Commercial Automobile - Wolters KluwerCommercial Automobile (New)Denotes change. PAGE CA 2 of 76 WOLTERS KLUWER Customer Support: 800-382-2424 UNIFORM EDITION BUREAU NUMBER DATE NUMBER

(New)Denotes change.PAGE CA 1 of 76 WOLTERS KLUWER Customer Support: 800-382-2424

Commercial Automobile

Policy Forms and Endorsements

IT IS WOLTERS KLUWER POLICY TO LIMIT THE SALE OF BUREAU FORMS TO THE MEMBERS AND SUBSCRIBERS OF THOSERESPECTIVE BUREAUS. PURCHASE AND USE OF BUREAU FORMS BY ENTITIES THAT ARE NOT MEMBERS OR SUBSCRIBERS TO THATRESPECTIVE BUREAU COULD BE A VIOLATION OF THEIR COPYRIGHT.

ALPHABETICAL INDEX

Forms are listed alphabetically by form title.

Users are cautioned that because of occasional long delays in adoption of new or revised programs in some areas, they must be guided in the use of all forms andendorsements by their Manual and State requirements

The insurance coverages to which the respective forms and endorsements basically apply are indicated by the following codes:

POLICY CODES+. For use with Commercial Auto ++. For use with Business Auto+++. For use with Simplified Commercial Auto 1. Business Auto2. Garage 3. Truckers4. Business Auto Physical Damage 5. Motor CarrierA. Basic Automobile Liability and Physical Damage Policy B. Basic Automobile Liability PolicyC. Basic Automobile Physical Damage Policy D. Business Auto PolicyE. Business Auto Policy Physical Damage Policy F. Commercial Lines PolicyG. Garage Policy H. General Liability-Automobile PolicyI. Massachusetts Combination Motor Vehicle Policy J. Massachusetts Motor Vehicle Garage PolicyK. Massachusetts Physical Damage Automobile Policy M Truckers Policy



UNIFORM EDITION BUREAUNUMBER DATE NUMBER CODES TITLE STATE

--------------------------------------------------------COVERAGE FORMS

--------------------------------------------------------(B)

CA104 D 03/92 TE00010392 BUSINESS AUTO COVERAGE FORM TX(G)

CADS38 05/08 CADS380508 GARAGE COVERAGE FORM—AUTO DEALERS' SUPPLEMENTARYSCHEDULE

VA

(M)CA0020 03/10 CA00200310 5, F MOTOR CARRIER COVERAGE FORM AL , AR , AZ , CT , DC , DE , GA ,

GU , IA , ID , IL , IN , KS , KY , LA ,MD , ME , MI , MN , MO , MS , MT ,NC , ND , NE , NH , NJ , NM , NV ,

OH , OK , OR , PA , RI , SC , SD , TN ,TX , UT , VT , WA , WI , WV , WY

CA0020 10/13 CA00201013 5, F MOTOR CARRIER COVERAGE FORM AK , AL , AR , AZ , CA , CO , CT , DC ,DE , GA , HI , IA , ID , IL , IN , KS , KY ,LA , ME , MI , MN , MO , MS , MT , NC ,ND , NE , NH , NJ , NM , NV , NY , OH ,

OK , OR , PA , PR , RI , SC , SD , TN ,TX , UT , VA , VT , WA , WI , WV , WY

(V)CA0427 03/06 CA04270306 VIRGINIA AUDIO, VISUAL AND DATA

ELECTRONIC EQUIPMENT COVERAGE -STATED AMOUNT

VA

--------------------------------------------------------DECLARATIONS

--------------------------------------------------------(B)

CA150-1 01/87 CA00020187(PG1) + BUSINESS AUTO COVERAGE FORMDECLARATIONS (PART 1)

PR


LA

CADS02-1 07/97 CADS020797(PT1) BUSINESS AUTO COVERAGE FORMDECLARATIONS (PART 1)(MULTI-LINE)

CA


PR

SJDL80662OA 04/89 BUSINESS AUTO COVERAGE FORMDECLARATIONS (PART 2)

TX


LA

CADS02-2 07/97 CADS020797(PT2) BUSINESS AUTO COVERAGE FORMDECLARATIONS (PART 2)(MULTI-LINE)

CA

CADS03-1 02/03 CADS030203[PT1]

BUSINESS AUTO DECLARATION (PART1)

AK , AL , AR , AZ , CA , CO , CT , DC ,DE , FL , GA , HI , IA , ID , IL , IN , KS ,

KY , LA , MD , ME , MI , MN , MO , MS ,MT , NC , ND , NE , NH , NJ , NM , NV ,NY , OH , OR , PA , RI , SC , SD , TN ,

TX , UT , VA , VT , WA , WI , WV , WYCADS03-1 02/04 CADS030204

(PT1)BUSINESS AUTO DECLARATION (PART1)

AK , CA , CO , CT , DE , FL , HI , IL ,IN , KS , LA , MI , MN , NC , NH , NV ,NY , OH , RI , SC , TX , VA , WI , WV

CADS03-1 10/01 CADS031001(PT1) BUSINESS AUTO DECLARATION (PART1)

MN

CADS03PAK 02/04 CADS030204 BUSINESS AUTO DECLARATION -DECPAK (PARTS 1,2,3,4)



TX , UT , VA , VT , WA , WI , WV , WY




CADS03PAK 03/06 CADS030306 BUSINESS AUTO DECLARATION -DECPAK (PARTS 1,2,3,4)



TX , UT , VA , VT , WA , WI , WV , WYSJDL190112OC

07/97 BUSINESS AUTO DECLARATIONS(CONTINUED)(PART 2)

AK , AL , AR , AZ , CA , CO , CT ,DC , DE , FL , GA , HI , IA , ID , IL ,IN , KS , KY , LA , MA , MD , ME ,MI , MN , MO , MS , MT , NC , ND ,NE , NH , NJ , NM , NV , NY , OH ,

OK , OR , PA , RI , SC , SD , TN , TX ,UT , VA , VT , WA , WI , WV , WY

CADS28-1 02/01 CADS280201(PT1) BUSINESS AUTO DECLARATIONS (PART1) - TEXAS

AK , AL , AR , AZ , CA , CO , CT ,DC , DE , FL , GA , HI , IA , ID , IL ,IN , KS , KY , LA , MD , ME , MI ,

MN , MO , MS , MT , NC , ND , NE ,NH , NJ , NM , NV , NY , OH , OK ,

OR , PA , RI , SC , SD , TN , TX ,UT , VA , VT , WA , WI , WV , WY

CADS28-1 12/02 CADS281202(PT1) BUSINESS AUTO DECLARATIONS (PART1) - TEXAS

TX

CADS03-2 02/03 CADS030203[PT2]

BUSINESS AUTO DECLARATIONS (PART2)




(PT2)BUSINESS AUTO DECLARATIONS (PART2)


CADS03 03/06 CADS030306 BUSINESS AUTO DECLARATIONS (PART2)

VA


AL , AR , AZ , CO , DC , DE , GA , HI , IA ,ID , IN , KY , LA , MD , MI , MO , MS ,

MT , ND , NE , NH , NM , NY , OH , OK ,RI , SC , SD , TN , UT , VT , WA , WI , WY


CA


AL , AR , AZ , CA , CO , CT , DC ,DE , GA , IA , ID , IL , IN , KS , KY ,LA , ME , MI , MN , MO , MS , MT ,NC , ND , NE , NH , NJ , NM , NV ,


CADS22-2 11/02 CADS221102(PT2) BUSINESS AUTO DECLARATIONS (PART2)

VA

CADS03-3 02/03 CADS030203[PT3]

BUSINESS AUTO DECLARATIONS (PART3)




(PT3)BUSINESS AUTO DECLARATIONS (PART3)


CADS11 BUSINESS AUTO PHYSICAL DAMAGECOVERAGE FORM DECLARATIONS







CADS11 07/97 CADS110797 BUSINESS AUTO PHYSICAL DAMAGECOVERAGE FORM DECLARATIONS

CA

CA162 12/90 CA00111290 BUSINESS AUTO PHYSICAL DAMAGECOVERAGE FORM DECLARATIONS



TX , UT , VA , VT , WA , WI , WV , WYCADS15-1 10/01 CADS151001(PT1) BUSINESS AUTO PHYSICAL DAMAGE

DECLARATIONS (PART 1)AK , AL , AR , AZ , CA , CO , CT , DC ,DE , FL , GA , HI , IA , ID , IL , IN , KS ,


TX , UT , VA , VT , WA , WI , WV , WYCADS15-2 10/01 CADS151001(PT1) BUSINESS AUTO PHYSICAL DAMAGE

DECLARATIONS (PART 2)AK , AL , AR , AZ , CA , CO , CT , DC ,DE , FL , GA , HI , IA , ID , IL , IN , KS ,


TX , UT , VA , VT , WA , WI , WV , WYCADS15 03/10 CADS150310 BUSINESS AUTO PHYSICAL DAMAGE

DECLARATIONS (PART 2)(MONOLINE)AL , AR , AZ , CA , CO , DC , DE , GA ,

HI , IA , ID , IL , IN , KS , KY , LA , MD ,ME , MI , MN , MO , MS , MT , ND , NE ,NH , NJ , NM , NY , OH , OK , OR , PA ,

