time pp
is effective from g_�_7p. and forms a part of Policy No. 41 6w 417
CFO] A.M. '
Issued by AE WICA® NM RIM 7NBUPJME CQ16 LoIIE'L aroyes Ii LnoLs
It Is agreed that:
1. Such insurance as is afforded by the policy by reason of the designation of Texas in Item 3 of the declarations does
not apply to injury, including death resulting therefrom, sustained by any executive officer, partner or sole proprietor of the.
insured, except such, if any, as are designated below or in Item 4 of the decl orations.
2. "Remuneration ", when used as a premium basis for such insurance, shall not include the remuneration of any exec -
five officer, partner or sole proprietor of the insured not so designated.
Designation of Persons
This endorsement Is subject to all the terms, conditions and exclusions of the policy and of forms and endorsements attached thereto
which are not inconsistent herewith.
Countersigned Corp" CbXJLOii TeM0
Md. #2 .-" C�
FC— TX 3.2 (9 -1 -73) r� Duly Authorized Representative
REORDER 4 14 -4232 eTECK- WARLICK
PRODUCER'S NO. PRODUCER
WORHMENS COMPENSATIO
AND EMPLOYERS LIABILITY
SUB-PRODUCER
ENDORSEMENTS ATTACHED
3 30 ♦
(J(- -0 419
RAME OF INSURED�E
Y JACKET YE®
STATE IF NEW RENEWAL OF FOR G0. USE - NAME CODE
REPLACES CARD. POL N0.
I
LOCATIONS - -ALL USUAL WORKPLACES OF THE INSURED AT OR FROM WHICH OPERATIONS COVERED BY THIS POLICY ARE CONDUCTED ARE LOCATED AT THE ABOVE ADDRESS
UNLESS OTHERWISE STATED HEREIN.
FOAM 2-1 . PAUrr OATS
EXTRA COPY � c Lem G� = 105 CUM. 6%
❑LUDIBEMIENS MUTUAL ® AMERICAN MOTORISTS ❑ AMERICAN MANUFACTURERS
CASUALTY COMPANY INSURANCE C031PANY MUTUAL INSURANCE COMPANY
WORHMENS COMPENSATIO
AND EMPLOYERS LIABILITY
POLICY NUMBER
DECLARATIONS FEDERAL MUTUAL
INSURANCE COMPANY
(J(- -0 419
RAME OF INSURED�E
��1.
—u —.,_q Ry_� q�����a �E
Coll Concession � 0 Bannatt db.
BTREET —CITY DR P0p9�T�O�FFICE�- CSOUNT Y -9T ATE —ZIP CDeDRE.)o
,�yyA�ODRF99w 91NwDM.�BEA-
0ByyR ;W6Q'i,':L1� QSS VYJAI� -• FTi/�
Il INDIVIDUAL ❑ PARTNERSHIP ❑ CORPORATION ❑ OTHER
LOCATIONS - -ALL USUAL WORKPLACES OF THE INSURED AT OR FROM WHICH OPERATIONS COVERED BY THIS POLICY ARE CONDUCTED ARE LOCATED AT THE ABOVE ADDRESS
UNLESS OTHERWISE STATED HEREIN.
402 U. �raDne Br., cbristi, TeXas
Fe le s
$- POLICY PERIOD. FROM TO 12.01 A.M. STANDARD TIME AT
p
+ y 8-3-75 ASESTATED HHEREIN. E INSURED
S. COVERAGE A OF THIS POLICY APPLIES TO THE WORKMEN'S COMPENSATION LAW AND ANY OCCUPATIONAL DISEASE LAW OF EACH OF THE FOLLOWING STATES.
4. CLASSIFICATION OF OPERATIONS
PREMIUM BASIS
RATES
ESTIMATED
ENTRIES IN THIS ITEM IXCEPf AS SPECIFICALLY PROVIDED CODE
ELSEWHERE IN THIS PbLICY, DO NOT MODIFY ANY OF THE NO.
ESTIMATED
TOTAL REMUNERATION
PER 5100
OF
PREMIUMS
OTHEB PROVISIONS OF THIS POLICY.
ANNUAL - ❑ THREE YEAR
REMUNERATION
it ANNUAL- ❑ THREE YR.
Concession Stand Bated Am
Caterers-ineludivS Clerical 9079
34,240.
2.74
937.00
Loss Constant (3L9.09) 4032
dense Constant (3L4,49) 0020
Experience gter
.92
MINIMUM PREMIUM
7 TOTAL ESTIMATED Lit ANNUAL PREMIUM— ❑ THREE YEAR PREMIUM S
IF INDICATED BELOW, INTERIM ADJUSTMENTS OF PREMIUM SHALL BE MADE,
❑ SEMI - ANNUALLY ❑ QUARTERLY ❑ MONTHLY DEPOSIT PREMIUM $f
B — EMPLOYERS' LIABILITY.
5. LIMIT OF LIABILITY FIOO�YRJ
�COVERAGE
$ SUBJECT TO ALL THE TERMS OF THIS POLICY HAVI BE E THERETO.
COUNTERS ISHHEDµ�AT�.,y
CDUNTERSIONATUBE DATE CW TURRE L AGENT
p� �p �e,T�
V orpu m La YY,L lati y 3ems
01
MO.RR DAY 18nn ��Z ✓ '
CK 3- 1 E, 1. 1 I -69 10M PAINTED IN U...&
ATTACH DECLARATIONS PAGE, EXTENSION SCHEDULES AND ENDORSEMENTS
This Is not a complete and valid contract without an accompanying Declarations Page properly countersigned.
CONDITIONS (Continued)
such person is securer) by other valid and collectible insurance or 5. Notice of Injury. When an injury occurs written notice shall
by any other tmdertakiug approved by the governmental agency be given by or on behalf of the insured to the company or any
having jurisdiction thereof. of its authorized agents as soon as practicable. Such notice shall
contain particulars sufficient to iden0v the insured and also rea-
If the declarations provide for adjustment of prenlinn on other
than An annual basis, the insurcrl shall pay the deposit premium
to the company upon the inception of this policy and thereafter,
interim premiums shall be computed in accordance with the man-
uals in use by the coutpany and paid by the insured promptly after
the end of each interval specified in the declarations. The deposit
premimn shall be retained by the company until termination of this
policy and credited to the final premium adjustment.
The insured shall maintain records of the information necessary
for premium computation on the bases stater[ it, the declarations.
nod shall scrod copies of such records to the coutpany at ll:e cud
of the policy period and at such times during the policy period
as the company may direcl. Ii the insured does not furnish records
of the remuneration of persons within division (b) of the definition
of remuneration foregoing, the remuneration of such persons shall
be computed in accordance u,itln the rmantals in use by the
company.
The premium stated in the declaialioits is an estimated pre -
orimn only. Upon termination of this policy, the canner) premilmt
shall lie computer) in accordance with the rules, rates, rating plans,
premiums and nlinimtun premiums applicable to this insurance in
accordance with the manuals in use by the company. If the earned
premium thus computed exceeds the premium previously paid, the
insured shall pav the excess to the company; if less, the company
shall return to the insurer) the unearned portion paid by the
insured. All premiums shall be fully earned whether any wenrk-
men's compensation law, or any part thereof, is or shall be declared
invalid or unconstitutional.
2. Long Term Policy. If this policy is written for a period longer
than one year, all the provisions of this policy shall apply sepa-
rately to each consecutive twelve months period, or, if the first
or last consecutive period is less than twelve months, to such
period of less than twelve months, in the same manner as if a
separate policy had been written for each consecutive period. Tile
earned premium for each such period shall be computed as pro-
vider) by Condition 1 of this policy, subject, except as othenvisr.
provided in the manuals ill use by the company with respect to
classification of operations for which this policy provides a per
capita premium basis, to the following provisions:
(a) The premium rates for the first consecutive period shall he
those staled in the declarations and those applicable for such
period in accordance with the manuals in use by the company;
(b) The premium bases, classifications of operations, rates,
rating plans, premiums and minimum premiums for each such
subsequent period shall be those applicable for such period in
accordance wilt the manuals in use by the company.
3. Partnership or joint Venture as Insured. If the insured is a
partnership or joint venture, such insurance as is afforded by this
policv applies In each partner or member thereof as an insured
only while he is acting within the scope of his duties as such
partner or member.
4. Inspection and Audit. The company and any rating authority
having jurisdiction by law shall each be permitted but not obligated
to inspect at any reasonable time the workplaces, operations, ma-
chinery and equipment covered by this policy. Neither the right
to make inspections nor the making thereof nor any report thereon
shall constitute an undertaking on behalf of or for the benefit of
the insured or others, to determine or warrant that such work-
places, operations, machinery or equipment are safe or healthful,
or are in compliance with any law, rule or regulation.
