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HomeMy WebLinkAbout0590 - w i• 1 • i I - - .u=°-"f•=.. . r :,•"'t`~•-Ktt'VI~T:tOF=L0~5~~"TRSJCKt-.:WMOLE~ALL~~:- . , r •.:•`.~'s - -:ARCO NATIONAL INSURANCE•COI~A~t r - .,r - _ r - ~ ' ~`i~'!..• V~ 1)RAAG~ 1Z• yl: ?..IIoLt~.l N R 'a•:CLAIM.~~iwraGR•~;~ ~s st~f•~'~~.,:'3,;,r... _l! r,~.! L U NiSCONSIN 53201• v,~ :r.: _,z,~ _ - . _ :MI wa icEE, - 25008 -;a:~'-{ _ •r.% y~~w a.a.lw ..•.ia ter.. O: • : ' y _y: sa ti . s:•.:xrs.tyhth~' ATE ~:L~'~• .tia• AMOUNT OF,OAMAGE:•-. `rr ~,.--~~t~_ • ' ~ ~ Bet. .9-9-& . ~-12-77 Sli Iwoaerat. T. h-:'t'~ ~,c+~-\~w}1`•': ~j.~ is: ~l'.'9.11$.v''~. ;?jZ is li'2b' flC: i~ 1/•! {7• • p- }t y[ l..lil _ ~ .•lM1 L^:~.~ "ti?Z s1 g ~1:~_-fSl': ; KIND• OF LOSS: tr' : 1•+•~ ~..~-:Ylnt >r! n» • ~Extensiw - .jj'o•Coti~~? ~ ' ~ ` . -s 13 5 0 ~ . . 6 - - - --r:-. ~j. s• :i. "'=r'? r • !ft .•ti2 j• a'-on - S=Vandalism ~ 0 ~ . e. B x - - - P O OR STREET-• ~`~=~ZJ~.~ p'~~ire• ,p 6-Wiod:: ~1:. t,1NR OPERABLFli.:~4:: S . ~:i Box 3 4 2 6 Thsn p 7-Frond - ? YES ~ -~,o _ ~ ~ TY STAT - = t p 9.Othsr: . ~•i~'-• - coZumbia S. - ~~~30 ' - tDes«ibe) - -T,: p ToTdt;;_..~p-PA~ru?L,. )FACER - - - Ossler and/or Store No. PREVIOUSLY REPORTED DATE HOW ~ AY WHOM 7'' i•• Kneece Truck .Company 733915 YHBHHY ~ No YES- ~"'-~"r;~'~~ _ a t_ STREET ADORE _ _ : ~ P . O. BOX 1856- _ - , . ~ , aT~ sp tw_~rr -r~_? . HOW_ OIO-LOSS OCCURT - , . - ,ea r , z .ai.-~ ::i•. - - - -;~T~-x~.~:~~ 1~:..,;.?:.: -Someone- -stole •_unit 'ficom-lot..:,.=~~-g;,-: .~`.r "~~umter - . _ a7-a~.~ JN Z y` 9150 ~ - ~ '•A ^,~`t -Y._ S'71:~L'•^.~. i:~.~; i.;1 ~ONTACL INSURED AT• - T~ ONE:-~-~~ ~ . ; UNIT CAN tlE-INSPECTED AT._;~' .c• ~i'T~•--• ~ - rs: f•.r tom- _ :y.. zfxs%.: ! •.~~i~~. ~ . B~A _ a 3~._.~?,'s, ~ a - - .3,~js: .r--h ~~.f: ; ?a. a r?wi..,' • T . N~ - .1- i..3.•'V • wt r.' AbOVe- adt~iess~. •"i ML'.~. - s~ r.. -s'.,;^' : a;~: -:ajit2l ~1~9(+jlP; ~51~[Y::ttr~}•:~t~.:." ?~:.r3.'Ll+jr~~"~~ -•~jy'~ :-FraiNc.;Sha~ a r. ~ ..a iria.it' "i, -w.s~ '~i•::,i~-+~i.OESCRIPTION OF...VEHICLE.- ..~.':;:.~.a.~t: ~.i::;~t•: , : DATE OF NOTE TEAR:=`~ •::3t/"~f~i?BADE-NAti£'~~:A?~'- EMODEI.N(1YEE11~} ^f3-~:i+!-L•MASSIS'NUWER:~ ::'NEM^ NEw-DMI~r l~ld OOwn COSt--'' • "MODES = .J...- - -USED USED-rr/s took V~Iw"`'. - ..e..