RI , SC , SD , TN , UT , VT , WA , WI , WYCADS15 07/97 CADS150797 BUSINESS AUTO PHYSICAL DAMAGE

DECLARATIONS (PART 2)(MONOLINE)CA

(C)ILDS00 07/02 ILDS000702 COMMON POLICY DECLARATIONS AK , AL , AR , AZ , CA , CO , CT ,

DC , DE , FL , GA , HI , IA , ID , IL ,IN , KS , KY , LA , MA , MD , ME ,MI , MN , MO , MS , MT , NC , ND ,NE , NH , NJ , NM , NV , NY , OH ,OR , PA , RI , SC , SD , TN , TX ,

UT , VA , VT , WA , WI , WV , WYILDS00 09/08 ILDS009S COMMON POLICY DECLARATIONS AK , AL , AR , AZ , CA , CO , CT , DC ,

DE , FL , GA , GU , HI , IA , ID , IL ,IN , KS , KY , LA , MA , MD , ME , MI ,


OR , PA , PR , RI , SC , SD , TN , TX ,UT , VA , VI , VT , WA , WI , WV , WY

(D)SJDL190203 DECLARATIONS - MASSACHUSETTS

BUSINESS AUTO COVERAGE FORMMA

SJDL190202 A 09/98 DECLARATIONS - MASSACHUSETTSBUSINESS AUTO COVERAGE FORM(PART 2)

MA

(G)CA151 01/87 CA00060187 GARAGE COVERAGE FORM

DECLARATIONSAK , AL , AR , AZ , CA , CO , CT , DC ,DE , FL , GA , HI , IA , ID , IL , IN , KS ,


TX , UT , VA , VT , WA , WI , WV , WYCADS06 07/97 CADS060797 GARAGE COVERAGE FORM

DECLARATIONSCA

CADS09-1 02/03 CADS090203[PT1]

GARAGE DECLARATIONS (PART 1) AK , AL , AR , AZ , CA , CO , CT , DC ,DE , FL , GA , HI , IA , ID , IL , IN , KS ,





TX , UT , VA , VT , WA , WI , WV , WYCADS09-1 03/06 CADS090306 GARAGE DECLARATIONS (PART 1) AK , CA , CO , CT , DE , FL , HI , IL ,

IN , KS , LA , MI , MN , NC , NH , NV ,NY , OH , RI , SC , TX , VA , WI , WV

CADS09-2 02/03 CADS090203[PT2]

GARAGE DECLARATIONS (PART 2) AK , AL , AR , AZ , CA , CO , CT , DC ,DE , FL , GA , HI , IA , ID , IL , IN , KS ,



[PT2]GARAGE DECLARATIONS (PART 2) AK , CA , CO , CT , DE , FL , HI , IL ,

IN , KS , LA , MI , MN , NC , NH , NV ,NY , OH , RI , SC , TX , VA , WI , WV

CADS09-3 03/06 CADS090306[PT3]

GARAGE DECLARATIONS (PART 3) AK , CA , CO , CT , DE , FL , HI , IL ,IN , KS , LA , MI , MN , NC , NH , NV ,NY , OH , RI , SC , TX , VA , WI , WV

CADS09-4 03/06 CADS090306[PT4]


CADS09-5 03/06 CADS090306[PT5]


CADS09-6 03/06 CADS090306[PT6]


CADS09PAK 03/06 CADS09PAK03/06

GARAGE DECLARATIONS-DECKPAK(MULTIPLE PARTS)




MM0094PAK 09/02 MM00940902[MA]

GARAGE DECLARATIONS—MASSACHUESTTS DEPAK (PARTS 1-6)

MA

SJDL190244 A 09/98 GARAGE DECLARATIONS—MASSACHUSETTS (PART 4)



MM0094-5 10/06 MM00941006 GARAGE DECLARATIONS—MASSACHUSETTS (PART 5)

MA

MM0094-6 10/06 MM00941006 GARAGE DECLARATIONS—MASSACHUSETTS (PART 6)

MA

SJDL190246 A 09/98 J GARAGE DECLARATIONS—MASSACHUSETTS (PART 6)



(M)CADS19-1 07/97 CADS190797(PT1) MOTOR CARRIER COVERAGE FORM

DECLARATIONS (PART 1) MULTILINECA

CADS19-2 07/97 CADS190797(PT2) MOTOR CARRIER COVERAGE FORMDECLARATIONS (PART 2) MULTILINE

CA

CADS21 03/06 CADS210306 MOTOR CARRIER DEC CADS21 PT 2 VA




CADS21 03/10 CADS210310 MOTOR CARRIER DEC CADS21 PT 2 AL , AR , AZ , CO , DC , DE , GA , HI , IA ,ID , IN , KY , LA , MD , MI , MO , MS ,

MT , ND , NE , NH , NM , NY , OH , OK ,RI , SC , SD , TN , UT , VT , WA , WI , WY

CADS21 07/97 CADS210797 MOTOR CARRIER DEC CADS21 PT 2 AK , AL , AR , AZ , CA , CO , CT ,DC , DE , FL , GA , HI , IA , ID , IL ,IN , KS , KY , LA , MD , ME , MI ,



CADS21 10/13 CADS211013 MOTOR CARRIER DEC CADS21 PT 2 AL , AR , AZ , CA , CO , CT , DC ,DE , GA , IA , ID , IL , IN , KS , KY ,LA , ME , MI , MN , MO , MS , MT ,NC , ND , NE , NH , NJ , NM , NV ,


SJDL1902220 A 07/97 CA0021 MOTOR CARRIER DECLARATIONS(CONTINUED) (PART 2)



CADS21PAK 03/06 CADS210306 MOTOR CARRIER DECLARATIONS (DECPAK PARTS 1-4)




[PT1]MOTOR CARRIER DECLARATIONS(PART 1)






CADS21-1 10/01 CADS211001(PT1) MOTOR CARRIER DECLARATIONS(PART 1)

MN

CADS21-2 02/03 CADS210203[PT2]

MOTOR CARRIER DECLARATIONS(PART 2)






CADS21-3 02/03 CADS210203[PT3]







CADS21-4 03/06 CADS210306[PT4]






(T)CADS28-3 12/02 CADS281202(PT3) TEXAS BUSINESS AUTO DECLARATION

(PART 3)TX

CADS34-1 02/01 CADS340201(PT1) TEXAS BUSINESS AUTO PHYSICALDAMAGE DECLARATION (PART 1)





TX


TX

CADS36-1 06/04 CADS360604(PT1) TEXAS FLEET SCHEDULE—LIABILITYAND PHYSICAL DAMAGE (PART 1)




CADS36-2 06/04 CADS3620604 TEXAS FLEET SCHEDULE—LIABILITYAND PHYSICAL DAMAGE (PART 2)

TX

CADS30 02/01 CADS300201 TEXAS GARAGE DECLARATION AK , AL , AR , AZ , CA , CO , CT ,DC , DE , FL , GA , HI , IA , ID , IL ,IN , KS , KY , LA , MD , ME , MI ,



CADS30 12/02 CADS301202 TEXAS GARAGE DECLARATION TXCADS33-1 02/01 CADS330201(PT1) TEXAS MOTOR CARRIER

DECLARATION (PART 1)TX

CADS33-1 12/02 CADS331202(PT1) TEXAS MOTOR CARRIERDECLARATION (PART 1)

TX


TX


TX

CADS29-1 02/01 CADS290201(PT1) TEXAS TRUCKERS DECLARATION(PART 1)

TX


TX


TX


TX

SJDL190131OB

12/93 F TRUCKERS COVERAGE FORMDECLARATIONS



CADS13-1 07/97 CADS130797(PT1) TRUCKERS COVERAGE FORMDECLARATIONS (PART 1) (MULTILINE)

CA

CADS13-2 07/97 CADS130797(PT2) TRUCKERS COVERAGE FORMDECLARATIONS (PART 2) (MULTILINE)

CA




SJDL80682O A 04/89 TRUCKERS COVERAGE FORMDECLARATIONS (PART 2) 5 PART SNAPSET—TEXAS



CADS14 01/09 CA01130109 TRUCKERS DEC CADS14 PT2 COCADS14 03/06 CADS140306 TRUCKERS DEC CADS14 PT2 AK , AL , AR , AZ , CA , CO , CT , DC ,

DE , FL , GA , HI , IA , ID , IL , IN , KS ,KY , LA , MD , MI , MN , MO , MS , MT ,NC , ND , NE , NH , NJ , NM , NV , NY ,OH , OK , OR , PA , RI , SC , SD , TN ,

TX , UT , VA , VT , WA , WI , WV , WYCADS14 07/97 CADS140797(PT2) TRUCKERS DEC CADS14 PT2 CACADS27-1 11/02 CADS271102(PT1) TRUCKERS DECLARATION (PART 1)—

VIRGINIAVA

CADS27-2 11/02 CADS271102(PT1) TRUCKERS DECLARATION (PART 2)—VIRGINIA

VA

SJDL190132 01/87 TRUCKERS DECLARATIONS(CONTINUED) (PART 2)

AK , AL , AR , AZ , CA , CO , CT ,DC , DE , FL , GA , HI , IA , ID , IL ,IN , KS , KY , LA , MA , MD , ME ,MI , MN , MO , MS , MT , NC , ND ,NE , NH , NJ , NM , NV , NY , OH ,OR , PA , RI , SC , SD , TN , TX ,

UT , VA , VT , WA , WI , WV , WYCADS14-1 02/03 CADS140203

[PT1]TRUCKERS DECLARATIONS (PART 1) AK , AL , AR , AZ , CA , CO , CT , DC ,

DE , FL , GA , HI , IA , ID , IL , IN , KS ,KY , LA , MD , ME , MI , MN , MO , MS ,MT , NC , ND , NE , NH , NJ , NM , NV ,NY , OH , OR , PA , RI , SC , SD , TN ,