The company and any rating authority having jurisdiction by
law shall each be permitted to e and audit the insured's
payroll re ards, general ledges, disbursements, vouchers, contracts,
tax reports and all other books, documents and records of any and
every kind at any reasonable time during the policy period and any
extension thereof and within three years after termination of this
policy, as far as they show or tend to shown or verify the amount
of remuneration or other premium basis, or relate to the subject
matter of this insurance.
souahly obtainable information respecting the lime, place and cir-
cumstances of the injury, the names and addresses of lire injured
and of available xitnesses.
6. Notice of Claim or Suit. If claim is made or suit or other
proceeding is brought against the insured, the insured shall imme-
diately forward to the company every demand, notice, summons
or other process received by hint or his representative.
7. Assistance and Cooperation of the Insured. The insured shall
cooperate with the company and, upon lire company's request,
shall attend hearings and trials and shall assist in effecting settle-
ments, securing and giving evideiwe, obtaining the attendance of
witnesses all(] in the conduct of suits or proceedings. The insured
;hall trot, except at lJS ow'n cost, voluntarily stake any payment,
.sonic any obligation or incur any expense other than for such
immediate medical and other services a[ the time of injury as are
required by Lire workmen's conipens'atiou Luc,
8. Statutory Provisions, Coverage A. The company shall be di-
rectly and primarily liable to any person entitled to the benefits of
the workmen's compensation law under this policy. The obligations
of tlue company may be enforced by ,cuch person, or for his benefit
Iry any agency authorized by law, whether against the company
alone or jointly with the insured. Bankruptcy or insolvency of the
insured or of the insured's estate, or any default of the insured,
shall not relieve the coutpany of any of its obligations under cov-
erage A.
As between the employee and the eompavy, notice or knowl-
edge of the injury on the part of the insured shall be notice or
kuon•ledge, as the case may he, on the part of the company; the
jurisdiction of the insured, for the purposes of the workmen's
compensation law, shall be jurisdiction of the company and the
company shall in all things he bound by and subject to the find-
ings, judgments, awards, decrees, orders or decisions rendered
against the insured in the form and manner provider) by such law
and within the terms, limitations and provisions of this policy not
inconsistent with such law.
All of the provisions of the workmen's compensation law, shall
be arc[ remain a part of this policy as fully and completely as if
written herein, so far as they apply to compensation and other
benefits provided by this policy and to special taxes, payments
into security or other special funds, and assessments required of
nr levied against compensation insurance carriers under such law.
The insured .shall reimburse the company for any payments
required of the company under the tvorknten's compensation law-,
n ewes' of the benefits regularly provided by such laic, solely
because of injury to (a) any employee by reason of the serious and
wilful misconduct of the insured, or (b) any employee employed by
the insured in violation of law with the knowledge or acquiescence
of the insured or any executive officer thereof.
Nothing herein shall relieve the insured of the obligations
imposed upon the insured by the other terms of this policy.
9. Limits of Liability, Coverage B. The words "damages because
of bodily injury by accident or disease, including death at any time
resulting therefrom," in coverage B include damages for care and
I— of services and damages for which the insured is liable by
reason of suits or claims brought against the insured by others to
recover the damages obtained from such others because of such
bodily injury sustained by employees of the insured arising out of
a nd it, the course of their employment. The limit of liability stated
in the declarations for coverage B is the total limit of the company's
liability for all damages because of bodily injury by accident, in-
cluding death at any time resulting therefrom, sustained by one or
more employees in any one accident. The limit of liability stated in
the declarations for coverage 13 is the total limit of the company's
liability for all damages because of bodily injury by disease, in-
cluding death at any time resulting therefrom, sustained by one or
more employees of the insured in operations in any one state desig-
nated in Item 3 of the declarations or in operations necessary or
incidental thereto.
The inclusion herein of more than one insured shall not operate
to increase the limits of the company's liability.
NSr78Will0 n
CONDITIONS (Continued)
10. Action Against Company, Coverage B. No action shall lie
against the company unless, as a condition precedent thereto, the
insured shall have fully complied with all the terms of this policy,
nor until the amount of the insured's obligation to pay shall have
been finally determined either by judgment against the insured after
actual trial or by written agreement of the insured, the claimant
and the company.
Any person or organization or the legal representative -hereof
who has secured such judgment or written agreement shall there-
after be entitled to recover under this policy to the extent of the
insurance afforded by this policy. Nothing contained in this policy
shall give any person or organization any right to join the com-
pany as a co- defendant in any action against the insured to deter-
mine the insured's liability.
Bankruptcy or insolvency of the insured or of the insured's
estate shall not relieve the company of any of its obligations under
coverage B.
11. Other Insurance. If the insured has other insurance against a
loss covered by this policy, the company shall not be liable to the
insured hereunder for a greater proportion of such loss than the
amount which would have been payable under this policy, had no
such other insurance existed, bears to the sum of said amount and
the amounts which would have been payable under each other
policy applicable to such loss, had each such policy been the only
policy so applicable.
12. Subrogation. In the event of any payment under this policy,
the company shall be subrogated to all rights of recovery therefor
of the insured and any person entitled to the benefits of this policy
against any person or organization, and the insured shall execute
and deliver instruments and papers and do whatever else is neces-
sary to secure such rights. The insured shall do nothing after loss
to prejudice such rights.
13. Changes. Notice to any agent or knowledge possessed by any
agent or by any other person shall not effect a waiver or a change
in any part of this policy or estop the company from asserting any
right under the terms of this policy; nor shall the terms of this
policy be waived or changed, except by endorsement issued to form
a part of this policy.
14. Assignment Assignment of interest under this policy shall not
bind the company until its consent is endorsed hereon. If, however,
during the policy period the insured shall die, and written notice is -
given to the company within thirty days after the date of such
death, this policy shall cover the insured's legal representative as
insured; provided that notice of cancelation addressed to the in-
sured named in the declarations and mailed or delivered, after
such death, to the address shown in this policy shall be sufficient
notice to effect cancelation of this policy.
15. Cancelation. This policy may be canceled by the insured by
mailing to the company written notice stating when thereafter the
cancelation shall be effective. This policy may be canceled by the
company by mailing to the insured at the address shown in this
policy written notice stating when not less than ten days thereafter
such cancelation shall be effective. The mailing of notice as afore-
said shall be sufficient proof of notice. The effective 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.
If the insured cancels, unless the manuals in use by the com-
pany otherwise provide, earned premium shall be (1) computed in
accordance with the customary short rate table and procedure and
(2) not less than the minimum premium stated in the declarations.
If the company cancels, earned premium shall be computed pro
rata. Premium adjustment may be made at the time cancelation is
effected and, if not then made, shall be made as soon as practicable
after cancelation becomes effective. The company's check or the
check of its representative mailed or delivered as aforesaid shall
be a sufficient tender of any refund of premium due to the insured.
When the insurance under the workmen's compensation law
may not be canceled except in accordance with such law, this
condition so far as it applies to the insurance under this policy
with respect to such law, is amended to conform to such law.
16. Terms of Policy Conformed to Statute, Coverage A. Terms of
this policy which are in conflict with the provisions of the work-
men's compensation law are hereby amended to conform to such
law.
17. Declarations. By acceptance of this policy the insured agrees
that the statements in the declarations are his agreements and rep-
resentations, that this policy is issued in reliance upon the truth of
such representations and that this policy embodies all agreements
existing between himself and the company or any of its agents re-
lating to this insurance.
As respects the company previously designated, the following correlative provision forms a part of this policy:
Mutual Policy Conditions. LUMBERMENS nuTUAL A1EBICAN MANOFACPUREaS FEWRAL MUTUAL
CASUALTY COMPANY MUTUAL INSURANCE COMPANY INSURANCE COMPANY
This is a perpetual mutual corporation owned by and operated for the benefit of its members. This is a non - assessable, participating
policy under which the Board of Directors in its discretion may determine and pay unabsorbed premium deposit refunds (dividends) to
the insured.
As respects the State of Texas, such provision is amended tIl read as follows:
Mutuals— Memberahip and Voting Notice. The insured is notified that by virtue of this policy he is a member of the company so desig-
nated, and is entitled to vote either in person or by proxy at any and all meetings of said company. The Annual Meetings are held in
its Home Office at the place and time stated on the front cover.
Mutuals— Participation Clause Without Contingent Liability. No Contingent Liability: This policy is non - assessable. The policyholder is
a member of such company and shall participate, to the extent and upon the conditions fixed and determined by the Board of Directors
in accordance with the provisions of law, in the distribution of dividends so fixed and determined.
Dividends. AMERICAN MOTORISTS
INSURANCE COCIPANY
This policy is participating and shall be entitled to receive unabsorbed premium deposit refunds as apportioned by the directors.
