Diller streets, in the town of Watts, county of Los Angeles, state of California, together with certain household furniture, wearing apparel, family stores, books, pictures, silver and plated ware, musical instruments, and other personal effects, therein contained and located, and was the owner thereof during all the time since said 31st day of July, 1905, and up to and at the time of the destruction of all said property by fire, as hereinafter mentioned, and during all of said time continuously used and occupied said building only as a dwellinghouse. That before said contract and policy of insurance was entered into between this plaintiff and defendant, and before said policy was issued by the defendant, this plaintiff fairly stated and disclosed to the defendant and to its agent the nature and character of the interest of plaintiff to and in the lot and parcel of land upon which said building was located, and then and there stated and disclosed to the defendant and its agent that plaintiff had purchased said real estate under a contract of sale from the Golden State Realty Company, a corporation, with its principal place of business in the city and county of Los Angeles, and was then paying the purchase price therefor in instalments, and that there was then due on said purchase price the sum of about $200, and that he, the plaintiff, did not at that time have a deed to said property; that thereupon said defendant and its agents issued and delivered to this plaintiff its said policy of insurance covering the said property therein described, the same being the property herein set forth; that before said fire, and before said loss occurred, this plaintiff fully paid the balance due on the said purchase price of said real estate to said Golden State Realty Company, and obtained a deed to said property; that plaintiff has at no time since said policy was issued, as aforesaid, parted with any of his right, title, or interest to or in said property, but has at all times been the sole and exclusive owner thereof, except as aforesaid. 3. That on the 31st day of July, 1905, at the city of Los Angeles, state of California, in consideration of the payment by the plaintiff to the defendant of the premium of $46, which was received and accepted by defendant as aforesaid, made and delivered to plaintiff its policy of insurance in writing, covering all of the foregoing and above-mentioned and described property, a copy of which said policy is annexed to plaintiff's first amended complaint in this action, as "Exhibit A," and said exhibit A is made a part hereof by stipulation of the parties hereto. 4. That on or about the 1st day of June, 1906, said dwelling-house and said furniture, stores, wearing apparel, family stores, books, pictures, silver and plated ware, musical instruments, and other personal effects therein contained, all of which were included in, and comprehended and covered by, said policy, were totally destroyed by fire. That the plaintiff's loss on account of the destruction by fire of said dwelling-house, the said furniture, stores, wearing apparel, books, wares, pictures, musical instruments, and other personal effects, included in and covered by said policy, was the sum of $5,564.50, the same being the actual and reasonable cash value of said. property at the time of its destruction by fire, as aforesaid. 6. That on or about the 4th day of June, 1906, this plaintiff gave to the defendant full and complete oral items and proof of his said loss on said property, and at said time rendered an oral statement to said company, stating the knowledge and belief of plaintiff, the said insured, as to the time and origin of said fire, and the interest of said insured and all others in said property, the cash value of each item thereof, and the amount of loss thereon, stating that there was no other insurance on said property, and giving all changes in the title, use, occupation, location, possession, and exposure of said property since the issuance of said policy, and by whom and for what purposes the said building and parts thereof were occupied at the time of said fire; that defendant did not require said notice and said. statement to be in writing, but then and there expressly waived said requirement, and then and there expressly waived written notice of loss, and then and there expressly waived a written, signed, and sworn statement, of the character aforesaid, in the manner and as follows, to wit: That defendant represented to, informed, and told plaintiff that defendant would not ask, require, or expect plaintiff to furnish said notice and said statement in writing, signed, and under oath, but that defendant was satisfied with the notice and statement then given and rendered by plaintiff as aforesaid; and defendant further represented and said to plaintiff that a written, signed, and sworn statement made no difference to defendant, as it intended to settle plaintiff's said loss with him in any event; that more than sixty days elapsed after giving said notice, and after rendering said statement aforesaid, and after ascertaining, estimating, and giving satisfactory proof as aforesaid of said loss, before the commencement of this action; that plaintiff has otherwise performed all the conditions of said policy to be performed by him. 7. That on the 28th day of August, 1906, plaintiff furnished to said defendant, at its special instance and request, additional and supplemental proof of plaintiff's said loss and interest of and in said property, in writing. 