[PT1]TRUCKERS DECLARATIONS (PART 1) AK , AL , AR , AZ , CA , CO , CT ,

DC , DE , FL , GA , HI , IA , ID , IL ,IN , KS , KY , LA , MD , ME , MI ,



CADS14-1 10/01 CADS141001(PT1) TRUCKERS DECLARATIONS (PART 1) AK , AL , AR , AZ , CA , CO , CT , DC ,DE , FL , GA , HI , IA , ID , IL , IN , KS ,


TX , UT , VA , VT , WA , WI , WV , WYCADS14PAK 03/06 CADS140306 TRUCKERS DECLARATIONS (PART 1-4) AK , AL , AR , AZ , CA , CO , CT ,




CADS14-2 02/03 CADS140203[PT2]

TRUCKERS DECLARATIONS (PART 2) AK , AL , AR , AZ , CA , CO , CT , DC ,DE , FL , GA , HI , IA , ID , IL , IN , KS ,










CADS14-2 10/01 CADS141001(PT2) TRUCKERS DECLARATIONS (PART 2) AK , AL , AR , AZ , CA , CO , CT , DC ,DE , FL , GA , HI , IA , ID , IL , IN , KS ,


TX , UT , VA , VT , WA , WI , WV , WYSJDL190212 A 09/98 TRUCKERS DECLARATIONS (PART 2)

MASSACHUSETTSMA

CADS14-3 02/03 CADS140203[PT3]

TRUCKERS DECLARATIONS (PART 3) AK , AL , AR , AZ , CA , CO , CT , DC ,DE , FL , GA , HI , IA , ID , IL , IN , KS ,







SJDL190213 A 09/98 TRUCKERS DECLARATIONS (PART 3)MASSACHUSETTS

MA

(V)CADS22-1 11/02 CADS221102(PT1) VIRGINIA BUSINESS AUTO

DECLARATION (PART 1)VA

CADS37 08/08 CADS370808 VIRGINIA GARAGE DECLARATION -NON-DEALERS

VA

--------------------------------------------------------SCHEDULES

--------------------------------------------------------(G)

CADS25-3 11/02 CADS251102(PT3) GARAGE COVERAGE FORM—AUTO DEALERS' SUPPLEMENTARYSCHEDULE

VA

CA187-2 12/93 CA00071293(PG2) F GARAGE COVERAGE FORM—AUTO DEALERS' SUPPLEMENTARYSCHEDULE (CONTINUED) PART 2 OF 2



TX , UT , VA , VT , WA , WI , WV , WYCADS25-1 11/02 CADS251102(PT1) GARAGE COVERAGE FORM—

AUTO DEALERS' SUPPLEMENTARYSCHEDULE (PART 1)

VA

CADS31-1 02/01 CADS310201(PT1) GARAGE COVERAGE FORM—AUTO DEALERS' SUPPLEMENTARYSCHEDULE (PART 1) (TEXAS)

TX


TX

CA156-1 B 03/92 GARAGE COVERAGE FORM—AUTO DEALERS' SUPPLEMENTARYSCHEDULE (PART 1) 5 PART SNAP SET(TEXAS)

TX

CADS25-2 11/02 CADS251102(PT2) GARAGE COVERAGE FORM—AUTO DEALERS' SUPPLEMENTARYSCHEDULE (PART 2)

VA




CA156-2 11/87 GARAGE COVERAGE FORM—AUTO DEALERS' SUPPLEMENTARYSCHEDULE (PART 2) 5 PART SNAP SET(TEXAS)

TX


TX


TX

CADS32-1 02/01 CADS320201(PT1) GARAGE COVERAGE FORM—NON-DEALERS' AND DEALERS'SUPPLEMENTARY SCHEDULE (PART 1)(TEXAS)

TX

CADS32-1 12/02 CADS321202(PT1) GARAGE COVERAGE FORM—NON-DEALERS' AND DEALERS'SUPPLEMENTARY SCHEDULE (PART 1)(TEXAS)

TX

CADS32-4 12/02 CADS321202(PT4) GARAGE COVERAGE FORM—NON-DEALERS' AND TRAILER DEALERS'SUPPLEMENTARY SCHEDULE (PART 1)(TEXAS)

TX

CA157-1 A 04/89 GARAGE COVERAGE FORM—NON-DEALERS' AND TRAILER DEALERS'SUPPLEMENTARY SCHEDULE (PART 1)5 PART SNAP SET (TEXAS)

TX

CADS32-2 12/02 CADS321202(PT2) GARAGE COVERAGE FORM—NON-DEALERS' AND TRAILER DEALERS'SUPPLEMENTARY SCHEDULE (PART 2)(TEXAS

TX

CA157-2 11/87 GARAGE COVERAGE FORM—NON-DEALERS' AND TRAILER DEALERS'SUPPLEMENTARY SCHEDULE (PART 2)5 PART SNAP SET (TEXAS)

TX

CADS32-3 12/02 CADS321202(PT3) GARAGE COVERAGE FORM—NON-DEALERS' AND TRAILER DEALERS'SUPPLEMENTARY SCHEDULE (PART 3)(TEXAS)

TX

(S)CA5000 11/03 SCHEDULE OF COVERED AUTOS YOU

OWN - EXTENSION OF DECLARATIONS(PART 1 AND PART 2)



TX , UT , VA , VT , WA , WI , WV , WYSJDL1901112132C

C SCHEDULE OF COVERED AUTOS YOUOWN (NEW YORK)

NY

CA191 11/87 SCHEDULE OF COVERED AUTOS YOUOWN—EXTENSION OF DECLARATIONS—5 PART SNAP SET (TEXAS)



TX , UT , VA , VT , WA , WI , WV , WY--------------------------------------------------------

QUICK REFERENCE FORMS--------------------------------------------------------

(B)CA182 02/91 BUSINESS AUTO COVERAGE FORM AK , AL , AR , AZ , CA , CO , CT , DC ,

DE , FL , GA , HI , IA , ID , IL , IN , KS ,KY , LA , MD , ME , MI , MN , MO , MS ,MT , NC , ND , NE , NH , NJ , NM , NV ,




NY , OH , OR , PA , RI , SC , SD , TN ,TX , UT , VA , VT , WA , WI , WV , WY

CA180 02/91 BUSINESS AUTO PHYSICAL DAMAGECOVERAGE FORM



TX , UT , VA , VT , WA , WI , WV , WY(G)

CA179 02/91 GARAGE COVERAGE FORM AK , AL , AR , AZ , CA , CO , CT , DC ,DE , FL , GA , HI , IA , ID , IL , IN , KS ,


TX , UT , VA , VT , WA , WI , WV , WY(T)

CA181 02/91 TRUCKERS COVERAGE FORM AK , AL , AR , AZ , CA , CO , CT , DC ,DE , FL , GA , HI , IA , ID , IL , IN , KS ,


TX , UT , VA , VT , WA , WI , WV , WY--------------------------------------------------------

GENERAL USE/STATE SPECIFIC--------------------------------------------------------

($)CA839 12/93 CA03031293 2 $100 DEDUCTIBLE FOR COMPLETED

OPERATIONS DOES NOT APPLYAL , AR , AZ , CO , DC , DE , FL , GA ,

GU , IA , ID , IL , IN , KS , KY , LA ,MA , MD , ME , MI , MN , MO , MS ,MT , NC , ND , NE , NH , NJ , NM ,

NV , OH , OK , OR , PA , RI , SC , SD ,TN , TX , UT , VT , WA , WI , WV , WY

(A)CA2528 10/13 CA25281013 ABUSE OR MOLESTATION EXCLUSION

FOR GENERAL LIABILITY COVERAGESAK , AL , AR , AZ , CA , CO , CT , DC ,

DE , GA , IA , ID , IL , IN , KS , KY ,LA , ME , MI , MN , MO , MS , MT ,

NC , ND , NE , NH , NJ , NM , NV , NY ,OH , OK , OR , PA , PR , RI , SC , SD ,

TN , UT , VA , VT , WA , WI , WV , WYUA186 A 04/04 DI45080700 ACKNOWLEDGEMENT OF

REQUIREMENT FOR PRE-INSPECTIONFL

A709 01/78 CA22350178 +, ++ ADDED PERSONAL INJURYPROTECTION ENDORSEMENT

ND

A712 01/78 CA22450178 +, ++ ADDED PERSONAL INJURYPROTECTION ENDORSEMENT

UT

CA382 A 03/94 CA22350394 +++ ADDED PERSONAL INJURYPROTECTION ENDORSEMENT

ND

A705 B 08/87 CC22150887 ADDED PERSONAL INJURYPROTECTION ENDORSEMENT

KS

CA719 03/92 TE9901B0392 1, 2, 3 ADDITIONAL INSURED TXCA2529 10/13 CA25291013 ADDITIONAL INSURED - GENERAL

LIABILITY COVERAGES -CONCESSIONAIRES TRADING UNDERYOUR NAME


KY , LA , ME , MI , MN , MO , MS , MT ,NC , ND , NE , NH , NJ , NM , NV , NY ,

OH , OK , OR , PA , PR , RI , SC , SD , TN ,TX , UT , VA , VT , WA , WI , WV , WY

CA2530 10/13 CA25301013 ADDITIONAL INSURED - GENERALLIABILITY COVERAGES -CONTROLLING INTERST







CA2546 10/13 CA25461013 ADDITIONAL INSURED - GENERALLIABILITY COVERAGES - CO-OWNEROF INSURED PREMISES




CA2532 10/13 CA25321013 ADDITIONAL INSURED - GENERALLIABILITY COVERAGES - GRANTOR OFLICENSES




CA2531 10/13 CA25311013 ADDITIONAL INSURED - GENERALLIABILITY COVERAGES - GRANTOR OFLICENSES - AUTOMATIC STATUS WHENREQUIRED BY LICENSOR