As respects the State of Texas, such provision is amended to read as follows:
Dividend Provision — Participating Companies. The named insured shall be entitled to participate in a distribution of the surplus of the
company, as determined by its Board of Directors from time to time, after approval in accordance with the provisions of the Texas Insur-
ance Code, of 1951, as amended.
As respects the State of California, the Mutual Policy Conditions and the Dividends Condition are supplemented by the following
paragraph:
Participating Provision The insured may participate in the earnings of the company represented by surplus accumulated from premiums
on California workmen's compensation policies to the extent and upon the conditions determined by the Board of Directors of the
company in accordance with law after the expiration of the policy period to which the dividend is applicable, provided that no dividend
shall be payable hereunder unless the insured has complied with the terms of the policy in respect to the payment of premium.
IN WITNESS WHEREOF, the company designated on the Declarations Page has caused this policy to be signed by its President
and Secretary, but this policy shall not be valid unless countersigned on the Declarations Page by a duly authorized representative of
the company.
LUMBEIRMEwS MUTUAL CABVAL7Y COMPANY FEDERAL MUTUAL INSURANCE COMPANY
AMERICAN MOTORISTS INSURANCE COMPANY
AMERICAN MANUFACTURERS MUTUAL INSURANCE COMPA/NYy // �/% /
8earernry Preddent' / Secretary Presiden6
CK 2 -2 JACKET PAGE 3 8 73 soM PRINTED IN u.9.A.
LUMBERMENS MUTUAL
CASUALTY COMPANY
IA Mutual Insurance Company, herein called the Company)
Home Office: Long Grove, Illinois 60049
AMERICAN MANUFACTURERS
MUTUAL INSURANCE COMPANY -
(A Mutual Insurance Company, herein called the Company)
Home Office: 90 willlem Street Nev; York 70038
E—utive Offices: Long Grove, Illinois 60049
AMERICAN MOTORISTS
INSURANCE COMPANY
(A Stock Insurance Company, herein called the Company)
Homo Office: Long Grove, Illinois 60049
FEDERAL MUTUAL
INSURANCE COMPANY
IA Mutual Insurance Company, herein called the Company)
Home Office: Long Grove, Illinois 60049
E—tive Offices: 2007 East Mound Road, Decatur, Illinois 62626
The company providing the insurance afforded by this policy is designated on the Declarations Page
ALL FORMS OF INSURANCE
BILL CURRAN AGENCY
Box 2727 853 -9601
Corpus Christi, Texas 78403
UFE • FIRE • AUTO • ACCIDENT • LIABILITY
The annual meeting of the Lumhermens Mu- The annual meeting of the American Manu- The annual meeting of the Federal Mutual
tual Casualty Company Is held at Its home facturers Mutual Insurance Company is held Insurance Company Is held at Its home office
office In Long Grove, III., on the third Tuesday at Its home office In New York, New York, In Long Grove, Illinois, on the Wednesday
In May of each year at eleven o'clock A.M. on the Thursday following the first Tuesday following the fourth Tuesday in May of
in June of each year at eleven o'clock A.M. each year at eleven o'clock A.M.
GENEIL4L INSURING AGREEMENT
In consideration of the payment of the premium, in reliance upon the statements in the declarations made a part hereof and subject to all of the terms of this policy, the com-
pany agrees with the named Insured as follows:
1. This policy is composed of this jacket, the declarations page with the applicable Coverage Parts, and any supplementary declarations or schedule pages and endorsements
made a part hereof;
2 The provisions of one Coverage Part do not apply to the insurance afforded under any other Coverage Part.
SUPPLEMENTARY PAYMENTS
The company will pay, In addition to the applicable limit of liability:
(a) all expenses Incurred by the company, all costs taxed against the insured in any suit defended by the company and all Interest on the entire amormt of any judgment therein which accrues
after entry of the judgment and before the company has paid or tendered or deposited in court that part of the judgment which does not exceed the limit of the company's liability thereon;
(b) premiums an appeal bands required in any such suit, premiums on bonds to release attachments in any such suit for an amount not in excess of the applicable limit of liability of this
policy, add the cost of hail bonds required of the insured because of accident or traffic law violation arising out of the use of any vehicle to which this policy applies, not to exceed
$250 per bail hand, but the company shall have no obligation to apply for or furnish any such bonds;
(c) expenses incurred by the insured for first aid to others, at the time of an accident, for bodily injury to which this policy applies;
(d) reasonable expenses Incurred by the insured at the company's request in assisting the company in the investigation or defense of any claim or suit, including actual loss of
earnings not to exceed $25 per day.
DEFINITIONS
Who used In this policy:
"aolmmihlla" means a land motor vehicle, trailer or semi - trailer designed for travel on public
roads (including any machinery or apparatus attached thereto), but does not include mobile
equipment;
"bodily fojury" means bodily injury, sickness or disease sustained by any parson which
occurs during the policy period, including death at any time resulting therefrom;
" completed operdvons; hand' includes bodily injury and property damage arising out of
operations or reliance upon a representation or warranty made at any time with respect thereto,
but only It the bodily injury or property damage occurs after such operations have been com-
pleted or abandoned and occurs away from premises ownDd,by or rented to the named insured.
"Operations" include materials, parts or equipment famished in connection therewith. Opera-
tions shall be deemed completed at the earliest of the following times:
(1) when all operations to be performed by or on behalf of the named insured under the
contract have been completed,
(2) when all operations to he performed by or on behalf of the named insured at the site of
the operations have been completed, or
(3) when the portion of the work cut of which the injury or damage arises has been put to
its intended use by any person or organization other than another contractor or sub-
contractor engaged in performing operations for a principal as a part of the same
project.
Operations which may require further service or maintenance work, or correction, repau ar
replacement because of any defect or deficiency, but which are otherwise complete, shall be
deemed completed.
The completed operations hazard does not include bodily injury or property damage arising
out of
(a) operations in connection with the transportation of property, unless the bodily ioury or
property damage arises out of a condition in or on a vehicle created by the Ins 'Ing or
unloading thereof,
(b) the existence of tools, uninstalled equipment or abandoned or unused materials, or
(c) operations for which the classification stated in the policy or in the company's manual
specifies "including completed operations';
"elaiator" means any hoisting at lowering device to connect floors or landings, whether or
not in service, and all appliances thereat including any car, platform, shaft, hoishvay, stair-
way, runway, power equipment and machinery; but does not include an automobile serdcing
hoist, or a hoist without a platform outside a building if without mechanical pourer or if not
attached to building walls, or a had or material hoist used in alteration, construction or
demolition operations, or an inclined conveyor used exclusively for carrying p rty or a
dumbwaiter used exclusively for carrying property and having a compartment height not
exceeding four feet;
"Incidental contract" means any written
(1) lease of premises,
(2) easement agreement, except in connection with construction or demolition operations
on or adjacent to a railroad,
(3) undertaking to Indemnify a municipality required by municipal ordinance, except in con-
nection with work for the municipality,
(4) sidetrack agreement, or
(5) elevator maintenance agreement;
"Insured" means any person or organization quali{yIng as an insured in the "Persons Insured"
urance
provision of the applicable Ins coverage. The insurance afforded applies separately to
each insured against whom claim is made or suit is brought, except with respect to the limits
of the company's liability;
"mohfie %pimml" means a land vehicle (including any machinery or apparatus attached
thereto), whether or not self - propelled,
(1) not subject to motor vehicle registration, or
(2) maintained for ass exclusively on premises owned by or rented to the named insured,
including the ways immediately adjoining, or
(3) designed for use principally off public roads, or
(4) designed or maintained for the sole purpose of affording mobility to equipment of the
following types forming an integral part of or permanently attached to such vehicle:
power cranes, shovels, loaders, diggers and drills; concrete mixers (other than the
mix -in- transit type); graders, scrapers, rollers and other road construction or repair
equipment; air - compressors, pumps and generators, includini spraying, welding and build-
ing cleaning equipment; and geophysical exploration and we. I servicing equipment;
"mod Ioued" means the person or organization named in Item 1 of the declarations of
this policy;
"named Insored's products" means goods or products manufactured, sold, handled or distributed
by the named insured or by others trading under his name, including any container thereof
(other than a vehicle), but "named insured's products" shall not include a vending machine or
any property other than such container, rented to or located for use of others but not sold;
"occurrence" means an accident, including continuous or repeated exposure to conditions,
which results in bodily injury at property damage neither expected nor intended from the
standpoint of the Insured;
"policy terriW means:
(1) the United States of America, its territories or possessions, or Canada, or
(2) international waters or air space, provided the bodily inI'ury or property damage does not
occur in the course of travel or transportation to or from any other country, state or
nation, or
(3) anywhere in the world with respect to damages because of bodily injury or property
damage arisins out of a product which fins sold for use or consumption within the
territory described in paragraph (1) above, provided the original suit for such damages is
brought within such territory;
"prodoets hazard" includes bodily injury and property damage arising out of the named insured's
ppmducts or reliance upon a representation or warranty made at any time with respect thereto,
but only if the bodily Injury or property damage occurs away from premises owned by or rented
to the named insured and after physical possession of such products has been relinquished
to others;
"property damage" means (1) physical injury to or destruction of tangible property which
occurs during the policy period, including the loss of use thereof at any time resulting
therefrom, or (2) less of use of tangible property which has not been physically injured or
destroyed provided such loss of use Is caused by an occurrence during the policy period;
CONDITIONS
1. Recount. t. All premiums for this policy shall be computed in accordance with the company's
rules, rates, rating plans, premiums and minimum premiums applicable to the insurance afforded
harem
Premium desi aled in this policy as "advance premium" is a deposit ppremium only which
shall be credite�to the amount of the earned premium due at the end of tha policy period. At
the close of each period (or part thereof terminating with the end of the policy period) deli q-
noted in the declarations as the audit period the earned premium stall be computed for such
period and, upon notice thereof to the named insured, shall become due and payable. If the
total earned premium for the policy period is less than the premium previously paid, the
COMM shall return to the named Insured the unearned portion paid by the named insured.
