xt7qnk361p0s_1003 https://exploreuk.uky.edu/dips/xt7qnk361p0s/data/mets.xml https://exploreuk.uky.edu/dips/xt7qnk361p0s/data/88m6.dao.xml Inland Steel Company 185 Cubic Feet archival material 88m6 English University of Kentucky Copyright has not been assigned to the University of Kentucky  Contact the Special Collections Research Center for information regarding rights and use of this collection. Wheelwright Collection Coal miners -- Housing -- Kentucky. Coal mines and mining -- Appalachian Region -- History. Company towns -- Kentucky -- Wheelwright. Community development -- Kentucky -- Wheelwright. Coal mines and mining -- Kentucky -- Wheelwright Houses 298-378 text Houses 298-378 2016 https://exploreuk.uky.edu/dips/xt7qnk361p0s/data/88m6/Box_314/Folder_21/88m6_314_21__3828.pdf section false xt7qnk361p0s_1003 xt7qnk361p0s mmmLu'ATLox ON HOUSE ’
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WDING =SALARY 4HRLY RATE $2.10|HRLY RATE $3.001HRLY RATE $2.30 HRLY RATE $2.50lHRLY RATE $2.20 ,
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1 ME OF COMPANY I
, FIRE, ALLIED LINES‘ HOMEDWNERS. OTHER MULTIPERIL POLICIES
USE REVERSE SIDE ‘LIP RE'URT m LIABILIT'I I,L‘AIM\
2. AGENCY NAME. STREET ADDRESS IRUBBER STAMP OR TYPE
I 7 POLICY PREFIX 1; NUMBER 8 PIILICY PERIOD I_FROM TU
10 KIND OF LOSS Ere WI'Id. Equ, et;
\ _ ,
II 'IJBABLE ‘ T ENTIRE LUSS IL PRDB AMT ILISS THIS POLICY
. 6 0 _.
’! INSURED Mpwffmd fiv‘sfmcw/r fl‘ I .0 I I “" °
. 13 HAS CREDIT GIVEN FIJR EXISTING INSURANCEI
4 paopgmy ADDRESS WHEeLfllcfilt A; WNE N9 yEg N0 BLDGS (;ONTENM
y‘r7 27", 14 MDRTCAGEI \
5 MAIL ADDRESS II dII‘IerEnI WWNE N3
0 LOSS IOCATION IF DIFFERENT THAN PROPERTY ADDRESS
FIRE, ALLIED LINES AND MULTI-PERII. POLICIES Comp/ere beIaw onIy IIemI/s) nvoIved In Loss as descrIbed by IDIS Ibo/Icy
I
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15 SUBIECT TI) FORM NUMBERS INSERT FORM NUMBERS AND EDITION DATES I’
16 Dew Ible I Dem ‘I I; e MI I In I»
N ndsrurm am HaI I‘I'he' m» I \ II E‘II‘dI'
S S i I
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HOMEDWNERS POLICIES Comp/eIe beIow Coverages A B C D and Add‘EIONUII Coverages excepI IabI/Ity
I COVERAGE A I COVERAGE B COVERAGE C COVERAGE D I _" I DESCRIBE ADDITIONAL COVERAGES PROVIDED
I I I
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19 OTHER INSURANCE LIST NAMES OF COMPANIES AND AMOUNT IN EACH
, I r I H 7; Hum? OI CevIeIaI IvIdnwan Dated
20 REMARKS BrIeI DeSITLIIIOI'I of Damage II emerzemy handIIng requIred‘ exfin Am I . COPIES , I Dem Um I2 I Agent I I
SENT TO’ I
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I CATASTRUPHE SERIAL N0. LAT. 2\I‘IE NO I
.7 l FOR CATASTROPHE ’I I
a]: bl air-(eflro I LOSSES ONLY I I
> I__—_________—_______.._.._______...—___——_-—-——-———-l
l NAME OF ADJUSTER T0 WHOM COPY THIS NOTICE HAS BEEN FCRWARL‘EL I
I .I
L-__________-____________-______-______....____-—-.'
