Creator:
Date Created:
Place Created:
Keywords:AMICA INSURANCE,May 1, 1973,May 1, 1973
Context:
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AMICA INSURANCE
May 1, 1973
May 1, 1973
Amica Mutual Insurance Company
10 Weybosset Street Providence, Rhode Island	|
940543-0003
DECLARATIONS	POLICY NO._
Item 1. Named Insured and Address (No., Street, Town or City and State)
H. Tracy Hall, Inc.
1711 North Lambert Lane	Renewal of Policy No. 9305^3-0009
Provo, Utah, 84601
Utah
County
Garage: The automobile will be principally garaged in the above town or city, county and state, unless otherwise stated herein:
Occupation of the named insured is...........................................................................................................................................................................................................................................................................................
Item 2. Designation of insured for purposes of division 2 of coverage C, if required by Insuring Agreement III:
r. , r, .. r» • J r _ May 1, 1973 _ May 1, 1974 1-J.ni A \/l Standard time at the address of the Item 3. Policy Period: From............................12:01 A. M., named insured as stated berdn
Item 4.___CAR NO. X___CAR NO. 2_
Year of Model	TradeName,No. of Cylinders,Body Type	YearofModel	Trade Name, No. of Cylinders, Body Type
1972 Ford 8 LTD Brougham ^ . . f	Hardtop (Pillared)
Description of -i-=-—----L-i---
Model	Identification, Serial or Motor Number	Model	Identi6cation, Serial or Motor Number
the automobile	^-^rr^-. r-, r,^ r
and facts —__2P66S161756______
Purchased (Month, Year) NeworUsed F.O.B. List Price ActualCost Purchased (Month, Year) NeworUsed F.O.B. List Price ActualCost
::r:rL ^n*_mZ \_Ljmi__^__i__^_
^ « .	« The automobile is unencumbered unless otherwise stated herein: The automobile is unencumbered unless otherwise stated herein:
named insured:	„„L„„„	Installment Payments	Due Date and Amount	Z	Installment Payments	Due Date and Amount
Encumbrance Numbcr Amount of Each	of Final Installment__Encumbrance Number I Amount of Each	of Final Installment
$ $ $ $ $ $
Item 5. The insurance afforded is only with respect to such and so many of the following coverages as are indicated by specific premium charge or charges. The limit of the company's liability against each such coverage shall be stated herein, subject to all the terms of this policy having reference thereto.
mucDArcc	LIMITS OF LIABILITY	D„culnu(,	LIMITS OF LIABILITY	DDC]UII,..C
COVERAGES	CAR NO. 1	PREMIUMS	CAR NO. 2	PREMIUMS
—	100,000 each person 1$ 73.00 U
each person 1$
A Bodily Injury Liability	OHO OHH
S	jUU j UUU each accident	$	each accident
B Property Damage Liability	$	2 5 3 0 0 0 each accident $ 4 9 * 0 0 ^	eac^ accident $
C Automobile Medical Payments $	5,000 each person $ 1 9 « Q 0_Is_each person 1$_I
D Collision or Upset	Actual Cash Value less $ 100 deductible $	1 ,00_ Actual Cash Value less $	deductible $
^lij"epsetc'udine	Actual Cash Value » 100.00	3
F Towing and Labor Costs	$	for each disablement J	$	for each disablement $
Rate Class:	B.I. P.D.	Collision	B.I. PD.	Collision
|| Uninsured Motorists	$ P.nn
w
2-
UJ
w
-
8_
z
w__
Total Premium $ 364.00
Item 6. Use: The purposes for which the automobile is to be used are "pleasure and business," unless otherwise stated herein:....................................................
Item 7. Except with respect to bailment lease, conditional sale, purchase agreement, mortgage or other encumbrance-, the named insured is the sole
owner of the automobile, unless otherwise stated herein:...................................................................................................................................................................................................................................
Item 8. Loss Payee: Any loss under coverages D and E is payable as interest may appear to the named insured and....................................................................................
Countersigned by.
P4524	F4-8D Agt. 12M 1-73
4.	Assistance and Cooperation of the Insured
After notice of claim under this endorsement, the company may require	rse sl(Je)
appropriate to preserve his right to recover damages from any person or organization alleged to and in any action against the company, the company may require the insured to join such person or orB„.~.
5.	Notice of Legal Action	, . ... ., .	, __
If before the company makes payment of loss hereunder, the insured or his legal representative shall institute any legal acuv. for bodily injury against any person or organization legally responsible for the use of an automobile involved in the accident a copy ot the summons and complaint or other process served in connection with such legal action shall be forwarded immediately to the company by the insured or his legal representative.
6.	Limits of Liability
(a)	The limit of liability stated in the schedule as applicable to "each person" is the limit of the company's liability for all damages, including damages for care or loss of services, because of bodily injury sustained by one person as the result of any one accident and, subject to the above provision respecting each person, the limit of liability stated in the schedule as applicable to "each accident" is the total limit of the company's liability for all damages, including damages for care or loss of services, because of bodily injury sustained by two or more persons as the result of any one accident.