The named inured shall maintain records of such information as is necessary for premium
computation, and shall send copies of such records to the company at the end of the policy
period and at such times during the polity period as the company may direct.
Vin*
L Inspection amt Audit The company shall be permitted but not obligated to inspect the
named Insureds property and operations at any time. Neither the company's right to make
inspections nor the maNing thereof nor any report thereon shall constitutte an undertaking, an
behalf of ar for the benefit of the named Insured at others, to determine or warrant that such
property or operations are safe or healthful, or are in compliance with any law, rule or
regulation.
The company may examine and audit the named insured's books and records at any time
during the policy period and extensions thereof and within three years after the final termination
of this policy, as far as they relate to the subject matter of this insurance.
(Conditions are eootimed an Jacket Page 3)
No. I PRODUCER - - - SUB - PRODUCER
BUSINESS I
NAME CODE
STATED
JI
C¢ANCELLED Pa 11 —11 ❑ ne P-1— neru unso
NAMED INSURED
NAIL ADDRESS Inuuaev—sree¢r--c,xr oe Pocr uPr,ce—xone �ounTr— sTAre —x:r cooe: C20" Christi, NUW",- U143
INDIVIDUAL ❑PARTNERSHIP ❑ JOINT VENTURE RUSINF59 OF E NAMED INSURED
❑ CORPORATION ❑OTHER: Cn
E.cC.
gEet.
LNIIBEIIMENS MUTUAL
CASUALTY COMPANY
AMERICAN MOTORISTS AMERICAN MANUFACTURERS
INSURANCE COMPANY MIITU AL INSURANCE "COII Y
COVERAGE PART
FEDERAL MUTUAL
INSURANCE COMPANY
l —Comprehensive Automobile Liability Insurance
ADDITIONAL COPY FOI
2— Garage Insurance
�- �� ��— a Q
DECLARATIONS COMBINATION AUTOMOBILF—GENERAL LIABILITY POLICY NUMBER •�
)��� L
4zz QD C
NAMED INSURED
NAIL ADDRESS Inuuaev—sree¢r--c,xr oe Pocr uPr,ce—xone �ounTr— sTAre —x:r cooe: C20" Christi, NUW",- U143
INDIVIDUAL ❑PARTNERSHIP ❑ JOINT VENTURE RUSINF59 OF E NAMED INSURED
❑ CORPORATION ❑OTHER: Cn
POLICY PERIOD:
FROM (A-1 orAre ne.e ,P orne¢ *xnx 11— •...I
-7-1"
TO
17:01 A.N. STANDARD TIME AT THE ADDRESS E EIN,
OF THE NAMED INSURED AS STATED HEREIN,
The insurance anorde is only with respect to such of the following Coverage Parts as are indicated by entry of -specilic advance premium applicable thereto.
ADVANCE PREMIUM
COVERAGE PART
$
l —Comprehensive Automobile Liability Insurance
2— Garage Insurance
3— Automobile Medical Payments Insurance
4— Protection Against Uninsured Motorists Insurance
5— Automobile Physical Damage Insurance (Fleet Automatic)
6— Automobile Physical Damage Insurance (Non - Fleet)
7— Comprehensive General Liability Insurance
8— Owners', Landlords' and Tenants' liability Insurance
9— Monufacturere and Contractors' Liability Insurance
10— Completed Operations and Products Liability Insurance
11— Contractual Liability Insurance (Designated Contracts Only)
12— Independent Contractors Liability Insurance
13— Premises Medical Payments Insurance
14— Personal Injury Liability Insurance
15— Comprehensive Personal Insurance
3 ?.�D
Special charge for endorsement yy„aors is A. W
Tit3e Is. Psi e,,
has sm. CE 9-72
� ���
TOTAL ADVANCE PREMIUM
aDHIN6 THE PAST TRREE YEAO9 NO INSURER NAS CANCELED ANY INSURANCE ISSUED TO THE NAMED INSURED, SIMILAR TO THAT AFFORDED HEREUNDER, UNLESS OTHERWISE
STATED HEREIN.
COUNTERSIGNED AT
Corpus C7ssistf, Te"s
COUNTERSIGNATOOE DATE
onrn8 ) } -� ,¢A
COUNTERSI6NA ELF LICENSED RES/IDEENNT AGEN1
L.r
FORM CK 802 5 -73 • 30M ED 66
- COVERAGE PART 8
DECLARATIONS — Applicable to Coverage Part 8 only
The insurance afforded under this Coverage Part is only with respect to such of the following Coverages as are Indicated by entry of specific advance premium in
the Schedule. The limit of the company's liability against each coverage shall be as stated herein. subiect to all the terms of the Dolim havina reference thereto.
UMPfSOF
LIABILITY
Coverage A— Bodily Injury Liability: $ 8 .: each occurrence.
Coverage B— Property Damage Llabllity: $ M. each occurrence.
PREMIUM
RATES
LOCATION OF INSURED PREMISES
[ENTER �I1r�4. IFSAME LOCATON AB ADDpE98H09VN WOEOJ�RAT1ON t�
NUMBER — STREET —CITY —STATE
INTEREST OF NAMED POURED
IM OF
CNPREMISES
(OWNER. LE�,TENANT,ETC)
PART OCCUPIED
BY NAMED INSURED
A
4W �� q� /1
lh\ rdIllm Co
COVERAGE
INJURY
COVERAGE
PRGPERTY
n
MOWPY-- CLLIMONSOROTHERTERMSOFTHISPOLICY)
BA515
SECTION I—PREMISES — OPERATIONS CODE
pDr.
a
(A) PER I009Q.
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LIABILITY
LIABILITY
CoMeWwaire, soLU ng
SCHEDULE— GENERAL LIARII.ITY HA7ARDS
_
DESCRIPTION OF HAZARDS
(ANY RATING CLASSIFICATION SHOWN HEREUNDER DOES NOT
PREMIUM
RATES
ADVANCE PREMIUMS
COV.A
COV.B
COVERAGE
INJURY
COVERAGE
PRGPERTY
n
MOWPY-- CLLIMONSOROTHERTERMSOFTHISPOLICY)
BA515
SECTION I—PREMISES — OPERATIONS CODE
IAJ AREA(SQ. PT.)
(A) PER I009Q.
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LIABILITY
LIABILITY
CoMeWwaire, soLU ng
beverages or food by lit
of ]3avWjzg or VeMing-
including completed
cperabims. 58=a
) 70,000.
.242
.025
169.00
18.00
TM. 05
— ESCALATOF9 (NUMBER AT PRENI ®I CODE
NUMBER INSURED
PER LANDING
- MINIMUM PREMIUMS COV. A$ 23.'M COV,B$�3it 0
POLICY NUMBER
Jt�
R 9
COV,PARTa THISCOVERAGE PART MEFFECTIVE
PAGE NO. vw{.. 0T —+ reax
"s+�i " dVV 4
POLICY EFFECTIVE
of pyTa vsx
1T1
, AM.
svgv
ipii_�
eor ro ee cawaaeo ux.xee exeosu ae exlere. (COVERAGE PART a CONTINUED ON REVERSE SIDE)
CK 810 -2 10 -72 100M ED. 73
COVERAGE PART 8— OWNERS, LANDLORDS' AND TENANTS' LIABILITY INSURANCE
COVERAGE FOR DESIGNATED PREMISES AND RELATED OPERATIONS IN PROGRESS
OTHER THAN STRUCTURAL ALTERATIONS, NEW CONSTRUCTION AND DEMOLITION
I. Coverage A— Bodily Injury Liability Coverage B— Properly Damage Liability
The company will pay on behalf of the insured all sums which the insured shall
become legally oblige pay 0 damages bemuse of
A: bodily injury or B. property damage
to which this insurance applies, mused by on accurrenco and arising out of the
ownership, maintenance Or use of the insured premises and all operations neress-
ery or incidental thereto, and the company shall have the right and duty to
defend any suit against the insured seeking damages an account of such bodily
injury or property damage, even if any of the allegations of the suit are ground-
less, false or fraudulent, and may make such investigation and settlement of any
claim or suit as it ties" expedient, but the company shall not be obligated to
pay any claim or judgment or-to defend any suit after the applicable limit of the
company's liability has been exhausted by payment of judgments or settle -
ments.