CA2545 10/13 CA25451013 ADDITIONAL INSURED - GENERALLIABILITY COVERAGES - LESSOR OFLEASED EQUIPMENT - AUTOMATICSTATUS WHEN REQUIRED IN LEASEAGREEMENT WITH YOU




CA934 07/97 CA20490797 2, F ADDITIONAL INSURED—GARAGES—GRANTOR OF FRANCHISE

AL , AR , AZ , CO , DC , DE , GA ,IA , ID , IL , IN , KS , KY , LA ,

MD , ME , MI , MN , MO , MS , MT ,NC , ND , NE , NH , NJ , NM , NV ,OH , OR , PA , RI , SC , SD , TN ,

TX , UT , VT , WA , WI , WV , WYCA1029 07/97 CA20490797(HI) 2, F ADDITIONAL INSURED—GARAGES—

GRANTOR OR FRANCHISEHI

CA651 03/92 TE2001A0392 1, 2, 3 ADDITIONAL INSURED—LESSOR(BROAD FORM COVERAGE)

TX

CA662 03/92 TE2002A0392 1, 2, 3 ADDITIONAL INSURED—LESSOR(LIMITED FORM COVERAGE)

TX

CA932 07/97 CA20470797 2, F ADDITIONAL INSURED—LESSOR OFLEASED EQUIPMENT


MD , ME , MI , MN , MO , MS , MT ,NC , ND , NE , NH , NJ , NM , NV ,OH , OR , PA , RI , SC , SD , TN ,

TX , UT , VT , WA , WI , WV , WYCA1027 07/97 CA20470797(HI) 2, F ADDITIONAL INSURED—LESSOR OF

LEASED EQUIPMENTHI

CA2233 11/18 CA22331118 F ADDITIONAL PERSONAL INJURYPROTECTION (NEW YORK)

NY

CA995 06/99 ADVISORY NOTICE TOPOLICYHOLDERS—1997 COMMERCIALAUTO MULTISTATE REVISION

NY

CA138 10/97 F ADVISORY NOTICE TOPOLICYHOLDERS—1997 COMMERCIALAUTO MULTISTATE REVISION



TX , UT , VA , VT , WA , WI , WV , WYCA188 02/99 +, ++, +++, 1,

2, 3, 4, 5, A, B,C, D, E, F, G,H, I, J, K, M

ADVISORY NOTICE TOPOLICYHOLDERS—1998 COMMERCIALAUTO MULTISTATE REVISION


KY , LA , MD , ME , MI , MN , MO , MS ,MT , NC , ND , NE , NH , NJ , NM , NV ,





CA1137 09/02 ADVISORY NOTICE TOPOLICYHOLDERS—BROADENINGS ANDCLARIFICATIONS OF COVERAGE (2002REVISION)



TX , UT , VA , VT , WA , WI , WV , WYGU564 09/02 ADVISORY NOTICE TO

POLICYHOLDERS—BROADENINGS ANDRESTRICTIONS OF COVERAGE


UT , VA , VT , WA , WI , WV , WYCA1113 10/01 ADVISORY NOTICE TO

POLICYHOLDERS—BROADENINGS,RESTRICTIONS AND CLARIFICATIONOF COVERAGE

FL

CA1115 10/01 ADVISORY NOTICE TOPOLICYHOLDERS—BROADENINGS,RESTRICTIONS AND CLARIFICATIONOF COVERAGE

IL

CA997 06/00 ADVISORY NOTICE TOPOLICYHOLDERS—BROADENINGS,RESTRICTIONS AND CLARIFICATIONSOF COVERAGE

RI


IN


KS


ME


MI




TX , UT , VA , VT , WA , WI , WV , WYCA1114 10/01 ADVISORY NOTICE TO

POLICYHOLDERS—BROADENINGS,RESTRICTIONS AND CLARIFICATIONSOF COVERAGE

GA


MO


NE





WV


NV


VT


NH


SD


UT


WA

CA1143 11/02 ADVISORY NOTICE TOPOLICYHOLDERS—BROADENINGS,RESTRICTIONS AND CLARIFICATIONSOF COVERAGE FOR VIRGINIA

VA

CA1106 06/00 ADVISORY NOTICE TOPOLICYHOLDERS—CALIFORNIA—BROADENINGS, RESTRICTIONS ANDCLARIFICATIONS OF COVERAGE

CA

CA2324 10/01 CA23241001 1, 3, 5, F AGRICULTURAL PRODUCE TRAILERS—SEASONAL

SC

CA2324 10/13 CA23241013 1, 3, 5, F AGRICULTURAL PRODUCE TRAILERS—SEASONAL




CA1055 A 10/01 CA23241001(HI) 1, 3, 5, F AGRICULTURAL PRODUCE TRAILERS—SEASONAL

HI

CA2592 10/13 CA25921013 ALASKA – COMPUTER DATE AND TIME-RELATED ELECTRONIC PROBLEMS –EXCLUSION OF SPECIFIED COVERAGESFOR DESIGNATED LOCATIONS,PRODUCTS, SERVICES OR WORK YOUPERFORMED

AK

CA2588 10/13 CA25881013 ALASKA - EXCLUSION - COMPUTERDATE AND TIME-RELATEDELECTRONIC PROBLEMS

AK

CA2589 10/13 CA25891013 ALASKA - EXCLUSION - COMPUTERDATE AND TIME-RELATEDELECTRONIC PROBLEMS - PRODUCTS/WORK YOU PERFORMED

AK

CA2591 10/13 CA25911013 ALASKA – EXCLUSION – COMPUTERDATE AND TIME-RELATED

AK




ELECTRONIC PROBLEMS – WITHEXCEPTION FOR BODILY INJURY ONYOUR PREMISES

CA2590 10/13 CA25901013 ALASKA – LIMITED COVERAGEOPTIONS – COMPUTER DATE ANDTIME-RELATED ELECTRONICPROBLEMS

AK

CA2623 07/11 CA26230711 ALASKA AMENDMENT OF SINGLEINTEREST POLICY PROVISIONS

AK

CA9945 02/14 CA99450214 ALASKA BUSINESS INTERRUPTIONCOVERAGE

AK

CA0179 09/14 CA01790914 ALASKA CHANGES AKCA0158 09/14 CA01580914 2 ALASKA CHANGES GARAGE

COVERAGE FORMAK

CA2381 05/04 CA23810504 1, 2, 3, 4, 5 ALASKA CONDITIONAL EXCLUSIONOF TERRORISM ABOVE MINIMUMSTATUTORY LIMITS (RELATING TODISPOSITION OF FEDERAL TERRORISMRISK INSURANCE ACT OF 2002)

AK

CA2382 05/04 CA23820504 1, 2, 3, 4, 5 ALASKA CONDITIONAL EXCLUSIONOF TERRORISM INVOLVING NUCLEAR,BIOLOGICAL OR CHEMICALTERRORISM ABOVE MINIMUMSTATUTORY LIMITS (RELATING TODISPOSITION OF FEDERAL TERRORISMRISK INSURANCE ACT OF 2002)

AK

CA0308 09/14 CA03080914 1, 2, 3, 5, F ALASKA DEDUCTIBLE LIABILITYCOVERAGE

AK

CA2371 06/03 CA23710603 1, 2, 3, 4, 5 ALASKA EXCLUSION OF CERTIFIEDACTS OF TERRORISM ABOVE MINIMUMSTATUTORY LIMITS

AK

CA2375 06/03 CA23750603 1, 2, 3, 4, 5 ALASKA EXCLUSION OF CERTIFIEDACTS OF TERRORISM; AND OTHERACTS OF TERRORISM ABOVE MINIMUMSTATUTORY LIMITS

AK

CA2374 06/03 CA23740603 1, 2, 3, 4, 5 ALASKA EXCLUSION OF CERTIFIEDACTS OF TERRORISM; AND OTHERNUCLEAR, BIOLOGICAL OR CHEMICALACTS OF TERRORISM ABOVE MINIMUMSTATUTORY LIMITS

AK

CA2388 10/13 CA23881013 1, 2, 3, 4, 5 ALASKA EXCLUSION OF TERRORISMABOVE MINIMUM STATUTORY LIMITS

AK

CA2389 10/13 CA23891013 1, 2, 3, 4, 5 ALASKA EXCLUSION OF TERRORISMINVOLVING NUCLEAR, BIOLOGICALOR CHEMICAL TERRORISM ABOVEMINIMUM STATUTORY LIMITS

AK

CA2332 09/14 CA23320914 ALASKA LIMITED MEXICO COVERAGE AKCA2372 06/03 CA23720603 1, 2, 3, 4, 5 ALASKA LIMITED TERRORISM

EXCLUSION (OTHER THAN CERTIFEDACTS OF TERRORISM) ABOVEMINIMUM STATORY LIMITS; CAP ONLOSSES FROM CERTIFIED ACTS OFTERRORISM

AK

CA2331 09/14 CA23310914 ALASKA MOTOR CARRIERENDORSEMENT

AK

CA2373 06/03 CA23730603 1, 2, 3, 4, 5 ALASKA NUCLEAR, BIOLOGICAL ORCHEMICAL TERRORISM EXCLUSION(OTHER THAN CERTIFIED ACTSOF TERRORISM) ABOVE MINIMUMSTATUTORY LIMITS; CAP ON LOSSESFROM CERTIFIED ACTS OF TERRORISM

