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lliam F. Smith eral Adjusters, Fine Arts SWORN STATEMENT IN PROOF OF LOSS e # 00902 Amount of policy at time of loss $9,925,000.--- Date Issued 30 Jan '85 Date Expires 15 June '85 Policy No. CTF. No. 291105 Company Claim No. AC 1.428 Agent Huntington T. Black Agency Washington, D.C. To the underwriters at Lloyds of By your Policy of Insurance above described, you insured Foundacion Juan March / Leo Castelli Gallery (hereinafter called Insured) according to the terms and conditions contained therein, including the written portion thereof and all endorsements, transfers and assignments attached thereto. AGAINST THE PERILS OF All Risks A Loss occurred on the D.sc. 25 day of May 1985 about the hour of o'clock M., which loss upon the best knowledge and belief of Insured was caused by Two works, Mixed Media. by Rauschenberg on loan to insured: Bucintoro; Jammer not returned from Barcelona When your policy was issued - or if assigned with your consent, when such assignment was made and consented to - Insured was the sole, absolute and unconditional owner of the property described and no other person or persons had any interest therein either as mortgagee or otherwise, no incumbrance of said property existed nor has since been made nor has there been made nor has there been any change in the title, use or possession of said property except SPECIAL WARRANTIES THE ACTUAL CASH VALUE of above described property at the time of said loss was...$ THE ACTUAL LOSS AND DAMAGE to above described property as a result of said loss was ...$170,000--- THE TOTAL INSURANCE covering above described property including this policy and all other policies (whether valid or not), binders or agreements to insure was at the time of said loss.... $ 9,925,000.--- INSURED HEREBY CLAIMS OF THIS COMPANY and will accept from this Company in full release and satisfaction in compromise settlement of all claims under this policy the sum of ...$ 170,000.--- In consideration of the payment to be made hereunder, the insured does hereby subrogate to said insurer all right, title, and interest in and to the property for which claim is being made hereunder, and agrees to immediately notify said insurer in case of any recovery of the property for which claim is being made hereunder, and will render all assistance possible in any endeavor to recover said property. Insured also agrees to turn over to said insurer, any such recovery which may be made, or reimburse said insurer in full to the extent of the payment for such property which may be recovered. The said loss was not caused by design or procurement on the part of the insured or this affiant; nothing has been done by or with the privity or consent of insured or this affiant, to violate the conditions of the policy, or render it void; no articles are mentioned herein or in annexed schedules but such as were interested in the loss and insured under this policy, and belonged to the insured at the time of said loss, no property saved has been in any manner concealed, and no attempt to deceive the said insurer as to the extent of said loss, has in any manner been made. Any other information that may be required will be furnished on call, and considered a part of this proof. It is expressly understood and agreed that the furnishing of this blank to the insured or the assistance of an adjuster, or any agent of the Insurer in the making of this proof, is not a waiver of any rights of said Insurer or of any of the conditions of this policy. Witness hand at this day of 19 by Leo Castelli State of County of Personally appeared before me, the day and date above written , signer of the fore-going statements, who being by me duly sworn, made solemn oath that the matters contained in the foregoing statements by him subscribed are in substance and in fact. Notary Public
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