Exclusions
This irrse ranw doze not apply:.
(a) to liability assumed by the insured under any contract or agreement except
an incidental contract; but with respect to bodily injury or property damage
occurring while work performed by the named insured is in progress, this ex-
clusion does not apply to a warranty that such work will be done in a workman-
like manner;
(b) to bodily injury or property damage arising out of the ownamhip, main-
tenance, operation, use, loading or unloading of
(1) any automobile or aircraft owned or operated by or rented or loaned to
any insured, or
(2) any other automobile or aircraft operated by any person In the course of
his employment by any insured,
but this exclusion does not apply to the parking of an automobile an insured
premises, if such automobile is not owned by or rented or loaned to any insured;
(c) to bodily injury or property damage arising out of (1) the ownership, now,
tenance, operation, use, loading or unloading of any mobile equipment while
being used in any prearranged or organized racing, speed or demolition contest or
in any stunting activity or In practice or preparation for any such contest or
activity or (2) the operation or use of any snowmobile or trailer designed for
use therewith;
(d) to bodily injury or property damage arising out of and in the course of the
transportation of mobile equipment by an automobile awned or operated by or
rented or loaned to any Insured;
(e) to bodily injury or property damage arising out of the ownership, main-
tenance, operation, use, loading or unloading of
(1) any watercraft owned or operated by or rented or loaned to any in-
insured, or
(2) any other watercraft operated by any person in the course of his employ-
ment by any insured;
but this exclusion does not apply to watercraft while ashore on the insured
premises;
If) to bodily injury or property damage arising out of the discharge, dispersal,
release or escape of smoke, vapors, soot, fumes, acids, alkalis, toxic chemicals,
liquids or gases, waste materials or other irritants, contaminants or pollutants
Into or upon land, the atmosphere or any water course or body of water; but
this exclusion does not apply if such discharge, dispersal, release or escape is
sudden and accidental;
(g) to bodily injury or property damage due to war, whether or not declared,
civil war, insurrection, rebellion or revolution or to any act or condition inci-
dent to any of the foregoing, with respect to
111 liability assumed by the insured under an incidental contract, or
(2) expenses for first aid under the Supplementary Payments provision;
(h) to bodily injury or property damage for which the insured or his indemnitee
may be held liable
(1) as a person or organization engaged in the business of manufacturing.
distributing, selling or serving alcoholic beverages, or
12) if notso engaged, as an owner or lessor of premises used for such purposes,
by reason of the selling, serving or giving of any alcoholic beverage
(i) In violation of any statute, ordinance or regulation,
(ill to a minor,
(fit) to a person under the influence of alcohol, or
(fvl which causes or contributes to the intoxication of any person;
but parts (ill, (Iii) and (iv) of this exclusion do not apply with respect to lia-
billty, of the insured or his indemnitee a, an owner or lessor described in (2)
above; -
(i) to any obligation for which the insured or any carrier as his insurer may be
held liable under any workmen's compensation, unemployment compensation or
disability benefits law, or under any similar low;
III to bodily injury to any employee of the insured arising out of and in the
course of his employment by the insured; but this exclusion does not apply to
liability assumed by the insured under an incidental contract;
(klia property damage to
(1) to property owned ar occupied by or rented to the insured,
(2) property used by the insured, or
(3) property in the core, custody or control of the insured or as to which the
insured is for any purpose exercising physical control;
but parts (2) and (3) of this exclusion do not apply with respect to liability
undera written sidetrack agreement and part (3) of this exclusion does not apply
with respect to property damage (other than to elavators) arising out of the use
at an elevator atthe insured premises;
If ) to property damage to premises alienated by the named insured arising out
Of such premises w any part thereof; - -
(m) to loss of use of tangible property which has not been physically injured
or destroyed resulting from -
(11 a delay in or lack of performance by or on behalf of the named insured
of any contract or agreement, or
(2) the failure of the named insured's products or work performed by or on
behalf of the named insured to meet the level of performance, quality, fit-
ness or durability warranted or represented by the named insured;
but this exclusion does not apply to loss of use of other tangible property re-
sulting from the sudden and accidental physical injury to or destruction of the
named Imured's products or work performed by or on behalf of the named in-
sured a''ter such products or work have been pat to use by any person or organ-
ization ether then an insured;
(n) to property damage to the named insured's products arising out of such
products or any part of such products;
(o) tal property damage to work performed by or on behalf of the named Il
sure) al'ising out of the work or any portion thereof, or out of materials, parts
or equipment furnished in connection therewith;
(p) to bodily injury or property damage included within the completed opera-
tions hazard or the products hazard;
(q) to bodily injury or property damage arising out of operations an or from
Premises (other than the insured premises) owned by, rented to or controlled by
the named insured, or to liability assumed by the insured under any contract or
agreement relating to such premises;
(r) to bodily Injury or property damage arising out of structural alterations
which involve changing the size or or moving buildings or other structures, new
construction or demolition operations performed by or on behalf of the named
insured.
11. Parsons Insured
Each of the following is an insured under this Fnsurancetatheextentsatforthbelow:
le) if the named insured is designated in the declarations as an individual, the
person so designated but only with respect to the conduct of a business of which
he is sole proprietor;
(b) if the named insured is designated in the declarations as a partnership or
joint venture, the partnership or joint venture so designated and any partner or
member thereof but only with respect to his liability as such;
10 if the named insured is designated In the declarations as other than an in-
dividual, partnership or joint venture, the organization so designated and any
executiNe officer, director or stockholder while acting within the scope of his
duties as such;
(d) any person (other than an employee, of the named insured) or organization
while aei',ing as real estate manager to, the nartred insured; and
(e) with respect to the operation, for the purpose of locomotion upon a public
highway, of mobile equipment registered under any motor vehicle registration
law,
(i) an employee of the named insured while operating any such equipment In
the course of his employment, and
Iii) any other person while operating with the permission of the named in-
sured any such equipment registered in the name of the named insured and
any person or organization legally responsible for such operation, but only if
there is no other valid and collectible insurance available, eitharnn a primary
or excess basis, to such person or organization;
provided that no person or organization shall be an insured under this paragraph
(a) with respect to:
(1) bodily injury to any fellow employee of such person injured in the course
of hill employment, or
(2) property damage to property owned by, rented to, In charge of or a=-
pied by the named insured or the employer of any person described in sub-
paragraph (ii). _
This insurance does not apply to bodily injury or property damage arising out
of the conduct of any partnership or joint venture of which the insured is a
partner or member and which is not designated in this policy as a named insured.
111. Limits of Liability
Regardless of the number of (11 insureds under this policy, (2) persons or or-
ganizations who sustain bodily injury or property damage, or (3) claims made or
suits brought on account of bodily injury or property damage, the company's
liability Tinder Coverage Part B is limited as follows: -
Coveralls A —The total liability of the company for all damages, including dam-
ages for rare and loss of services, bemuse of bodily injury sustalned by one or
more persons as the result of any one occurrence shall not exceed the limit of
bodily injury Inability stated in the declarations as applicable to "each occur-
rence".
Coverage- B —The total liability of the company for all damages bemuse of all
property , damage sustained by one or more persons or organizations as the
result of any one occurrence shall not exceed the limit of property damage
liability stated in the declarations as applicable to "each occurrence".
Coverages Aand B —For the purpose of determining the limit of the company's
liability fill bodily injury and property damage arising out of continuous or re-
peated eliposure to substantially the same general conditions shall be considered
as
arising out of one occurrence.
IV. Additional Definition
When wed in reference to this insurance:
"insured premises" means 11) the premises designated in the declarations, -(2)
premises alienated by the named insured (other than premises constructed far
mle by tine named insured), if possession has been relinquished to others, and
(3) premises w to which the named insured acquires ownership or control and
reports his intention td insure such premises under this policy and no other
within 30 days after such acquisition; and includes the ways immediately adjoin-
ing such premises on land.
V. Policy Territory
This ireuronge applies only to bodily injury or property damage which occurs
within the polity territory.
