TWs,bv. rVhraury gijjgi
Taco Six
Accidents Happen EvenDaBMmJB
THELAMATH NEWS
Offers to Every Reader a Travel
and Pedestrian Accident Insurance
Policy Which rays You
Three Hurtt
Street Canl
d from R.ij, "
' hi....
r- "I Mil
U irkrl lrrr
atvlllli-. uu.l kilmt,.! i. . "
tiun. .in I,,,,,.,., , ,V
Knirrcrm ),.i..i ' " UJ
III 1.4,11, . Uji.,1.. ...
... ".SUM .
Mm.-i .iron ,., h,4 UWH
ah. I lhi.H i . .. 'i
. " '" It, M
i in- mi,,,,.. ,fr -j
Ctes
$750G
$2,500
f- t rc- rl" T TI",T? or crrtain injuries pci Mb. SUSTAINED BY THE WRECKmrJ
l'UR LUOO yjl 1.11 DISABLEMENT OK ANY KAILKOAu PASSENGER CAR OR PASSLVJ
3 S3 I STEAMSHIP OR STEAMBOAT OR LICENSE FERRYBOAT, INTLRURBAN OR STREET RAILWAY CAR, M
UU VAT ED RAILWAY CAR OR SUBWAY CAR. IN WHICH THE INJURED IS TRAVELING AS A FARE-PAYs
PASSENGER. (See Part I printed below.)
rit i ncc rl Tim? or injuries pecif icd in the policy SUb lAIlNLU BY THE WRECKING 08 !
An I'UU wr lU'lv ABLEMENT OF ANY PRIVATE AUTOMOBILE. MOTOR-DRIVEN CA10
,JU KCRSE-DRAWN VEHICLE. IN WHICH THE INSURED I S RIDING OR DRIVING, OR BY BEING ACCIDENTAL
THROWN FROM SUCH AUTOMOBILE, CAR OR VEHICLE. (See fart II of policy printed below.)
ron T ACC HP T TI7I? or certain injuries specified in the policy SUSTAINED BY BEING STRUCK 0
rwiv lwoo ji Lsii KNOCKED DOWN OR RUN OVER WHILE IN OR ON A PUBLIC W
WAV CV ANV AIITflMflRIIF OP ANY VFHIfM F PROPFI I Ffl RY STFAM PARI F FI FPTRirtTV
r t U a t a - w a v a wa naa'w-w a v u w wa wbm v itivi t iWk
THA. GASOLINE, HORSE. COMPRESSED AIR, OR LIQUID POWER (excluding injuries sustained while on il
road Right of Way in violation of any Statute, or any Regulation of the Railroad Company.) See Part HI of policy pit
ed below. :
$10.00 Per Week for 15 Weeks During Disability Resulting From Any Such Accil
AND IT ONLY COSTS YOU $1.50 PER YEAR
Read and Note the Protection Given You in How to Qet Thig polj
si,250-o
Parts One, Two, Three, Four and Five
PAT OXK
By tb wrockins or disa!i!em-nt of any railroad paswn
ter car or iia.wr.ser tambip or atcamboat or licensed
Jrryboat, Imcrnrltn or street railway nr. e'.evated rail
way car or subway car, in r on which the Insured is trav
eling as a tare paring passenger, and "fh injuries so su--t&Ined
dball result in any of the specific Ioms-x furili
i this Part 1. provided -j'h lo&, shall rciult within thirty
days from dale of aceidonr. The Company will pav the
sum set opposite such los as follo-ns:
FOR LOSS OF LIFE -
For Iohh of both eyn 7
For loss of both hand. 7
For loss of both fet 7
For loss on one hand and one for.t 7
For loss of one hand and :gbt. of one eve 7
For loss of ,ne foot and night of one eye 7
For loss of one hand ' s
For loss of one foot
For loss of one eye
For loss of time, per week i.-M dfinwl in I'i'rt ii
Payment shall not be m.i4 for more M.an 1,
enumerated In above payment.
.vmoti
"oo.oo
r.u.) ni
sou no
.".00. no
r.oo.oo
r.Oo no
7',o on
r.o.do
10.0(1
! 11
r.t of a:.
fi : ;j w :( ;
.r by 1,
f;ir or vr-
v:it
r.i!T iu
fa) By the wrecking or dlahi :
automobile, motor driven car or no:
which the insured Is r.ding or dri.i
dentally thrown from such ati-oa.oi,;;.
'b) By the wrecking or diablr -u-.'-n- ,' ,!,ie
omnibus. UsMeab or automobile su ,-, -i i- b- 'n-' ,1-iv-
ur PWWMI. at the tim- of ,..,.-1, .-Hn- or d'.able-
whku the inured ,H trav,;, a faro pay.tm j,i,-.v7..r.
'': fly the wrecking ,,f ,., ,.ng,.r ,.leV;r (iu!nr
In mine, ex.-er.-ed, n K;lit.h lh ,.,, is r,u
" ':r. provided aiw,, -::-.t ,:, (..juries .-,..,. . d
Sm' l " ""U,,n ' 1 tMs Part" twi.
shall r-ul m ar.v of ti,!: M.,ifi- Io-:e3 ?,.t ror.b below.
from date of a..:.Ie. .. Tl,.- (-on.p.-.ny iM .
FOR IJSS OF LIFK
For losn of bo'h eye.-. ...
For Iohs of botii hiti.rl
For l.:iK of both f' -rf.