AK




CA0516 01/18 CA05160118 ALASKA PUBLIC OR LIVERYPASSENGER CONVEYANCE ANDTRANSPORTATION NETWORKSERVICES EXCLUSION

AK

CA0517 01/18 CA05170118 ALASKA PUBLIC OR LIVERYPASSENGER CONVEYANCE,TRANSPORTATION NETWORK ANDON-DEMAND DELIVERY SERVICESEXCLUSION

AK

CA3124 04/00 CA31240400 F ALASKA SPLIT UNINSURED ANDUNDERINSURED MOTORISTSCOVERAGE LIMITS

AK

CA2160 01/19 CA21600119 1, 2, 3, 5, F ALASKA UNINSURED ANDUNDERINSURED MOTORISTSCOVERAGE

AK

CA765 01/92 TE0039A0192 AMENDATORY ENDORSEMENT TXCA765 A 12/92 TE0039B1292 AMENDATORY ENDORSEMENT TXCA859 B 02/03 TE0040B0203 1, 2, 3, F AMENDATORY ENDORSEMENT TXCA996 01/00 RC001 AMENDATORY ENDORSEMENT

(AUTOMOBILE RENTAL LIABILITYPOLICY—AUTOMOBILE RENTALLIABILITY EXCESS POLICY)

TX

CA2558 10/13 CA25581013 AMENDMENT OF LIMITS OFINSURANCE - GENERAL LIABILITYCOVERAGES




CA904 11/90 CA26031190 F AMENDMENT OF SINGLE INTERESTCOVERAGES

PR

CA906 04/80 CA26070480 F AMENDMENT OF SINGLE INTERESTPOLICY PROVISIONS

SC

CA905 04/80 CA26060480 F AMENDMENT OF SINGLE INTERESTPOLICY PROVISIONS - KANSAS

KS

CA908 01/81 CA26090181 F AMENDMENT OF SINGLE INTERESTPOLICY PROVISIONS - MISSOURI

MO

CA2608 03/06 CA26080306 F AMENDMENT OF SINGLE INTERESTPOLICY PROVISIONS - NORTHCAROLINA

NC

CA2604 11/16 CA26041116 AMENDMENT OF SINGLE INTERESTPOLICY PROVISIONS - PUBLIC ORLIVERY PASSENGER CONVEYANCEAND ON-DEMAND DELIVERY SERVICESEXCLUSION

AK , AL , AR , AZ , CA , CO , CT , DC ,DE , GU , HI , IA , ID , IL , IN , KY ,LA , MD , ME , MI , MN , MO , MS ,MT , NC , ND , NE , NH , NJ , NM ,

NV , OH , OK , OR , PA , RI , SC , SD ,TN , UT , VI , VT , WA , WI , WV , WY

CA909 02/81 CA26100281 F AMENDMENT OF SINGLE INTERESTPOLICY PROVISIONS - WISCONSIN

WI

CA2614 01/02 CA26140102 AMENDMENT OF SINGLE INTERESTPOLICY PROVISIONS—WAR, MILITARYACTION AND TERRORISM



TX , UT , VA , VT , WA , WI , WV , WYCA2397 03/10 CA23970310 1, 2, 4, 5 AMPHIBIOUS VEHICLES AL , AR , AZ , CO , DC , DE , GA ,

IA , ID , IN , KY , LA , MD , MI ,MO , MS , MT , ND , NE , NH ,

NM , NV , OH , OK , RI , SC , SD ,TN , UT , VT , WA , WI , WV , WY

CA687 03/92 TE2031A0392 1, 2, 3 AMPHIBIOUS VEHICLES TXCA2397 10/13 CA23971013 1, 2, 4, 5 AMPHIBIOUS VEHICLES AK , AL , AR , AZ , CA , CO , CT , DC ,

DE , GA , HI , IA , ID , IL , IN , KS , KY ,




LA , ME , MI , MN , MO , MS , MT , NC ,ND , NE , NH , NJ , NM , NV , NY , OH ,


CA701 03/92 TE2325A0392 1 AMUSEMENT DEVICES MOUNTED ONCOMMERCIAL AUTOS

TX

CA686 A 01/94 TE2032B0194 1, 2, 3 ANTIQUE, COLLECTIBLE OR SPECIALINTEREST AUTO

TX

A3843 A 04/00 APPLICATION FOR BENEFITS GAA3973 A 04/84 APPLICATION FOR BENEFITS MIA3836 A 11/94 APPLICATION FOR BENEFITS MNA3951 01/72 APPLICATION FOR BENEFITS

(AUTOMOBILE PERSONAL INJURYPROTECTION)

OR

A3976 09/73 APPLICATION FOR BENEFITS(AUTOMOBILE PERSONAL INJURYPROTECTION)

TX

A3980 01/74 APPLICATION FOR BENEFITS(PERSONAL INJURY PROTECTION)

UT


KS


ND

A3965 A 01/95 PIP1(NJ) APPLICATION FOR BENEFITS(PERSONAL INJURY PROTECTION)

NJ

A3956 A 03/09 PIP-1 APPLICATION FOR BENEFITS(PERSONAL INJURY PROTECTION)

DE

A3815 B 12/07 APPLICATION FOR BENEFITS(PERSONAL INJURY PROTECTION)

MA

A3947 01/96 APPLICATION FOR FLORIDA "NO-FAULT" BENEFITS - SPANISH VERSION

FL

A3944 C 01/96 APPLICATION FOR ''NO-FAULT''BENEFITS

FL

CA0423 07/04 CA04230704 1, 2, 3, 4, 5 ARIZONA - FULL GLASS COVERAGE AZCA0423 10/13 CA04231013 1, 2, 3, 4, 5 ARIZONA - FULL GLASS COVERAGE AZCA0175 10/13 CA01751013 1, 2, 3, 4, 5 ARIZONA CHANGES AZCA0205 05/14 CA02050514 ARIZONA CHANGES – NONRENEWAL AZCA2140 10/13 CA21401013 1, 2, 3, 5, F ARIZONA UNDERINSURED MOTORISTS

COVERAGEAZ

CA2139 10/13 CA21391013 1, 2, 3, 5, F ARIZONA UNINSURED MOTORISTSCOVERAGE

AZ

CA0162 10/13 CA01621013 1, 2, 3, 4, 5, F ARKANSAS CHANGES ARGU512 03/98 IL09090398 ARKANSAS NOTICE ARCA2202 11/16 CA22021116 1, 2, 3, 5, F ARKANSAS PERSONAL INJURY

PROTECTIONAR

CA3128 11/18 CA31281118 1, 2, 3, 5, F ARKANSAS UNDERINSUREDMOTORISTS COVERAGE

AR

CA2108 11/18 CA21081118 1, 2, 3, 5, F ARKANSAS UNINSURED MOTORISTSCOVERAGE

AR

CA2166 11/18 CA21661118 1, 2, 3, 5, F ARKANSAS UNINSURED MOTORISTSCOVERAGE - PROPERTY DAMAGE

AR

A3957 PIP-2 ATTENDING PHYSICIAN'S REPORT DEA3961 ATTENDING PHYSICIAN'S REPORT ARA3952 01/72 ATTENDING PHYSICIAN'S REPORT ORA3970 01/73 ATTENDING PHYSICIAN'S REPORT MDA3981 01/74 ATTENDING PHYSICIAN'S REPORT UTA3986 01/74 ATTENDING PHYSICIAN'S REPORT KSA3924 01/76 ATTENDING PHYSICIAN'S REPORT NDA3844 03/75 ATTENDING PHYSICIAN'S REPORT GAA3977 09/73 ATTENDING PHYSICIAN'S REPORT TXA3816 A ATTENDING PHYSICIAN'S REPORT MA




A3966 A 01/95 PIP2(NJ) ATTENDING PHYSICIAN'S REPORT NJA3774 A 01/96 ATTENDING PHYSICIAN'S REPORT CTA3848 A 03/95 ATTENDING PHYSICIAN'S REPORT PAA3974 A 04/84 ATTENDING PHYSICIAN'S REPORT MIA3837 A 11/94 ATTENDING PHYSICIAN'S REPORT MNA3993 A 11/94 NF130775 ATTENDING PHYSICIAN'S REPORT KYA3945 C 01/96 ATTENDING PHYSICIAN'S REPORT FLGU495 07/96 ATTORNEY FEES COVERAGE NOTICE—

AAK , AL , AR , AZ , CA , CO , CT ,


UT , VA , VT , WA , WI , WV , WYGU496 07/96 ATTORNEY FEES COVERAGE NOTICE—

BAK , AL , AR , AZ , CA , CO , CT ,



CAK , AL , AR , AZ , CA , CO , CT ,



DAK , AL , AR , AZ , CA , CO , CT ,


UT , VA , VT , WA , WI , WV , WYCA9960 10/13 CA99601013 1, 2, 3, 4, 5, F AUDIO, VISUAL & DATA ELECTRONIC

EQUIPMENT COVERAGEAK , AL , AR , AZ , CA , CO , CT , DC ,DE , GA , HI , IA , ID , IL , IN , KS , KY ,LA , ME , MI , MN , MO , MS , MT , NC ,ND , NE , NH , NJ , NM , NV , NY , OH ,