(b)	any amount payable under the terms of this endorsement because of bodily injury sustained in an accident by a person who is an insured under this coverage shall be reduced by
(1)	all sums paid on account of such bodily injury by or on behalf of (i) the owner or operator of the uninsured automobile
and (ii) any other person or organization jointly or severally liable together with such owner or operator for such bodily injury
including all sums paid under the Bodily Injury Liability Coverage of the policy, and
(2)	the amount paid and the present value of all amounts payable on account of such bodily injury under any workmen's
compensation law, disability benefits law or any similar law.
(c)	any payment made under this endorsement to or for any insured shall be applied in reduction of the amount of damages which he may be entitled to recover from any person insured under the Bodily Injury Liability Coverage of the policy.
(d)	the company shall not be obligated to pay under this Coverage that part of the damages which the insured may be entitled to recover from the owner or operator of an uninsured automobile which represents expenses for medical services paid or payable under the Medical Payments Coverage of the policy.
7.	Other Insurance
With respect to bodily injury to an insured while occupying an automobile not owned by the principal named insured, the insurance under this endorsement shall apply only as excess insurance over any other similar insurance available to such insured and applicable to such automobile as primary insurance, and this insurance shall then apply only in the amount by which the limit of liability for this coverage exceeds the applicable limit of liability of such other insurance.
Except as provided in the foregoing paragraph, if the insured has other similar insurance available to him and applicable to the accident, the damages shall be deemed not to exceed the higher of the applicable limits of liability of this insurance and such other insurance, and the company shall not be liable for a greater proportion of any loss to which this Coverage applies than the limit of liability hereunder bears to the sum of the applicable limits of liability of this insurance and such other insurance.
8.	Arbitration
If any person making claim hereunder and the company do not agree that such person is legally entitled to recover damages from the owner or operator of an uninsured automobile because of bodily injury to the insured, or do not agree as to the amount of payment which may be owing under this endorsement, then, upon written demand of either, the matter or matters upon which such person and the company do not agree shall be settled by arbitration in accordance with the rules of the American Arbitration Association, and judgment upon the award rendered by the arbitrators may be entered in any court having jurisdiction thereof. Such person and the company each agree to consider itself bound and to be bound by any award made by the arbitrators pursuant to this endorsement.
9.	Trust Agreement
In the event of payment to any person under this endorsement:
(a)	the company shall be entitled to the extent of such payment to the proceeds of any settlement or judgment that may result from the exercise of any rights of recovery of such person against any person or organization legally responsible for the bodily injury because of which such payment is made;
(b)	such person shall hold in trust for the benefit of the company all rights of recovery which he shall have against such other person or organization because of the damages which are the subject of claim made under this endorsement;
(c)	such person shall do whatever is proper to secure and shall do nothing after loss to prejudice such rights;
(d)	if requested in writing by the company, such person shall take, through any representative designated by the company, such action as may be necessary or appropriate to recover such payment as damages from such other person or organization, such action to be taken in the name of such person; in the event of a recovery, the company shall be reimbursed out of such recovery for expenses, costs and attorneys' fees incurred by it in connection therewith;
(e)	such person shall execute and deliver to the company such instruments and papers as may be appropriate to secure the rights and obligations of such person and the company established by this provision.
10.	Payment of Loss by the Company
Any amount due hereunder is payable (a) to the insured, or (b) if the insured be a minor to his parent or guardian, or (c) if the insured be deceased to his surviving spouse, otherwise (d) to a person authorized by law to receive such payment or to a person legally entitled to recover the damages which the payment represents; provided, the company may at its option pay any amount due hereunder in accordance with division (d) hereof.
11.	Action Against Company
No action shall lie against the company unless, as a condition precedent thereto, the insured or his legal representative has fully complied with all the terms of this endorsement.
SCHEDULE
Designation of named insured for purposes of this endorsement (see Insuring Agreement 2 (a)).....................................................................................................
Limits of Liability: $ 10,000 each person; $ 20,000 each accident.
The advance premium for this endorsement is $
2..Q..Q.........................
Description of Insured Automobiles
Check appropriate box
□	Any automobile owned by the principal named insured
□	Any private passenger type automobile owned by the principal named insured
□	Any automobile to which are attached Dealer's Automobile Registration Plates issued in the name of the principal named insured
0 Any automobile designated in the declarations of the policy and an automobile ownership of which is acquired during the policy period by the principal named insured as a replacement therefor
Attached to and forming part of Policy NoJlQlM™?.?..?......issued to............H......Tracy. Hall.,......Inc....................................
................................................................................................................................and underwritten by Amica Mutual Insurance Company and taking effect
oa...........May.....1,.....1973..........................................\at 12:01 A.M.J and expiring on.....May 1, 1974	\ at 12:01 A.M. /
/ standard time \	CTj)	J standard time J
Providence, R. I.........March.....27, 1973.................................................................................QAssistant Vice President
Fi^Q.fi OCOQ !_73	t	«	v\