For lo-.s of one baud .md
Injuries sn.'tained while on a railroad ricbt of way In Tlo.
Ulion of any Htatuf-, or any regulation of the railroad
company).
lb) Fiy the burning of a dwelling house, hotel, theatre,
office building. lol(!e room, dub house, srhm)! building,
store, church or barn white the Inaured is therein aud pro
vided the insured is therein at the beginning of the lire
.md is burned by such fire or suffocated by the sn.oke
therefrom.
(c Ity being stru' k by llKhtnlntr, ur In consequence of
a cyclone or tornado.
d. liy the collapsing of the outer walls of a buildinj.
fe) The result of accidental drowning at a public
bathing beach during tlie time that a lifesaver is on dutv,
and not otherwise, provided always thai such Injuries sus.
rained a described in sections la), (b., (c, id) and (e.
of this Fart lliree shall result in anv of the gperiflc Ioshcs
m-i forth b'-low and provided such loss shall result within
thirty days from date of an iden-t, then the ('ouipnny Mill
pay tho sum sit opixisltc stirli Iims as follows:
,'J.-4).lio
2r.o.i)i)
,250. mi
2r.ll.00
.J! 60. II I)
,250.01)
625.00
f.25 DO
025. Ill)
10. IH)
d.ivs
St....
i.y.iit of 1, no
KiiL of one 1
for loss or ono hdnd and
For If ,f one fo(-. j t
For loss of one hai,.
1 or lis of one foot
For loss of one eye
For losa of time per wok (ai d.
H-2H.i..imi
.. 2.500.00
.. 2.51)0.00
.. 2.500.011
... 2.501) 00
. 2.5O0.OO
.. 2.
... 1
... 1.
1,
1.500.00
250.00
.250.00
1,25
50.00
fined In Part 1 10 00
Payment shall not be mad., for more than one lo s
enumerated 111 above payments.
pakt tiiui k
(a) By being stnyk or knock d down or run over
while In or on a pul l, c highway. ,,v ,lllv allim,(i,Ki r
any v.-biclo propelled by sieam, c.bi.-. ele.trlcitv nanib.
gasoline, horse, comprised air or li.uid power (.'x., ding
FOR LOSS OF LIFE si
For loss of both hands $1
For loss- of both feet 1
For loss of sight of boll, eves 1
For loss of one hand anil onu foot 1
ror loss of one hand and sltfht of one eye 1
Yiiv loss of ono foot and sight of one eve 1
For loss of either hand
For loss of either foot
For liws of sl-ht of cither eyo
lor loss vt time pr week las defined In Part 4)
Payment shall not he made for more than one los
enumerated In above payments.
The loss of any member or members specified In either
Part One. Part Two or Part Three Khali mean tho loss by
actual and complete severance, nt or above the wrist or
ankle; loss of eye or eyes shall mean the irrecoverably
los of the entire sight thereof.
PART KOI It
If the insured shall, durinn tho term nt one year from
the beginning of the insurance covering such insured, as
provided herein, by the means and under tho conditions
recited in Part One, Part Two or Part Three be (Immedi
ately and wholly disabled and prevented by Injuries so
received, from performing: any and every duty pertaining
to bis or l.er usual business or occupation, lim (toiupnny
will pay for n, hi-Ik! not pxemlliiK flf.een (!.) ronnccn.
live weeks, .Kiiile.il liiib innl.y m i,n rale of 'Jen Dollars
OS 1 11.00) pel- w eek.
I'AP.T I IVK
F.aoh consecutive renewal hereof without default in
Payment of premium will increase the nmount of benetli,
herein provided for death, dismemberment, or loss of sh-ht
or the Insured Incurred under conditions as described In
Paris Two and Three, at the Tate of ten per cent of the
original amounts until fifty per cent Is thus added, and
lhi-reart.-r so long as this policy Khali remain 1n rontln
nous force tho insurance will bo for ho eiiid orl-ln-.l
uinounts In addition to the accumulations.
Simply fill out, sign and mail or bring in the Application Form with
rency, money order or personal check. A pplications can be perioral?
The Klamath Ne
Your Insurance is in force the minute your signed application with$lX
USE THIS APPLICATION
!( Not Winn; HliitK
APPLICATION
!
Vtffjj!
Date
To A. E. LoDIEU, RcgUtrar:
I hereby apnlv for tk. t7 Ron nn a :j . 1 .. . . . retinal)!
cr 1 : -" -r ..-.w.v "iucii. insurance r o icv. mued or no w i
In conaideralior. of rcccivin, ..!d policy, I hereby ,8ree ontJ rtify a. follow.
Present Subscribers Check I fere i , , rrmlar nu,,riiT to The KU.-.
L 1 ciMiiliiiin ns unci, ilm lng tl.n iiollcjr jrar. I
Policy Increases 10 Every Year for Five Years
(See Part Five)
AVw Subscribers Check lien
re
I liereby enter my .tilm-i Iptlon fo The hl"'' ' lWf. I j
(iiinie.llt,.y nl,, , ,nilim durtnd the '"'"'f,wwl
.vour isrtlrsi.,, or ngrnt tlm reit.ilnr ulwHp"l' P"" I
nioi.tli I., nilvnnco.
NAME
Street Address
City
R. F. I).
(WlilTi: PLAINLY WITH I l-.M'll, INK WILL lL'T
: ace ....
Apt. No
Occupation
Box No State
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