CA772 12/93 CA99601293 1, 2, 3, 4, 5 AUDIO, VISUAL, AND DATAELECTRONIC EQUIPMENT COVERAGE



TX , UT , VA , VT , WA , WI , WV , WYUA213 01/01 AUTO BODY REPAIR CONSUMER BILL

OF RIGHTSCA

CA0025 10/13 CA00251013 AUTO DEALERS COVERAGE FORM AK , AL , AR , AZ , CA , CO , CT , DC ,DE , FL , GA , HI , IA , ID , IL , IN , KS ,



CA2516 10/13 CA25161013 2, F AUTO DEALERS COVERAGE FORM -GENERAL LIABILITY COVERAGES -TOTAL POLLUTION EXCLUSION

AK , AL , AR , AZ , CA , CO , CT , DC ,DE , FL , GA , HI , IA , ID , IL , IN , KY ,

MI , MO , MS , MT , NC , ND , NE ,NH , NM , NV , NY , OH , OK , PR , RI ,SC , SD , UT , VT , WA , WI , WV , WY

CA2536 10/13 CA25361013 2, F




AUTO DEALERS COVERAGE FORM- GENERAL LIABILITY COVERAGES- TOTAL POLLUTION EXCLUSIONWITH A BUILDING HEATING, COOLINGAND DEHUMIDIFYING EQUIPMENTEXCEPTION AND A HOSTILE FIREEXCEPTION

AK , AL , AR , AZ , CA , CO , CT ,DC , DE , FL , GA , HI , IA , ID , IL ,IN , KS , KY , MI , MO , MS , MT ,NC , ND , NE , NH , NJ , NM , NV ,

NY , OH , OK , OR , PA , PR , RI , SC ,SD , UT , VT , WA , WI , WV , WY

CADS26 10/13 CADS261013 AUTO DEALERS DECLARATIONS AL , AR , AZ , CA , CO , CT , DC ,DE , GA , IA , ID , IL , IN , KS , KY ,LA , ME , MI , MN , MO , MS , MT ,NC , ND , NE , NH , NJ , NM , NV ,


CA1134 10/01 CA20711001(HI) AUTO LOAN/LEASE GAP COVERAGE HICA2071 10/01 CA20711001 1, 2, 3, 4, 5, F AUTO LOAN/LEASE GAP COVERAGE AL , AR , AZ , CO , DC , DE , GA ,

IA , ID , IL , IN , KY , LA , MD , MI ,MO , MS , MT , NC , ND , NE , NH ,NM , NV , OH , OK , RI , SC , SD ,TN , TX , UT , VT , WI , WV , WY

CA2071 10/13 CA20711013 1, 2, 3, 4, 5, F AUTO LOAN/LEASE GAP COVERAGE AK , AL , AR , AZ , CA , CO , CT , DC ,DE , FL , GA , HI , IA , ID , IL , IN , KS ,

KY , LA , ME , MI , MN , MO , MS , MT ,NC , ND , NE , NH , NJ , NM , NV , NY ,OH , OK , OR , PA , PR , RI , SC , SD ,

TN , TX , UT , VA , VT , WI , WV , WYCA718 03/92 TE9903B0392 AUTO MED PAYMNTS INS [TX] TXCA9903 03/06 CA99030306 1 AUTO MEDICAL PAYMENTS

COVERAGEAL , AR , AZ , CO , DE , GA , IA , ID , IN ,KY , LA , MS , MT , NE , NH , NM , NV ,OH , OK , RI , SD , TN , VT , WA , WY

CA583 06/92 CA99030692 1, 2, 3 AUTO MEDICAL PAYMENTSCOVERAGE



TX , UT , VA , VT , WA , WI , WV , WYCA9903 10/13 CA99031013 1 AUTO MEDICAL PAYMENTS

COVERAGEAK , AL , AR , AZ , DC , DE , FL , GA ,

HI , IA , ID , IL , IN , KS , KY , LA , ME ,MI , MN , MO , MS , MT , NC , ND , NH ,NJ , NM , NV , NY , OH , OK , OR , PR ,

RI , SC , SD , TN , TX , UT , VT , WA , WYCA798 12/93 CA99031293 1, 2, 3, 5 AUTO MEDICAL PAYMENTS

COVERAGEAK , AL , AR , AZ , CA , CO , CT , DC ,

DE , FL , GA , IA , ID , IL , IN , KS , KY ,LA , MD , ME , MI , MN , MO , MS ,

MT , NC , ND , NE , NH , NJ , NM , NV ,NY , OH , OK , OR , PA , RI , SC , SD ,TN , TX , UT , VA , VT , WA , WI , WY

CA747 03/92 TE9981A0392 1, 2, 3 AUTOMOBILE DEATH INDEMNITY ANDTOTAL DISABILITY COVERAGE

TX

UA100 C 09/14 AUTOMOBILE INSURANCE COVERAGEAND PREMIUM REDUCTION OPTIONSBOOKLET

PA

A3954 01/72 AUTOMOBILE PIP SUBROGATIONNOTICE

OR

CA790 12/93 CA20331293 1, 2, 3, 4, 5 AUTOS LEASED, HIRED, RENTEDOR BORROWED WITH DRIVERS—PHYSICAL DAMAGE COVERAGE



TX , UT , VA , VT , WA , WI , WV , WYCA1026 A 10/01 CA20331001(HI) 1, 2, 3, 4, 5, F HI




AUTOS LEASED, HIRED, RENTEDOR BORROWED WITH DRIVERS—PHYSICAL DAMAGE COVERAGE

CA2033 03/10 CA20330310 1, 2, 3, 4, 5, F AUTOS LEASED, HIRED, RENTED,BORROWED WITH DRIVERS PHYSICALDAMAGE

AL , AR , AZ , CO , DC , DE , GA , IA , ID ,IN , KY , LA , MD , MI , MO , MS , MT ,ND , NE , NH , NM , OH , OK , RI , SC ,SD , TN , UT , VT , WA , WI , WV , WY


VA


AK , AL , AR , AZ , CA , CO , CT , DC ,DE , GA , HI , IA , ID , IL , IN , KS , KY ,

LA , ME , MI , MN , MO , MS , MT ,NC , ND , NE , NH , NJ , NM , NV , NY ,OH , OK , OR , PA , PR , RI , SC , SD ,

TN , TX , UT , VT , WA , WI , WV , WY(B)

CA296 A 09/94 CA22050994 1, 2, 3, 5, F BASIC REPARATIONS BENEFITSENDORSEMENT

CT

CA586 06/92 CA25010692 2 BROAD FORM PRODUCTS COVERAGE AK , AL , AR , AZ , CA , CO , CT , DC ,DE , FL , GA , HI , IA , ID , IL , IN , KS ,


TX , UT , VA , VT , WA , WI , WV , WYCA800 12/93 CA25011293 2 BROAD FORM PRODUCTS COVERAGE AL , AR , AZ , CO , DC , DE , GU , IA ,

ID , IL , KS , KY , LA , MD , ME , MI ,MN , MO , MS , MT , ND , NE , NH ,

NJ , NM , NV , OH , OK , OR , RI , SD ,TX , UT , VT , WA , WI , WV , WY

CA1059 12/93 CA25011293(HI) 2, F BROAD FORM PRODUCTS COVERAGE HICA0001 10/13 CA00011013 1, F BUSINESS AUTO COVERAGE FORM AK , AL , AR , AZ , CA , CO , CT , DC ,

DE , GA , HI , IA , ID , IL , IN , KS , KY ,LA , ME , MI , MN , MO , MS , MT , NC ,ND , NE , NH , NJ , NM , NV , NY , OH ,


CA9905 02/14 CA99050214 BUSINESS INTERRUPTION COVERAGE AL , AZ , CA , CO , CT , DC , DE ,FL , GA , HI , IA , ID , IL , IN , KS ,KY , LA , MA , MD , ME , MI , MT ,NC , ND , NE , NH , NJ , NM , NV ,OH , OK , OR , PA , PR , RI , SC ,SD , TN , VI , VT , WI , WV , WY

(C)GU270 06/89 IL00030689 CALCULATION OF PREMIUM NY , TX , VAIL0003 08/07 IL00030807 CALCULATION OF PREMIUM NEIL0003 09/08 IL00030908 CALCULATION OF PREMIUM AK , AL , AR , AZ , CA , CO , CT , DC ,