COVERAGEPART13
DECLARATIONS — Applicable to Coverage Part 13 only
The limit of the company's liability against this Coverage shall be as stated herein, subject to all the terms of this policy having reform= thereto,
LIMBS OF��r�!c s�tfs-
LIABILITY Coverage E— Pmmises Medical Payments: $ 20(Ws each person; $10#0YV• each accident.
SCHEDULE
HAZARDS
RATES
O.L. &T. M. &C.
ADVANCE
PREMIUMS
(o) Promises acrd operations
14.3
$ 32.00
(bl Escalators - -
-
-
$ -
lol Sports Activities
$
Minimum Premium:$ O.L. &T.;$
M. &C.
Total Advance Premium
$ _r;
PyOO��L..I.�CyY NNUM�BEBRpc��q -
` M + 1
COVPART I3 THIS COVERAGE PART IS EpFFE OT'
PAG1 NO. 2ZU ! M. 8:2 4- ra
POLICY EFFECTIVE
mfr. � 141..R
-
.
COVERAGE PART 13— PREMISES MEDICAL PAYMENTS INSURANCE
I. Coverage E— Premises Medical Payments
The company will pay to or for each person who sustains bodily injury mused
by accident all reasonable medical expense incurred within one year from the
date of the accident on account of such bodily Injury, provided such bodily
injury arlses out of la) a condition in the Insured premises or bbl operations with
respect to which the named insured Is afforded coverage for bodily injury
liability under this policy.
Exclusions
This Imurance don not apply:
(a) to bodily injury
(1) arising out of the ownership, maintenance, operation, use, loading or un-
loading of
Ill any automobile or aircraft owned or operated by or rented or loaned
to any Insured, or
Ili) any other automobile or aircraft operated by any person in the course
of his employment by any insured;
but this exclusion does not apply to the parking of an automobile on the in-
sured premises, if such automobile is not owned by or rented or loaned to any
insured;
(2) arising out of (f) the ownership, maintenance, operation, use, loading or
unloading of any mobile equipment while being used in any prearranged or
organized racing, speed or demolition contest or in any stunting activity or
In practice or preparation for any such contest or activity or (Ill the operation
or use of any snowmobile or trailer designed for use therewith;
13) arising out of the ownership, maintenance, operation, use, loading or
unloading of
(f) any watercraft owned or operated by or rented or loaned to any insured,
or
(Ili any other watercraft operated by any person In the course of his em-
ployment by any Insured;
but this exclusion does not apply to watercraft while ashore on the Insured pre -
misw; or
(4) arising out of end in the course of the transportation of mobile equip-
ment by an automobile owned or operated by or ranted or loaned to any
insured;
Ibl to bodily Injury
(1) Included within the completed operations hazard or the products hazard;
(2) arising out of operations performed for the named insured by Inde-
pendent contractors other than 111 maintenance and repair of the Insured
premises or (ii) structural alterations at such promises which do not Involve
changing the size of or moving buildings or other structures; -
(3) resulting from the selling, serving or giving of any alcoholic beverage (1)
in violation of my statute, ordinance or regulation, Ili) to a minor, (fil) to a
person under the influence of alcohol or (Iv) which causes or contributes
to the intoxication of any parson, If the named insured is a person or organ -
izatlon engaged in the business of manufacturing, d6vibnting, selling or
serving alcoholic beverages or, If not so engaged, is an owner or lessor of pre-
mises used for such purposes but only part (f) of this exclusion (b) 131
applies when the named insured is such an owner or lessor;
(4) due to war, whether or not declared, civil war, insurrection, rebellion or
or revolution, or to any act or condition Incident to my of the foregoing;
(c) to bodily injury
(11 to the mitred insured, any partner therein, any tenant or other person
regularly residing an the Insured premises or any employee of any of the
foregoing if the bodily Injury arises out of and in the course of his employ-
ment therewith;
CK 816-3 4-73 BUM ED. 73
(2) to any other tenant if the bodily injury occurs on that part of the insured
promises ranted from the named insured or to any employee of such a tenant
If the bodily injury occurs on the tenant's part of the insured premises and
arises out of and in the course of his employment for the tenant; i
13) to any person while engaged In maintenance and repair of the Insured
premises or alteration, demolition or new construction at such promises;
(4) to any person If any benefits for such bodily injury are payable or re-
quired to be provided under any workmen's compensation, unemployment i
compensation or disability benefits law, or under any similar law; {
(6) to any person practicing, Instructing or participating In any physical
[reining, sport, athletic activity or content unless a premium charge Is entered
for sports activities In the policy with respect to Premises Medical Payments i
Coverage; y
(d) to any medical expense for services by the named insured, any employee I
thereof or any person or organization under contract to the named insured to
provide such services. j
11. Limits of Liabffity
The limit of liability for Premises Medical Payments Coverage stated in the
declarations as applicable to "each person" is the limit of the company's i
liability for all medical expense for bodily injury to anyone person as the result of it
any one accident; but subject to the above provision respecting "each person ", I
the total liability of the company under Premises Medical Payments Coverage
for all medical expense for bodily injury to two or more persons es the result of
any one accident shell not exceed the limit of liability stated in the declarations
as applicable to "each accident ".
When more than one medical payments coverage afforded by this policy up-
plles to the loss,the company shall not be liable for more than the amount of the
highest applicable limit of liability.
III. Additional Definitions
When used in reference to this Insurance:
"insured pre " means all promises owned by or ranted to the named Insured
with respect to which the named Insured is afforded coverage for bodily Injury {
liability under this policy, and Includes the ways Immediately adjoining on land; I
"medical expense" means expenses for necessary medical, surgical, x -ray and ?
dental services, Including prosthetic devices, and necessary ambulance, hospital,
professional nursing and funeral services.
IV. Policy Period; Territary
This Insurance applies only to accidents which occur during the policy period 1
within the United States of America, Its territories or possessions, or Canada.
V. Additional Condition
Medical Raporfs; Proof and Payment of Chdm
Assoon as practicable the injured person or someone on his behalf shall give to j
the company mitten proof of claim, under oath If required, and shall, after each
request from the company, execute authorization to enable the company to ob-
tain medical reports and copies of records. The injured person shall submit to
physical examination by physicians selected by the company when and as often
as the company may reasonably require. The company may pay the Injured
person or any person or organization rendering the services and such payment
shall reduce the amount payable hereunder for such Injury. Payment hereunder
shall not constitute an admission of liability of any parson or,except hereunder
of the company.
G610 ENDORSEMENT
This endorsement modifies such Insurance as is afforded by the provisions PRODUCTS uezepn EXCEPTIONS
of the policy relating to the following:
COMPRERENSIVE GENERAL LIpBIUTY INSURANCE
MANUFACTURERS' AND CONTRACTORS' LIABILITY INSURANCE
OWNERS', LANDLORDS' AND TENANTS' LIABILITY INSURANCE
It is agreed that the products hazard does not include bodily injury or property damage analog out of the named insured's products
manufactured, sold, handled or distributed in connection with (1) the use of any premises described in this endorsement, owned by or
rented. to the named insured or (2) any operation, described In this endorsement, conducted by or on behalf of the named insured.
Description of Premises end Operations)
Code 5ft23e
The effective date and hour of this endorsement is stated below and reference to hour shall be Standard Time at the address of the
named insured as stated in the policy. This endorsement shall terminate with the policy.
This endorsement Is Subject to the declarations, conditions, and other terms of the polity which are not Inconsistent herewith, and when
countersigned by an authorlud representative of the company, forms a part of the polity described below.
❑
CASUALTY COMPANY ® AMERICAN NSURANCE COMPANY ❑ MUTUAL INSURANCE COMPANY ❑ INSURANCE COMPANY
ISSUED TO
POLICY EFFECTIVE
OR NUMBER
r .a
Flit
CafteenRien
1
POLICY NUMBER
ENaoae MNENT
EN OOaSEtl ENT EFFECTIVE
COUNTERSIGNATURE OF LICENSED RE.M.T AGENT
n
N 1,%.
Mr �u w
A.M.
COUNTERSIGNED AT
L OUNTERSIGNATIIRE DATE
G610 ENDORSEMENT 1111
CK 881 11.72 31A (REV. 10 -1 -66) 04PJRANICE
This endorsement nwdiflev such ilsmrmrce as is afforded by the provisions CAGLP -101 ENDORSEMENT
of the policy relating to the following: ADDITIONAL INSURED
omeSAll Lllaalo?ds• aw Te=tev (Non-0peratfng)
i$a ty Insurains
It is agreed that the "Persons Insured" provision Is amended to include as an insured the person or organization designated below, subject
to the-following provisions:
1. The Insurance afforded to such person or organisation only applies with respect to operations performed by the named insured at the
location designated below.
