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National Standard No. A 72242323
Automobile Liability Policy A Capital Stock Company :

FORM 4304
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HOME OFFICE NEW YORK

   
  
     
 

   

 

 

 

 

 

 

 

 

 

DECLARATIONS
Item 1. Name of insured Forrest 0. Allen
The named insured is individual.
CGndividual, corporation, or co-partnership—if latter, give names of partnerz)
Address sien OL, LOULSLana Street 8 Lawrence.._Douglas. Kansas
QO. gE _ Street Town County State)
The automobile will be principaily garaged and used in the above town, county and state, sales. otherericc specified
herein 7 Lewrence, Kansas

 

The occupation of the named insured is.._Athletie Instr. & _foach - Kensas University _
(if married woman, give husband’s occupation or business)
Item 2. Policy Period: From Mareh 15 19.40. to Mareh..15 19.41.
12:01 A. M., standard time at the address of the named insured as stated herein.

Item 3. The insurance afforded is only with respect to such and so many of the following coverages as are indicated
by a specific premium charge or charges. The limit of the company’s liability against each such coverage
shall be as stated herein, subject to all of the terms of the policy having reference thereto.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

ee ae Premiu
Coverages Limits of Liability Automobile No. 1 Automobile Na. 2_
; : ae 10,000.00 each person
A. Boddy fajucy Liskéli vaeerees ps
ee g¢ 20,000.00 each accident * 15.80 :
B. Property Damage Liability $ 5,000.00 each accident |$ 4,80 $
Nil.
Nil.
Total Premium /|$18,60 $
Item 4. Description of Automobiles
ag T of Body Serial No. No. of Cylinders
wet Tent Name oe Food re
1938 Buiek Sedan * 13262143 =
| : m 83402753 ma, 98-81

 

DRIVE OTHER PRIVATE PASSENGER AUTOMOBILES

 

‘It is agreed that such insurance as is afforded by the policy for Bodily Injury Liability and for
Property Damage Liability also applies

(1) to the named insured, if an individual and the owner of the private passenger automobile de-
scribed in the policy, hereinafter called “the named insured”, and to the wife or husband of such
named insured, as an insured, if a resident in the household of such named insured, or

to the named insured, if a husband and wife and if the private passenger automobile described
in the policy is owned by either or both, hereinafter called “the named insured” ; and

(2) to the individual named below, as an insured, if a relative of and a resident in the household of
the named insured,

with respect to the operation of any other private passenger automobile by any such insured, or by a private
chauffeur or domestic servant in the employ of any such insured, and with respect to the presence of any
such insured in any other private passenger automobile, provided:

(a) such use is “pleasure and business” as defined in the policy; and
(b) such use is with the permission of any person having the right to grant such permission; and

(c) the automobile is not (1) owned in full or in part by, or registered in the name of the named
insured or any member of the named insured’s household, other than a private chauffeur or
~domestic servant employed in connection therewith, or (2) hired as part of a frequent use of hired
automobiles by, or furnished for regular use to the named insured, a member of the named
insured’s household, or a private chauffeur or domestic servant employed in connection there-
with; and

(d) the insurance applies only to such insured; and —

(e) the insurance shall be excess insurance over any other valid and collectible insurance available
to the insured, either as an insured under a policy applicable with respect to the automobile or
otherwise, against a loss covered hereunder.

Except as used in paragraph (c) the word “automobile” wherever used in this endorsement and in
other parts of the policy, when applicable to this endorsement, shall include a trailer other than a trailer
home, while used exclusively for personal, pleasure or family purposes, other than business purposes, with
such other private passenger automobile.

Names of individuals, other than aforesaid husband and wife, who are relatives of and residents in

the household of the named insured and who are to be covered hereunder as insured -...

 

 

 

 

None
Premiums for such insureds:
Bodily Injury Liability $ Nil.
Property Damage Liability $ Nil.
‘Total $ Nil.

 

This endorsement is effective from March 15 1940. at 12:01 o’clock A. M. Standard Time.

 

Nothing herein contained shall be held to vary, alter, waive or extend any of the terms and conditions
of said policy other than as above stated.

This endorsement is hereby made a part of Policy No A 21.4235 issued by the

Phenix Indemnity Company, new vork, nv. v,, to
Forrest C. Allen

who is the owner of the automobile and is the named insured as respects the coverage extended by this endorsement,
but this endorsement shall not take effect unless countersigned by a duly authorized representative of the company.

   
        

Cig oseccnnn he eA P—Fe....... v6
Authorized Representative. President.
Form 4381 25M 9-39

NSF