8. That after said fire, and before the commencement of this action, the plaintiff at divers times made demand on said defendant for payment of his said loss, according to the terms of said policy, in the sun of $3,000, but the defendant refused, and still refuses, to pay the same. 9. That the defendant has not paid said loss, or any part thereof, and the same is now due, owing, and unpaid. Wherefore, plaintiff prays judgment against the defendant for the sum of $3,000, as provided for in said policy, and that plaintiff be given judgment for his costs, and for all other proper relief in the premises to which he may be entitled. [Verification.] C. W. Pendleton, Attorney for plaintiff. FORM No. 711-On agreement to insure and give policy. [Title of court and cause.] [After introductory part:] 1. [Allege incorporation of defendants.] 2. That on the day of 19 the plaintiff applied to L. M., who was then and there the duly authorized agent of the defendants, for insurance against loss or damage by fire upon [describe what], the property of said plaintiff, and the defendants, by their said agent, in consideration of a premium of $ , to be paid them by the plaintiff, agreed to insure the plaintiff on the said [state what] from 12 o'clock noon of said day for the space of months, and to execute and deliver to the plaintiff within a reasonable and convenient time their policy of insurance therefor in the usual form of policy issued by them. day of 3. That the usual form of policy issued by the defendants agrees, among other things, to [set out legal effect of contemplated policy]. 4. That afterward, to wit, on the 19 the said property was damaged [totally destroyed] by fire, whereby the plaintiff sustained a loss to the amount of $ 5. That the defendants neglected and refused, and still refuse, to execute and deliver their said policy of insurance in writing to the plaintiff in pursuance of said agreement. 6. That the plaintiff has duly performed all the conditions of said agreement and insurance on his part to be performed, and on the day of 19 notified the defendants of said loss, and on the day of 19 , duly furnished the defendants with proofs of loss. 7. That although more than days have elapsed since said proofs were furnished, no part of said loss has been paid, and the whole thereof remains due and payable to the plaintiff. [Concluding part.] FORM No. 712-Action by executor on life policy. [Title of court and cause.] The plaintiff complains of the defendants, and alleges: 1. [Allegation of incorporation.] annually [or other tion of the payment of the premium of $ wise] during life, the defendants, by their agents duly authorized thereto, executed their policy of insurance in writing to one L. M. on his life, in the sum of $ a copy of which policy is hereto annexed, marked "Exhibit A," and made a part of this complaint [or petition]. [but not by his own hands, or at the hands of justice, etc.,-if such causes be excepted], having previously, and on the day of 19 made his last will and testament in due form, thereby appointing the plaintiff sole executor thereof. 4. That said last will and testament was duly proved and admitted to probate in the probate court of the county of and letters testamentary thereupon, by an order of said court therein duly given and made in said proceeding, were issued to this plaintiff on the 19 and the plaintiff thereupon duly quali day of fied as such executor, and entered upon the discharge of the duties of his said office. 5. That on the day of 19 the plaintiff furnished the defendant with proofs of the death of the said L. M., and that the said L. M. and the plaintiff each duly performed all the conditions of said policy of insurance on his part. 6. That no part of the said sum has been paid, and that the whole thereof is now due thereon from the defendants to the plaintiff, as such executor. [Concluding part.] FORM No. 713—Action by assignee in trust for wife of insured. [Title of court and cause.] The plaintiff complains of the defendants, and alleges: 1. [Allegation of incorporation.] in consideration annually [or otherwise] of the payment of the premium of $ during life, the defendants, by their agents duly authorized thereto, executed their policy of insurance in writing to one L. M. on his life, in the sum of $ , a copy of which policy is hereto annexed, marked "Exhibit A," and made a part of this complaint [or petition]. 3. That on the day of 19 the said L. M. [with the written consent of the defendants] duly assigned said policy of insurance to this plaintiff, in trust for E. M., his wife. 4. That up to the time of the death of said L. M. all premiums accrued upon said policy were fully paid. 5. That on the day of 19 at said L. M. departed this life [but not by his own hands, or at the hands of justice, etc.,—if such be excepted causes of death]. 6. That said L. M. and the plaintiff each performed all the conditions of said insurance on his part, and the plaintiff, more than days before the commencement of this action, to wit, on the day of 19 , gave to the defendants notice and proofs of the death of said L. M. as aforesaid, and demanded payment of the said sum of $ 7. That said sum has not been paid, nor any part thereof, and the same is now due thereon from the defendants to the plaintiff. [Concluding part.] FORM No. 714-Action by wife, partner, or creditor of insured. [Title of court and cause.] The plaintiff complains of the defendants, and alleges: 1. [Allegation of incorporation.] 2. That on the of the payment by the plaintiff to the defendants of the [annual] premium of $ the defendants executed to the plaintiff their policy of insurance upon the life of [her husband] L. M., of which a copy, marked "Exhibit A," is hereto annexed as a part of this complaint [or petition], and thereby insured the life of said L. M. in the sum of $ , payable to the plaintiff. |