2. The Insurance afforded by this endorsement shall be ezwess insurance over any other valid and collectible insurance available to such
person or organization.
NAME OF PERSON OR ORGANIZATION AND LOCATION
INTEREST
IN
LEGAL ENTITY AND RELATIONSHIP
TO NAMED INSURED
City Corpus Christi, �p
C Yy of Corpus Christi, Tons
Owner
Owner
city
City Gove moot
Advance Premium for this Endorsement: $ 100 RI. $ 2 ?00 pD. i] Additional $ Included
The affective date and hour of this endorsement is stated below and reference to hour shall be Standard Time at the address of the
named Insured as stated in the policy. This endorsement shall terminate with the policy.
This endorsement Is subject to the declarations, conditions, and other terms of the policy which are not inconsistent herewith, and when
countersigned by an authorized representative of the company, forms a part of the polity described below. FEDERAL MUTUAL
❑ CASUALTY 19 MUTUAL ® INSURANCE COMPANY ❑ MUTUAL, INSURAMM COMPANY ❑ INSURANCE COMPANY COMPANY
CAGLP -101 ENDORSEMENT �.
CK 888 9.72 5M (REV. 161 -66) DBURMCIE PRINTED IN D.S.A.
G620 ENDORSEMENT
This endorsement modifies such insurance as is afforded by the pro-
visions of the policy relating to the following: AMENDATORY ENDORSEMENT
COMPRERENSIIIE GENERAL LIABILITY INSURANCE
MANUFACTURERS' AND CONTRACTORS' LIABILITY INSURANCE
OWNERS', LANDLORDS' AND TENANTS LIABILITY INSURANCE
It is agreed that:
1. Exclusion (h) is amended to reed:
(h) to bodily injury or property damage for which the insured or his indemnitee may be held liable
(1) as a person or organisation engaged in the business of manufacturing, distributing, selling or serving alcoholic bevemges, or
(2) if not so engaged, as an owner or lessor of premises used for such purposes,
if such liability is imposed
(I) by, or because of the violation of, any statute, ordinance or regulation pertaining to the sale, gift, distribution or use of any
alcoholic beverage, or
(it) by reason of the selling, serving or giving of any alcoholic beverage to a minor or to a person under the influence of alcohol
or which causes or contributes to the intoxication of any person;
but part (ii) of this exclusion does not apply with respect to liability of the insured or his indemnitee as an owner or lessor de-
scribed in (2) above;
2. Exclusion (j) is amended to read:
(j) to bodily injury to any employee of the insured arising out of and In the course of his employment by the insured or to any obligation
of the insured to indemnify another because of damages arising out of such injury; but this exclusion does not apply to liability assumed
by the insured under an incidental contract;
3. Subdivision (a) of the "Persons Insured" provision is amended to read:
(a) if the named insured is designated in the declarations as an individual, the person so designated but only with respect to the conduct
of a business of which he is the sole proprietor, and the spouse of the named insured with respect to the conduct of such a business;
Effective Date: Unless an effective date is entered below, this endorsement shall be effective as of the beginning of the policy period stated
in the declarations of the policy.
This endorsement shall form a part of the polity to which it is attached.
LL74DERMENS MUTUAL (AMERtCA.N MOTORISTS S AMERICAN MANUFACTURERS FEDERAL MUTUAL SEQUOIA
CASUALTI COMPANY INSURANCE COMPANY MUTUAL INSURANCE COMPANY INSURANCE COMPANY INSURANCE COMPANY
0w "611lon
POLICY NUMBER ENOORSENENT EFFECTIVE
maath oar vacs
41H 620 419 8 -3-74 laid• 0 �
*Completion necessary only for policies when issued subsequent to policy preparation
G620 ENDORSEMENT
CK 1128 12 -72 tOOM (REV. 1 -1 -73) R7AJRANCIS
G525 ENDORSEMENT
This endorsement modifies such Insurance as Is afforded by the ADIENDATORY ENDORSEMENT— NOTICE
pmvisions of any QENF K UABILRT INSURANCE (T—)
As respects bodily injury liability, coverage and property damage liability coverage, unless the company Is prejudiced by the Insured's failure to
comply with the requirement, any provision of this Polley requiring the Insured to give notice of action, occurrence or loss, or requiring the
Insured to forward demands, notices, summons or other legal process, shall not bar liability under this policy.
Effective Dates Unless an effective data Is entered below, this endorsement shall be effective as of the beginning of the policy perlod stated
in the declaretbre of the policy.
This endorsement shall form a part of the policy to which it to attached.
LUMBERMENS MUTUAL AMERICAN MOTOmml AMERICAN MANUFACTURERS FEDERAL MUTUAL SEQUOIA
CASUALTY COMPANY INSURANCE COMPANY f (MUTUAL INSURANCE COMPANY INSURANCE COMPANY INSURANCE COMPANY
BARED INSURED
conegm comeeelOA
POU YT�{� UB Wo
ENg7. B0.
I 8_� �� OATL-
*Completion necessary only when Issued subsequent to policy preparation.
G525 ENDORSEMENT �Iq
CK 1142 5.73 IOM (REV. 5 -1 -73) OiR1RANCII
1-- 7 1-29-
PRINTED IN U.B.A.
ATTACH DECLARATIONS PAGE, COVERAGE PARTS, SUPPLEMENTARY DECLARATIONS OR SCHEDULES AND ENDORSEMENTS HERE
This endorsement modifies the provisions of the policy relating to ALL AUTOMOBILE
LIABILITY, GENERAL LIABILITY AND MEDICAL PAYMENTS INSURANCE OTHER THAN
COMPREHENSIVE PERSONAL AND FARMER'S COMPREHENSIVE PERSONAL INSURANCE
but is inapplicable with respect to automobiles principally garaged or used in the
State of New York.
It is agreed that:
I. The policy does not apply:
A Under any Liability Coverage, to bodily injury or property damage
(1) with respect to which an insured under the policy is also an insured under
a nuclear energy liability policy issued by Nuclear Energy Liability Insurance
Association, Mutual Atomic Energy Liability Underwriters or Nuclear Insur-
ance Association of Canada, or v+ould be an insured under any such policy
but for its termination upon exhaustion of its limit of liability; or
(2) resulting from the hazardous properties of nuclear material and with respect
to which (a) any person or organization is required to maintain financial
protection pursuant to the Atomic Energy Act of 1954, or any law amenda-
tory thereof, or (b) the insured is, or had this policy not been issued would
be, entitled to indemnity from the United States of America, or any agency
thereof, under any agreement entered into by the United States of America,
or any agency thereof, with any person or organization.
B. Under any Medical Payments Coverage, or under any Supplementary Payments
provision relating to first aid, to expenses incurred with respect to bodily
mlury resulting from the hazardous properties of nuclear material and arising
out of the operation of a nuclear facility by any person or organization.
C. Under any Liability Coverage, to bodily injury or property damage resulting from
the hazardous properties of nuclear material, if
(1) the nuclear material (a) is at any nuclear facility owned by, or operated
by or on behalf of, an insured or (b) has been discharged or disperse,
(2) the nuclear material is contained in spent fuel or waste at any time pas.
sensed, handled, used, processed, stored, transoorled or disposed of by or
on behalf of an insured; or
(3) the bodily injury or property damage arises out of the furnishing by an
insured of services, malenas, parts or equipment in connection with the
planning, construction, maintenance, operation or use of any nuclear facility,
but if such facility is located within the United Stales of America, its
territories or possessions or Canada, this exclusion (3) applies only to prop-
erty damage to such nuclear facility and any property thereat.
A0009 ENDORSEMENT
6320 ENDORSEMENT
NUCLEAR ENERGY LIABILITY EXCLUSION
(Broad Form)
II. As used in this endorsement:
"hazardous properties" include radioactive, toxic or explosive properties;
"unclear material" means source material, special nuclear material or byproduct
material;
"source material ", "special nuclear material ", and "byproduct material" have the
meanings given them in the Atomic Energy Act of 1954 or in any law amendatory
thereof;
"spent foal" means any fuel element or fuel component, solid or liquid, which has
been used or exposed to radiation in a nuclear reactor;
"waste" means any waste material (1) containing byproduct material and (2) result-
ing from the operation by any person or organization of any nuclear facility in. cluded within the definition of nuclear facility under paragraph (a) or (b) thereof;
"nuclear facility" means
(a) any nuclear reactor,
b) any equipment or device designed or used for (1) separating the isotopes
of uranium or plutonium, (2) processing or utilizing spent fuel, or (3) ham
dling, processing or packaging waste,
(c) any equipment or device used for the processing, fabricating or alloying of
special nuclear material if at any time the total amount of such material
in the custody of the insured at the premises where such equipment or
device is located consists of or can lains more than 25 grams of plutonium
or uranium 233 or any combination thereof, or more than 250 grams of
uranium 235,
(d) any structure, basin, excavation, premises or place prepared or used for the
storage or disposal of waste,
and includes the site on which any of the foregoing is located, all operations con.
ducted on such site and all premises used for such operations;
"nuclear reactor" means any apparatus designed or used to sustain nuclear fission
in a self - supporting chain reaction or to contain a critical mass of fissionable
material;
"property damage" includes all forms of radioactive contamination of property.