-. t~..l^ --w' - ~ ..z :?:~'a~._ ~~.x3~ :'Y. .w Ju mot.' .a..- _.-_'~.'.`t':- -t• - - L~~i ~s:. ..:.,.,.~r?,- - `WT-9000 _ •S47981~ ' z'~~ -s .:~y.~st725~00 =*:'a:;!t' 5-27 77 '1974 Z>K.:i?ord.::_~t,-~ sty - - r. ..,,,,~yly~? J Y !tom..` ..e'S.;~.k_ . - r t. 1•~.?~'f"1_'~1 L ~•7`k? .~~-jam .+•~tR :1~''ly.s v / - ='.'(.?~i~~••:•+s~> ^ti~^,C;:'~~•.' ~ ~~•~f7'~~? .~ic~j1 i :-c ~'i i .a~~.~...: ,il ,i ~l" i~"•~`Tysi yf ~?..y ~',--~'-~'~,.rj• ~~.~j`~~?~'~~~LL~'n• ''`t~`~• '+.'?"F~}!'-t. y ;t ~.'.rs'lr .y„i.3~j-.6~'`.'~`i.,-siie. •+'.1~f•*ar~';~`Rb. ! ~'2. ti ! r ~ . - tom` . _ii.!.:°~:~- •wsS~. ~v~r~. t-.~"r't3,t?r Y~6•~~,.9.tiazayt~ ~}c1i:i•;fa•,~a:i s ^~ixz_c.~:a.u: s1 y s: ~:s~ ~`3~..+r1,~1 . •_"?'i#-• • ::6•f. w !t rF ~•t2_f,-- ~~i+T~~•'Y-1'~ ~•.~~..r' - ~i - rL-t. - ~ ~ - .C•11 ~ -~:3~' iY?.?~4L~1?fji~'~iF~~ .•~~i NOTE NUMBER - :~=.1 - " _ "~'-~:=;'.:Y - UNPAID•BALANCE (AT DATE OF LOSS) AMOUNT PAST DUE T80203A-= ~~3~~' ~-~~~~~~~r'-',~r., • --13 '725-: 00t- . ~:._~0=~~~c;:?~;~:~_~~~`•~,_. .1$i,.~k~~.~'='i*:-.'«R3''~L.'t•~.~. ~-Tf415tO6S ISBEING%1SSIGNED BYti.:.:_s;wa:•. ~.~`~=.•~v.~:.:a_.-~tir? «r,..••rs'•: - •,~..ar.,~-.~i"`~~`.~~''~~~.=`-'~f~~*{i,y:. :~sttAliCQ-INSURANCE'S VICES'd. ..'rw°"-`:E£~'~:`•~,'°.i~,~~~+,,;~~ STREET ADDRESS 'i~ 'ice ti_ ,*s- ':.!i.{:,- ~ - -`'.;N:-s:::•'- • ---:t~-:s. t CCO CODE NlN1ABER•,rs='r' ~ 610Yr=Idlewild:Road_;>~Suite~300':,{:~'~:,~- .--z~. ~ ~ 60u~~~~~, CI Y •.f'~7~'r:.-c;:..~•~wyyi~,~.r- "at-'+tds- STX7~_..S_ ZI~Pr'~=':~ `BY-.i1. _ - - ij A~~~=_-~~~;~::.~i lotte;~~: ~ :Ih O ZZ.:~.` r.-~`~. `t ~"'~'-_:4~5'..:. 's'1..'i:''• 5.12:' .ii' Char- C• t~13S~ :~~~Nr7..F `t? 2. 2 9=1.4.; 77± lc~;. Tyrr`io T:4~aa• `.a letKf!«epGrt ?rs~: iC~r''='Tttf~~?~?(tT .Y - _r,u . 2 - - 3 ~.~y,: 21::x:% ,~.ti~~,~- i .~,~`s,~{fie-t~~;~~t-wti:'~_~~it~~,,~._~~ y~ INSTRUCTIONS-TO'AQJUSTERS::~•'-os~ti~~~i4wc~t .~e~+~•~~:i`',^;;~:,;,, - :('ti,~R-b:>s{t~¢la•+OL~=~~:~i'~~+•'~.=C.~'~1pSi.ioXJ$,`.~f !r v:7~~it(fl:.i,~.i;S!it-=t^:.:f'~s.9t.~-tJM3t~t~- •~1~~119~~•~ j~~-3,~:e~ ~ACKNOWLEDGMENT.•OF ASSIGIYMENT:~ '~t ~ . _ ; e _ar; a ....t.,--_ 2 . .ft t ls~~[ii- .!7 s' r ! t~;~- 1_ ~ .~''r, l.,~w l.iiC... = i t :...TgtiS : •i.:7 ~f:ri •,r-C ^i~!.n~"li ~_'Jf: -'.SR.:,~Yy-~ t .i:~media.ely upon-gctificaburt-ot_to~3;}~ ~l ~ t r;~? ~ ~+r+f~.: L!