LEAVE SPACE BELOI‘I EUR CDT/IDANY IISE ONLY
INSTRUCTIONS TO AGENTS:* ImvrI dITIIILJIII “I IIHHJI‘ I? II mymopr JIIx FIIUmI’I III IIII'I II‘II ELwIILIII/n VII *rIwIIge may TIP _ITID'I‘v ATM I'I‘UI'IVI. I9 AUUIIIUI‘MI LII/mg Expense , A.L,E
IITII‘TOvaL’TIIS dIIII BCIU‘II’TIE‘V‘I‘» I X. B Bu IIII‘T- RNA 8 R TIme EIvmenI Cowhide» TE I'rm» IQ IIIIIImII'II E 8.0 Lw \nt I L‘I Mm II ITE‘IV x. Eunpment M &F. IUInIIUTl‘
8. Titurex , F&I SIDI‘R SA Yar'I TIxILIIw» VT IIII "III ‘JITIT‘II‘I IIIL’ I'IImrIdny In any II‘TYI III I‘ve II A ’erI UIIII‘SS \Ime IIIII ITISIIII IIIII I] III SI) UNDER NO CIRCUMSTANCES MAKE
ANY CHANGE OR ENTRY ON A POLICY AITIR A IDS“,
RECOMMENDED BY THE AMERICAN INSURANCE ASSOCIATION 865 I. FORM N0 5 '_‘i

 NAME OF COMPANYE,r7i, ,Eiriii ,D,7,i "E 7,", ,,,,WEE, EEHEE ,W,, ,, USE REVERSE SIDE EDR
REPORTING PROPERTY LOSSES
CASE NO
POLICY NUMBER ‘ POLICY DATES NAME & ADDRESS OI AGENT DR RROIIER
I
COVERAGE ; LIABILITY MED PAYMENIS ELEVATOR PRODUCTS CONTRACTUAL OTHER ISPEINII)
DATA m B ' I I
I— ; I
E B777 777 +777 7 7777+77 77777 7777 77 77 77 777 7 77 777 7-7 77 7 77 7 . 7 7 7 . 7
TO BE 3 I I
COMPLETED ‘ P D I
BY AGENT I I
III NAME BUS. PHONE RES PHONE
INSURED ADDES 7777777 77777777 777777 77 7 7 7 77777 7 7 777 77 7777 7777 77 7
EOCATION77O7E77INSURED PREMISES 7 777(777) SAME,7AS7AI7I7O7\I7E 7 777 7 7
(2’ DATE 8. TIME OE ACCIDENT
W 7 < ) A M ( ) PM
TIME 8. PLACE LOCATION
NAME AGE
I3I
INJURED 7A7DDRESS777777 7 7 7777 77 77 77 7 7 77 HUS PHONE 7 RES PHONE 7
PERSON
O7CCUPAH(7J7N777 7 77 7 7 77 7 7 7 RELATIONSHIP 7H) INSURED 77 77 7
EMP7L767YE7D BY 77 77 7 7 77 7 7 7 7 7 7
77WH7AT WAS I7T‘7477J7UII’7ED DOIN7I7$ W77HE7N HURT ’ 7 7 7 7 7 7 7 7
‘4' NATURE & EXTENT OE INJURY
THE INJURY WHERE WAS INJURED TAKEN AETER ACCIDENT ., 7 7 7 7 7 NAME OE DOCTOR 7
WHY 7va5 INJURED ON PHEIWSES’ 7 77 7 77 7 7 77 7
I’ROHABEE 7DI7SABIIIIV 7 7 7 7 7 HAS INJURED RESUMED WI RK’
I I YIS I I NO
‘5’ OWNER ADDRESS ROS PHONE RES PHONE
PROPERTY ,,,, , , ,,, ,,, , fl , ,,, ,, , 7 ,
DAMAGE LIST DAMAGE ESTIMATED COST OE REPAIR
‘6’ NAME ADDRESS BUS PHONE RES PHONE
WITNESSES 777777777 77777 7 7 77 7777 777 777 77 7 77 7 777 7 7 77 7 77 7
I7I
DESCRIPTION 7777 777 7 7 77777 77 77777 777 7777777 7777777 77 7 77 7 7 77 7 7 7 7 7 77 7 77
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ACCIDENT ” ""’“i' ’ ,,,, " ”W’W ’ """” " " " " ’ "”" " ' ' '
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DATE SIGNATURE OF AGENT 0R BROKER , Kinny: OF INS/URED
RECOMMENDED BY THE AMERICAN INSURANCE ASSOCIATION 865 /

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