This is not a complete and valid contract without an accompanying Declarations Page, properly countersigned,
together with one or more Coverage Parts.
JACKET PAGE 2
3. Financial Resproaslhlllty Laws When this policy is certified as proof of financial resgonsibilily
for the future under the provisions of any motor vehicle financial responsibility law, such
insurance as is afforded by this policy for bodily injury liability or for property damage liability
shall comply with the provisions of such law to the extent of the coverage and limits of liability
required by' such law. The insured agrees to reimburse the company for any payment made by
the cam ny which it would not have been obligated to make under the terms of this policy
except for the agreement contained in this paragraph.
4. Imoued's Duties to the Event of Occurrence, Claim or SOIL (a) In the event of an occur.
reme, written notice containing particulars sufficient to identify the insured and also reason-
ably obtainable Information wlth respect to the time, place and circumstances thereof, and
the names and addresses of the injured and of available w 'ho e sses, shall be given oy or far
the Insured to the company or any of its authorized agents as soon as practicable.
(b) It claim Is made or suit is brought against the insured, the insured shall immediately
forward to the company every demand, notice, summons or other process received by him or
his representative.
(c) The insured shall cooppeerate with the company and, upon the companys request, assist
in making settlements, in the conduct of suits and in enforcing any right of contribution or
indemnity against any person or organization who may be liable to the insured because of
injury or damage with respect to which insurance is afforded under this policy; and the
insured shall attend hearings and trials and assist in securin8 and giving evidence and
obtaining the attendance of wib asses. The insured shall not, except at his own cast voluntarily
make any payment, assume any obligation or incur any expense other than for first aid to
others at the time of accldenL ,
". Action Against Company. No action shall lie against the company unless, as a condition
precedent thereto, there shall have been full compliance with all of the terms of this policy,
nor until the amount of the insured's obligation to pay shall have been finally determined either
by judgment against the insured after actual trial or by written agreement of the insured, the
claimant and the company.
Any person or organization or the legal representative thereof who has secured such judgment
or written agreement shall thereafter ha entitled to recover under this policy to the extent of
the insurance afforded by this policy. No person or organization shall have any right under
this policy to loin the company as a party to any action against the insured to determine the
homed's liability, nor shall the compaary be impleaded by the insured or his legal representative.
Bankruptcy or insolvency of the insured or of the insured's estate shall not relieve the company
of any of its obligations hereunder.
S..0ther losmance. The insurance afforded by this policy Is primary insurance, except when
stated to apply In excess of or contingent upon th e absence of other insurance. When this
insurance is primary and the insured has other insurance which is stated to be applicable to
the loss on an excess or contingent basis, the amount of the company's liability under this
policy shall not be reduced by the existence of such other insurance.
When bath this insurance and other insurance apply to the loss an the same basis, whether
primary, excess or contingent the Compaq shall not be liable under this policy for a greater
proportion of the less than that stated in the applicable contribution prowsion below:
(a) Cmtrlbudoo by fEgoal Shares. If all of such other valid and collectible insurance pro.
vides for contribution by equal shares, the cam anp shall not be liable for a greater
proportion of such loss than would be payable if each insurer contributes an equal share
until the share of each insurer equals the lowest applicable limit of liability under any
one policy or the full amount of the loss is paid, and with respect to any amount of lass
not so paid the remaining insurers then continue to contribute equal shares of the
remaining amount of the loss until each such insurer has paid its limit in full or th e
full amount of the loss is paid.
(b) Cantribattaa by Limits If any of such other insurance does not provide for contribution
by equal shares, the company shall not be liable for a greater proportion of such loss
than the applicable limit of liability under this policy for such loss bears to the total
applicable limit of liability of all valid and collectible insurance against such loss.
T. Subrogation. In the event of any payment under this policy, the company shall be subrogated
to all the insured's rights of recovery therefor against any person or organlzation and the
insured shall execute and deliver instruments and papers and do whatever else is necessary to
secure such rights. The insured shall do nothing after loss to prejudice such rights.
B. Chingos. Notice to any agent or knowledge possessed by any agent or by any other person
shall not effect a waiver or a change in any part of this policy or estop the campmry from
asserting any right under the terms of this policy; nor shall the t erms of this police he waived
or changed, except by endorsement issued to form a part of this policy, signed by a duly
authorized officer or representative of Be company,
9. Assignment Assignment of interest under this policy shall not bind the company until its
consent is endorsed hereon; if, however, the named insured shall die, such insurance as is
afforded by this policy shall apply (1) to the named insured's legal representative, as the
named insured, but only while acting within the scope of his duties as such, and (2) with
respect to the property of the named insured, to the person having proper temporary custody
thereof, as insured, but only until the appointment and qualification of the legal representative.
10. Three Year Policy. If this policy is issued for a period of three years any limit of the
companys liability stated in this policy as "aggregate" shall apply separately to each con-
secutive annual period thereof.
11. Cancelatan. This policy may be canceled by the named insured by surrender thereof to
the company or any of its authorized agents or by mailing to the company written notice stating
when thereafter the cancelation shall be effective. This policy may be canceled by the company
by mailing to the named insured at the address shown in this policy written notice stating
when not less than ten days thereafter such cancelation shall oe effective. The mailing of
notice as aforesaid shall be sufficient proof of notice. The time of the surrender or the
effective date and hour of cancelation stated in the notice shall become the and of the policy
period. Delivery of such written notice either by the named Insured or by the company shall he
equivalent to mailing.
If the named insured cancels, earned premium shall be computed in accordance with the
customary short rate table and procedure. If the comM cancels, earned premium shall be
computed pro -rata. Premium adjustment may be made either at the time cancelatlon is effected
or as soon as practicable after cancelation becomes effective, but payment or tender of
unearned premium is not a condition of cancelation.
12 Declarations. By acceptance of this policy, the named insured agrees that the statements
in the declarations are his agreements and representations, that this policy is issued in reliance
upon the truth of such representations and that this policy embodies all agreements existing
between himself and the company or any of its agerds relating to this Insurance.
As respects the company preNmrsly designated, the folloeiag mrrefatlre jamrlsfoo forms a pmt of this policy:
idatsal Pogcy Cmrtitims. ` LUnBERermvn MUTUAL AMERICAN MANUFAC JRERS FEDERAL MUTUAL
' CASUALTY COMPANY MUTUAL INSURANCE COMPANY INSURANCE COMPANY
This is a perpetual mutual corporation owned by and operated for the benefit of its members. This is a non - assessable, participating policy under which the Board of Directors
in its discretion may determine and pay unabsorbed premium deposit refunds (dividends) to the Insured.
As respects of the State of Texas, such provision is amended to read as follows:
Muluais— Memhershlp and Yotiag Notice. The insured Is notified that by virtue of this policy he is a member of the company so designated, and Is entitled to vote either in person
or by proxy at any and all meetings of said company. The Annual Meetings are held In Its Home Office at the place and time stated an the front cover.
Motuels- -Perticlpallm Chose WHhaut Contingent Llahlllty. No Contingent Liability: This pollc is non - assessable. The policyholder is a member of such company and shall particl.
pete,e tote extent and upon the conditions fixed and determined by the Board of Directors to accordance with the provisions of low, in the distribution of dividends so fixed and
01&Mds AMMCAN MOTO1118"
INSURANCE COMPANY
This policy Is participating and shall be entitled to receive unabsorbed premium deposit refunds as apportioned by the directors.
As respects the State of Texas, such provision is amended to read as follows:
Dividend Pratlalm— Parflclpefing Company. The named insured shall be untitled to participate in a distribution of the surplus of the company, as determined by the Board of
Directors from time to time, after approval in accordance with the provisions of the Texas Insurance Code, of 1951, as amended.
IN WITNESS WHEREOF, the company designated on the Declarations Page has caused this policy to be signed by its President and Secretary, but this policy shall not be valid
unless countersigned on the Declarations Page by a duly authorized representative of the company.
LAMBERIENS MUTUAL CASUALTY COMPANY
AMEBIC'AN MOTOBISIE INSURANCE COMPANY
AMERICAN MANOFACrUHEBS MUTUAL INSURANCE COMPANY
_5L G St
JACKET PAGE 3
CK 801 -1 3 -74 25M ED. 73
FEDERAL MUTUAL INSURANCE COMPA1Ng
Se-a-Y Pre.M