~.: ;'K-1~ { - . in `!!M. -f'r -T . -.,+.t • 4-i-.--. ~ r,. s'iA=. ~ r . . - ~t,:_Contacttthe,~suiedby„telejliane'tettei:p~an person and-inform him-that you have been assi~ned.to adjust his-loss _ ~ fry: and that tie is`obligateo• to protect the property. ' ~ - . - ; - ~ 2. Mail acknowledgment„to the Marco National. Insurance:Co., P.O: Drawer 12U, Milwaukee. Wi_scon_ sin 53201. with aI • copy~to the liareo Insurance Services office that assigned the loss to you. ~ _ ~ - TOTAL LOSS ADJUSTMENTS. ' - . • _r.-.,,. - - 1...Dc not take a -Proof of _Loss~without first submitting•:a preliminary report inclu?ing a •data lt~ed~epa~r~e~t(male=vim;;`-: : salvage bids and six color photographs: ; - - - = ~ -•~-r•:~ , i= 2. Do not take a Proof of Loss-on total thefts wifhout authorization from the Harco Natiional Insurance Co.' ` _ _.t:i•-::J. . S • t~~rwi+.~x_ - sir-• 3 3, Oo not delay a first report it atl~'information is not available. - _ - ja ..z" _ .•r_r~ :~.~•-;~i F;EI'ORTS AND CORRESPONDENCE. ~ red =~=z 1. All reports and correspondence -to the Harco National Insuranne Co., P.O. Drawer 12U, Milwaukee, Wisconsin.. Preliminary reports: - _ - - - :.:.,..-.::--:..:r~:»:.~'~:"%,'~~-A.: a. Must be mailed no later than 15 days after receiving notification of loss. This _report_in•addition to usual=-tfata:.~~.-~~' should include full information re rdin other insurance a l,cable.to loss. ~ ---L • ::,za;.- • b. intermediate reports must be- mailed at intervals not exceeding fifteen (15) days. - Z:i ~Yr uded in vious re is. *~r..r-- ,,.~~1~° c. Final report must incorporate all data not incl pre pox j - _ - ~ PROOF OF LOSS AND'PAYMENT OF CLAIMS. ~ • - = - - • - ' - ~ - _ = ' r¢• 1.. Obtain signature on proof of loss naming Harco National Insurance Co.' ~•~f • - a'- 'ss~~ •~'~=~~1•+~~ ~ qtr'::; _.:.::r. 2. Direction to pay: A. Repairable losses -International Flarvester Credit Corporation or the Repair-Agency..;;~~i•~: - _ `13. Total losses.- In_ ternational Harvester=Credit Corporation or the Named Insured. r_~.r,-:_ u,_y . ~ . - -(CONTINUED ON REVERSE SIDE) , _ ;r;'~ ~f3 ~ . ~ ; - ~ ~ oz-ZOCa EXHIBIT NO. • 1 OR!G1~lAt. - TO ADJUSTER - - ~ ~y'` z.:.~ - - _ - - - _ • _ • ~:~~x31~7 589.. - • . PAGE