DE , FL , GA , GU , IA , ID , IL , IN , KS ,KY , LA , MD , ME , MI , MN , MO ,

MS , MT , NC , ND , NH , NJ , NM , NV ,OH , OK , OR , PA , RI , SC , SD , TN ,

UT , VA , VI , VT , WA , WI , WV , WYGU266 11/85 IL00031185 CALCULATION OF PREMIUM AK , AL , AR , AZ , CA , CO , CT ,


UT , VA , VT , WA , WI , WV , WYCA720 03/92 TE9900A0392 1, 2, 3 CALCULATION OF PREMIUM—TERMS

LONGER THAN 12 MONTHSTX




CA0424 10/13 CA04241013 1, 2, 3, 5, F CALIFORNIA AUTO MEDICALPAYMENTS COVERAGE

CA

CA0143 05/17 CA01430517 1, 2, 3, 4, 5, F CALIFORNIA CHANGES CAIL0270 12/19 IL02701219 CALIFORNIA CHANGES -

CANCELLATION AND NONRENEWALCA

CA0305 10/13 CA03051013 CALIFORNIA CHANGES - WAIVER OFCOLLISION DEDUCTIBLE

CA

CA350 B 02/97 CA03050297 1, 2, 3, 4, 5, F CALIFORNIA CHANGES-WAIVER OFCOLLISION DEDUCTIBLE

CA

CA0426 03/10 CA04260310 CALIFORNIA DRIVER OTHER CARCOVERAGE - BROADENED COVERAGEFOR NAMED INDIVIDUALS

CA

CA0426 10/13 CA04261013 CALIFORNIA DRIVER OTHER CARCOVERAGE - BROADENED COVERAGEFOR NAMED INDIVIDUALS

CA

CA0425 10/13 CA04251013 1, 3, 4, 5, F CALIFORNIA INDIVIDUAL NAMEDINSURED

CA

CA2154 11/16 CA21541116 1, 2, 3, 5, F CALIFORNIA UNINSURED MOTORISTSCOVERAGE - BODILY INJURY

CA

CA2155 10/13 CA21551013 1, 2, 3, 5, F CALIFORNIA UNINSURED MOTORISTSCOVERAGE PROPERTY DAMAGE

CA

CA640 03/92 TE0202A0392 1, 2, 3 CANCELLATION PROVISION ORCOVERAGE CHANGE ENDORSEMENT



TX , UT , VA , VT , WA , WI , WV , WYCA2712 12/19 CA27121219 CANNABIS EXCLUSION FOR GENERAL

LIABILITY COVERAGESAK , AL , AR , AZ , CA , CO , CT , DC ,

DE , FL , GU , IA , ID , IL , IN , KS ,LA , MA , MD , ME , MI , MN , MO ,

MS , MT , NC , ND , NE , NH , NJ , NM ,NV , OH , OK , OR , PA , RI , SC , SD ,

TN , UT , VA , WA , WI , WV , WYCA2714 12/19 CA27141219 CANNABIS EXCLUSION WITH HEMP

AND LESSOR RISK EXCEPTION FORGENERAL LIABILITY COVERAGES

AK , AL , AR , AZ , CA , CO , CT , DC ,DE , FL , GU , IA , ID , IL , IN , KS ,LA , MA , MD , ME , MI , MN , MO ,

MS , MT , NC , ND , NE , NH , NJ , NM ,NV , OH , OK , OR , PA , PR , RI , SC ,

SD , TN , UT , VA , WA , WI , WV , WYCA2713 12/19 CA27131219 CANNABIS EXCLUSION WITH HEMP

EXCEPTION FOR GENERAL LIABILITYCOVERAGES

AK , AL , AR , AZ , CA , CO , CT , DC ,DE , FL , GU , IA , ID , IL , IN , KS ,LA , MA , MD , ME , MI , MN , MO ,

MS , MT , NC , ND , NE , NH , NJ , NM ,NV , OH , OK , OR , PA , PR , RI , SC ,

SD , TN , UT , VA , WA , WI , WV , WYTE9988 04/03 TE99880403 1, 2, 3, F CAP ON LOSSES FROM ACTS

OF TERRORISM PURSUANT TOTHE FEDERAL TERRORISM RISKINSURANCE ACT OF 2002

TX

CA1144 11/02 CA23561102(HI) 1, 2, 3, 4, 5 CAP ON LOSSES FROM CERTIFIED ACTSOF TERRORISM

HI

CA489 04/88 CHANGE IN DECLARATIONSENDORSEMENT—5 PART SNAPOUT SET



TX , UT , VA , VT , WA , WI , WV , WYCA0183 01/16 CA01830116 1, 2, 3, 4, 5 CHANGES WVIL0176 06/11 IL01760611 CHANGES - APPRAISAL AKIL0176 07/02 IL01760702 CHANGES - APPRAISAL AKIL0184 09/07 IL01840907 CHANGES - APPRAISAL SD




IL0121 03/00 IL01210300 CHANGES - ATTORNEYS FEES AKIL0121 07/02 IL01210702 CHANGES - ATTORNEYS FEES AKIL0121 09/00 IL01210900 CHANGES - ATTORNEYS FEES AKIL0121 09/08 IL01210908 CHANGES - ATTORNEYS FEES AKGU429 04/89 IL02810489 CHANGES - CANCELLATION WVIL0247 02/11 IL02470211 CHANGES - CANCELLATION AND

NONRENEWALME

IL0262 02/15 IL02620215 CHANGES - CANCELLATION ANDNONRENEWAL

GA


MI


AK


OK


OH


PA


WY


NV


IN


CO


AR


TN


UT


KY


IA


ID


OR


ND


AK

IL0110 07/01 IL01100701 CHANGES - CONCEALMENT,MISREPRESENTATION OR FRAUD

NV


ME


VT


NH


NV


CO


VT


NH





ME

IL0167 10/13 IL01671013 CHANGES - CONFORMITY WITHSTATUTES

MT

IL0165 09/08 IL01650908 CHANGES - EXAMINATION OF YOURBOOKS AND RECORDS

ND

IL0183 08/08 IL01830808 CHANGES - FRAUD NYCA978 02/99 CA00220299 1, 2, 3, 4, 5, F CHANGES IN COMMERCIAL AUTO

COVERAGE FORMSAK , AL , AR , AZ , CA , CO , CT , DC ,DE , FL , GA , HI , IA , ID , IL , IN , KS ,


TX , UT , VA , VT , WA , WI , WV , WYCA0051 12/04 CA00511204 1, 3, 4, 5, F CHANGES IN COVERAGE FORMS -

MOBILE EQUIPMENT SUBJECT TOMOTOR VEHICLE INSURANCE LAWS

MS

CA675 03/92 TE2046A0392 1, 2, 3 CHANGES IN TRANSFER OF RIGHTS OFRECOVERY AGAINST OTHERS TO US

TX

CA2562 10/13 CA25621013 CHANGES TO THE BANKRUPTCY ORINSOLVENCY EXCLUSION FOR ACTS,ERRORS OR OMISSIONS LIABILITYCOVERAGES




IL0260 01/19 IL02600119 CHANGES—CANCELLATION ANDNONRENEWAL

CT


NJ


NJ

IL0249 07/19 IL02490719 +, F CHANGES—CANCELLATION ANDNONRENEWAL

SC


NJ


NJ

IL0232 09/08 IL02320908 +, F CHANGES—CANCELLATION ANDNONRENEWAL

SD

IL0141 09/08 IL01410908 CHANGES—CIVIL UNION NJCA2026 10/13 CA20261013 1, 3, 5 CHANGES—LEASING OR RENTAL

CONCERNS—CONTINGENT COVERAGECA

CA285 01/87 CA01410187 1, 2, 3 CHANGES—PHYSICAL DAMAGECOVERAGE



TX , UT , VA , VT , WA , WI , WV , WYCA622 A 03/94 CA02710394 1, 2, 3, 4, 5 CHANGES—SUSPENSION OF

INSURANCE—PRIVATE PASSENGERAUTOS

ID

CA288 A 01/87 CA21010187 1, 2, 3 CHANGES—UNINSURED MOTORISTSCOVERAGE

KY

CA753 03/92 TE9975A0392 1, 2, 3 CHRISTIAN SCIENCE CARE TXUG184 12/00 CIVIL UNION ENDORSEMENT VTCA0440 01/11 CA04400111 COLORADO AUTO MEDICAL

PAYMENTSCO

CA0440 10/13 CA04401013 COLORADO AUTO MEDICALPAYMENTS

CO

CA0113 10/13 CA01131013 COLORADO CHANGES COCA9911 10/13 CA99111013 COLORADO CHANGES - DRIVERS

EXCLUSIONCO




CA329 A 12/93 CA99111293 1, 2, 3 COLORADO CHANGES-DRIVEREXCLUSION

CO

CA0412 10/13 CA04121013 F COLORADO EMERGENCY VEHICLES -FELLOW VOLUNTEER FIREFIGHTERSAND WORKERS INJURIES EXCLUSIONBUYBACK

CO

CA2099 10/13 CA20991013 1, F COLORADO EMERGENCY VEHICLES- VOLUNTEER FIREFIGHTERS ANDWORKERS INJURIES EXCLUDED

CO

CA2570 10/13 CA25701013 COLORADO EMPLOYEE BENEFITSLIABILITY COVERAGE

CO

CA2581 10/13 CA25811013 COLORADO EXTENDED REPORTINGPERIOD ENDORSEMENT FOREMPLOYEE BENEFITS LIABILITYCOVERAGE

CO

CA0437 11/16 CA04371116 COLORADO INDIVIDUALLY OWNEDMOTOR VEHICLES (CO)

CO

CA2150 07/17 CA21500717 1, 2, 3, 5, F COLORADO UNINSURED MOTORISTSCOVERAGE - BODILY INJURY

CO

CA2126 10/13 CA21261013 1, 2, 3, 5, F COLORADO UNINSURED MOTORISTSCOVERAGE - PROPERTY DAMAGE

CO

CA734 03/92 TE9926B0392 1, 2 COMBINED LIABILITY LIMITS TXCA1151 11/02 COMMERCIAL AUTO NOTICE TO

POLICYHOLDERSAK , AL , AR , AZ , CA , CO , CT , DC ,DE , FL , GA , HI , IA , ID , IL , IN , KS ,


TX , UT , VA , VT , WA , WI , WV , WYCA159 12/88 COMMERCIAL AUTO—GARAGE

COVERAGE GARAGE AGGREGATELIMIT CHANGES—SUMMARYOF COVERAGE RESTRICTIONS,BROADENING AND CLARIFICATIONS



TX , UT , VA , VT , WA , WI , WV , WYCA764 03/92 TE00170392 COMMON POLICY CONDITIONS TXIL0146 08/10 IL01460810 COMMON POLICY CONDITIONS WAGU519 11/98 IL00171198 F COMMON POLICY CONDITIONS AK , AL , AR , AZ , CA , CO , CT , DC ,

