No. ---------.

X. Y. COMPANY OF ---------

Amount $---------. Rate ---------. Premium $-------

In consideration of the stipulations herein named and of --------- dollars premium does insure A. B. for the term of ---------, from the ---------day of ---------,

19-, at noon, to the ---------day of ---------, 19-, at noon, against all direct loss or damage by fire, except as hereinafter provided, to an amount not exceeding

--------- dollars, to the following described property while located and contained as described herein, and not elsewhere, to-wit: ---------[insert description of property, both realty and personalty].

Specifications

Dwelling. - It is hereby understood and agreed that the term "Dwelling," or "Building," when insured above, shall apply as follows: To the dwelling or building and its additions, foundations, plate and ornamental glass, heating apparatus, gas and water pipes and their fixtures, electric wiring and its fixtures, elevators and their appliances, decorations, window shades, verandas, screens, awnings and all other permanent fixtures, and its appliances, therein or attached thereto.

Household Goods. - It is hereby understood and agreed that the term "Household Goods," when insured above, shall apply as follows: To the household and kitchen furniture and utensils, useful and ornamental, consisting principally of bed linen and equipment, plate and plated ware, china, glassware and crockery, draperies, hangings and curtains, carpets, rugs, linoleum and other floor coverings, laundry articles and their equipment, household stores and their supplies, traveling articles and their equipment, sporting and game articles and their equipment, military and society articles, desks, typewriting machines, bicycles and toys, all musical instruments, mirrors, pictures, paintings, engravings, portraits and photographs, including frames (at not more than their actual cost), bric-a-brac, statuary, bronzes, vases, pedestals and other works of art, all jewelry and time pieces, sewing machines, photographic articles and their equipment, household, garden and lawn tools and their equipment, wines, liquors, and beverages, family, guests' and servants' wearing apparel, articles and effects (if not otherwise specifically insured), library, books, music, printed matter and stationery and all other articles and effects usual to housekeeping not more hazardous.

Stable, Sheds and Fences. - It is hereby understood and agreed that the term "Stable, Sheds and Fences," when insured above, shall apply as follows: To the building, its additions, foundation, heating apparatus, gas and water pipes, their fixtures, electric wiring and its fixtures, to the fence adjoining and all permanent fixtures and its appliances therein or attached thereto.

Vehicles and Horse Equipment. - It is hereby understood and agreed that the term "Vehicles (excluding Automobiles) and Horse Equipment," when insured above, shall apply as follows: To the vehicles, sleighs, harness, bicycles, robes, blankets, whips, hand tools and implements, hay, grain, feed and bedding, and family and servants' household goods, wearing apparel and effects.

Permits Granted. - Permission for other insurance.

Permission for temporary unoccupancy and vacancy without notice, pending rental, change of tenants and absence of family.

Permission to complete building if under construction; to make ordinary alterations, additions and repairs, this policy to cover on and in same under appropriate divisions herein, while under construction and when completed,

Natural Gas and Electricity. - Permission is hereby granted for the use of Natural Gas and Electricity for fuel, light and power, subject to the following conditions: This company will not be liable for damage by explosion of Natural Gas on the premises, unless fire ensues, and then for damages by fire only.

Gasoline Permit. - In consideration of the assured's compliance with the hereinafter named warranties, permission is hereby given to use a Gasoline or Vapor Stove in the building or (buildings) described in this policy, and to keep on hand not exceeding One Gallon in All of Gasoline, Benzine and Naphtha, the same to be kept in and used from well secured metal cans, to be free from leaks, and to be filled outside of the building or'(buildings) where this policy covers.

Warranted by the assured that the stove reservoir shall be filled by daylight only and when the stove is not in use, and that no artificial light other than incandescent electric shall be permitted in the room when the stove reservoir is being filled, or when any of the Fluids are being used, that no Gasoline, Benzine or Naphtha, except that contained in the stove reservoir shall be kept within the building or (buildings) where this policy covers (except as above provided), and that not more than Five Gallons shall be kept in a tight and entirely closed metallic can, free from leaks, on the premises adjacent thereto.

Caution. - The principal danger from Gasoline stoves is in having Gasoline about. At ordinary temperature Gasoline continually gives off inflammable and explosive vapor, and a flame some distance from the material will ignite it through the medium of this vapor. The vapor from one pint of Gasoline will make 200 cubic feet of air explosive. It depends upon the proportion of air and vapor whether it becomes a burning gas or destructive explosive. Beware of any leaks, and never forget how dangerous a material you are using.

Lightning Clause. - This policy shall cover any direct loss or damage caused by lightning (meaning thereby the commonly accepted use of the term "lightning," and in no case to include loss or damage by cyclone, tornado or windstorm not exceeding the sum insured nor the interest of the insured in the property and subject in all other respects to the terms and conditions of this policy; provided however, that if there shall be any other insurance on said property this company shall be liable only pro rata with such other insurance for any direct loss by lightning, whether such other insurance be against direct loss by lightning or not; and provided further, that if Switch-Boards, Dynamos, Motors, Batteries, Wires, Lamps, Cables or other Electrical Appliances or Devices are insured by this policy, this company shall not be liable for any loss or damage to such property resulting from any electrical injury or disturbance, whether from artificial or natural causes, and will be liable only for such loss and damage to them which may occur in consequence of fire in the building herein described and originating outside of the machines and appurtenances themselves.