yO 
20 
Sg oehae 
Ny 
Ey 
TABLE No. 2 po gibtiothe 
Adjustment of the BASIC ESTIMATE (C-3) for Coverage Under BLANKET CO-INSURANC 2 
FORM 2, 
TEM 1 Noy 
'. BASIC ESTIMATE (C-3) coors. $23 A 00 > 
!. Full Annual Ordinary Payroll............. s.\o Soo 
}. FuliCost of Heat, Light and Power...... s____voe 
1. Total of No. 2and No. 3 (deduct from No.1)... s-\\ \oo 
3. Insurance necessary under ITEM lof Form... s_ vv %oo 
TEM 11 
I. Full Ordinary Payroll for largest 90 consecutive days.. 53, 000 Rate 1. VS Prem. 531. So 
FINAL AMOUNT for Coverage under BLANKET 
CO-INSURANCE FORM (Total Items l and 11)... 57S $oo Av. Rate bSv_ Prem.5_¥19. A 0 
NOTE: The BLANKET CO-INSURANCE FORM is adaptable for coverage of earnings of all 
zlasses of business, and in many cases provides complete coverage at lower costs than other 
forms. It is especially designed to cover earnings of those businesses whepe such earnings are 
subject to marked fluctuations, seasonal or otherwise. 
0 | 
TABLE Neo. 3 
Adjustment of the BASIC ESTIMATE (C-3) for Coverage Under FORMS OTHER THAN 
BLANKET CO-INSURANCE FORM 
COLUMN I: Place opposite the proper item all operating charges and expenses 
anticipated for next ensuing year. 
COLUMN |i: Place opposite the proper item those expenses (or portions thereof) 
which could be discontinued during interruption, care being taken not 
to limit the coverage which the policy contract permits. 
mn 
Sw 
ty 
0 
™ 
= 
“2 
COLUMN | COLUMN {I 
. Interest on Borrowed (or owned) Capital................... $._¥ \oo s. Node. 
A TV Mao 
be RENBIS. psvirnisivsmns amma “ A, Aco (ror tit 
1. Advertising and publicity... AR NYoO ___ 
5. Salaries of Officers and indispensable employes... _ 5,000 erm er 
3. Other Salaries (Ordinary Pay Roll).........c........ ee Ae Soo _% 000 
7. Maat, Light and Power. oom ses Yb oo — eco 
3. INSURANCE PremMiUMS.  o.ooooeeerereiencis caress eninmec ns rssninene bo oD MNoue_ 
J. Maintenance, Repairs and Depreciation...............coone. A Jo So J... J 
0. Other operating charges and expenses... =o v2 So =), Yoo 
TOTALS OF COL. | AND COL. Ili. $ 30 \S0 5s Foo 
[OTAL ANTICIPATED OPERATING CHARGES AND EX- 
PENSES (COL. 1)eovor $20,150 
ESTIMATED NET PROFIT (OR LOSS)... $_ 2,150 
RESULT (MUST EQUAL BASIC ESTIMATE C-3)............ 5-33 AQ e0 
LESS COLUMN Th.ooooooooooeeees oor eeesnsessinesssse snes 5-1, %00 
FINAL AMOUNT for Coverage UNDER OTHER FORMS... >_Y\e, Y00 Rate _+D_ Prem.s 13.1 \s 
NOTE: OTHER FORMS have been designed primarily to cover earnings of businesses where 
such earnings are constant or are subject to established fluctuations during definite periods, 
usual to certain businesses. TABLE NO. 3, when properly used, will also serve to verify or 
modify the Basic Estimate (C-3) as determined by the operations of TABLE NO, 1.