DE , FL , GA , GU , HI , IA , ID , IL ,IN , KS , KY , LA , MA , MD , ME ,MI , MN , MO , MS , MT , NC , ND ,NE , NH , NJ , NM , NV , NY , OH ,

OK , OR , PA , PR , RI , SC , SD , TN ,TX , UT , VA , VI , VT , WI , WV , WY

CA9966 02/18 CA99660218 1, 2, 3, 5, F COMMONWEALTH OF VIRGINIAEMPLOYEES USING AUTOS INGOVERNMENT BUSINESS

VA

CA2557 10/13 CA25571013 COMMUNICABLE DISEASE EXCLUSIONFOR GENERAL LIABILITY COVERAGES

AK , AL , AR , AZ , CA , CO , CT , DC ,DE , FL , GA , HI , IA , ID , IN , KS ,KY , LA , ME , MI , MN , MO , MS ,

MT , NC , ND , NE , NH , NJ , NM , NV ,NY , OH , OK , OR , PA , PR , RI , SC ,SD , TN , UT , VA , VT , WI , WV , WY

A3860 B 08/89 COMPLETED WORK CLAIM FORM(MASSACHUSETTS)

MA

IL0024 10/14 IL00241014 COMPULSORY LIABILITY INSURANCEPOLICY - PUERTO RICO

PR

CA2391 07/04 CA23910704 1, 2, 3, 4, 5 CONDITIONAL EXCLUSION OFTERRORISM INVOLVING NUCLEAR,BIOLOGICAL OR CHEMICALTERRORISM (RELATING TO

WA




DISPOSITION OF FEDERAL TERRORISMRISK INSURANCE ACT OF 2002)

UA126 01/90 CONFIRMATION OF VEHICLE STATUS DECA0107 10/13 CA01071013 1, 2, 3, 5, F CONNECTICUT CHANGES CTIL0140 09/08 IL01400908 CONNECTICUT CHANGES - CIVIL

UNIONCT

CA0190 10/13 CA01901013 1, 2, 3, F CONNECTICUT CHANGES – LIABILITYOF MUNICIPALITIES

CT

CA2578 10/13 CA25781013 1, 2, 3, 5, F CONNECTICUT EMPLOYEE BENEFITSLIABILITY COVERAGE

CT

CA2396 10/13 CA23961013 1, 2, 3, 5, F CONNECTICUT SILICA OR SILICA-RELATED DUST EXCLUSION FORCOVERED AUTOS EXPOSURE

CT

CA2580 10/13 CA25801013 1, 2, 3, 5, F CONNECTICUT SUPPLEMENTALEXTENDED REPORTING PERIODENDORSEMENT FOR EMPLOYEEBENEFITS LIABILITY COVERAGE

CT

CA699 03/92 TE2328A0392 1 COTTON TRAILERS TXCA1133 10/01 CA20701001(HI) 1, 2, 3, 5, F COVERAGE FOR CERTAIN OPERATIONS

IN CONNECTION WITH RAILROADSHI

CA2070 10/01 CA20701001 1, 2, 3, 5, F COVERAGE FOR CERTAIN OPERATIONSIN CONNECTION WITH RAILROADS

AL , AR , AZ , CO , DC , DE , GA ,IA , ID , IL , IN , KY , LA , MD , MI ,MO , MS , MT , NC , ND , NE , NH ,NM , NV , OH , RI , SC , SD , TN ,TX , UT , VT , WA , WI , WV , WY

CA2070 10/13 CA20701013 1, 2, 3, 5, F COVERAGE FOR CERTAIN OPERATIONSIN CONNECTION WITH RAILROADS




CA938 07/97 CA23250797 1, 2, 3, 5, F COVERAGE FOR INJURY TO LEASEDWORKERS

AL , AR , AZ , CO , DC , DE , GA ,GU , IA , ID , IL , IN , KS , KY , LA ,MD , ME , MI , MN , MS , MT , NC ,ND , NE , NH , NJ , NM , NV , OH ,OK , OR , PA , RI , SC , SD , TN ,

TX , UT , VT , WA , WI , WV , WYCA1056 07/97 CA23250797(HI) 1, 2, 3, 5, F COVERAGE FOR INJURY TO LEASED

WORKERSHI

CA951 07/97 CA99540797 1, 2, 3, 4, 5 COVERED AUTO DESIGNATIONSYMBOL

CA

CA1101 07/97 CA99540797(HI) +++, 1, 2,3, 4, 5, F

COVERED AUTO DESIGNATIONSYMBOL

HI

CA852 11/93 TE9954A1193 1, 2, 3 COVERED AUTO DESIGNATIONSYMBOL

TX

CA547 12/90 CA99541290 1, 2, 3, 4 COVERED AUTO DESIGNATIONSYMBOL



TX , UT , VA , VT , WA , WI , WV , WYCA776 12/93 CA99541293 1, 2, 3, 4, 5 COVERED AUTO DESIGNATION

SYMBOLAK , AL , AR , AZ , CA , CO , CT , DC ,DE , FL , GA , HI , IA , ID , IL , IN , KS ,


TX , UT , VA , VT , WA , WI , WV , WYCA2566 10/13 CA25661013 CUSTOMER COMPLAINT LEGAL

DEFENSE COVERAGEAL , AZ , CA , CT , DC , DE , GA ,HI , IA , ID , IL , IN , KS , KY , LA ,ME , MI , MN , MO , MS , MT , NC ,ND , NE , NJ , NM , NV , OH , OK ,





(D)CA363 B 10/97 CA99091097 DC EMPLOYEES USING AUTOS IN

GOV'T BUSINESS - MDDC

CA1060 12/93 CA25021293(HI) 2, F DEALERS DRIVEAWAY COLLISIONCOVERAGE

HI

CA690 03/92 TE25020392 2 DEALERS' DRIVEWAY COLLISIONCOVERAGE

TX

CA269 01/87 CA03020187 1, 2, 3 DEDUCTIBLE LIABILITY COVERAGE AK , AL , AR , AZ , CA , CO , CT , DC ,DE , FL , GA , HI , IA , ID , IL , IN , KS ,


TX , UT , VA , VT , WA , WI , WV , WYCA0301 03/10 CA03010310 1, 2, 3 DEDUCTIBLE LIABILITY COVERAGE AL , AR , AZ , CA , CO , CT , DC ,

DE , GU , ID , LA , MI , MO , MS , NC ,ND , NE , NM , NV , OH , OK , RI ,

SC , SD , TN , TX , UT , VT , WI , WYCA0302 03/10 CA03020310 1, 2, 3 DEDUCTIBLE LIABILITY COVERAGE DE , GA , IA , IN , KY , MD ,

MT , NH , WA , WV , WYCA0302 10/13 CA03021013 1, 2, 3 DEDUCTIBLE LIABILITY COVERAGE AK , CA , CT , DE , GA , IA , IL ,

IN , KS , KY , MN , MT , NH ,NJ , NY , OR , PA , SD , WA , WV

CA0301 10/13 CA03011013 1, 2, 3 DEDUCTIBLE LIABILITY COVERAGE AK , AL , AR , AZ , CO , DC , ID , LA ,ME , MI , MO , MS , NC , ND , NE ,NM , NV , NY , OH , OK , PR , RI ,

SC , SD , TN , TX , UT , VT , WI , WYCA841 12/93 CA03021293 1, 2, 3 DEDUCTIBLE LIABILITY COVERAGE VACA657 03/92 TE0301B0392 1, 2, 3 DEDUCTIBLE LIABILITY INSURANCE TXCA341 A 03/94 CA22090394 ++ DELAWARE ADDED PERSONAL INJURY

PROTECTION ENDORSEMENTDE

PA0255 09/20 PA02550920 1, 2, 3, 4, 5, F DELAWARE CANCELLATION CHANGES DECA0177 10/13 CA01771013 F DELAWARE CHANGES DECA0255 02/20 CA02550220 F DELAWARE CHANGES -

CANCELLATION AND NONRENEWALDE

IL0151 01/12 IL01510112 DELAWARE CHANGES - CIVIL UNION DECA2208 11/16 CA22081116 DELAWARE PERSONAL INJURY

PROTECTION ENDORSEMENTDE

CA340 E 11/97 CA22081197 1, 2, 3, 5, F DELAWARE PERSONAL INJURYPROTECTION ENDORSEMENT

DE

CA2110 01/14 CA21100114 1, 2, 3, 5, F DELAWARE UNINSURED MOTORISTSCOVERAGE

DE

CA1028 02/99 CA20480299(HI) 1, 2, 3, 5, F DESIGNATED INSURED HICA933 07/97 CA20480797 1, 2, 3, 5, F DESIGNATED INSURED AK , AL , AR , AZ , CA , CO , CT , DC ,


TX , UT , VA , VT , WA , WI , WV , WYCA2559 10/13 CA25591013 DESIGNATED LOCATION(S) GENERAL

LIABILITY AGGREGATE LIMIT FORCERTAIN GENERAL LIABILITYCOVERAGES




CA849 10/93 DISCLOSURE FORM—OPTIONAL BASICPERSONAL INJURY PROTECTION—INDIVIDUAL NAMED INSURED

CO

IL0034 01/15 IL00340115 DISCLOSURE OF PREMIUM ANDESTIMATED PREMIUM FOR CERTIFIED

MO




ACTS OF TERRORISM COVERAGE(PURSUANT TO TERRORISM RISKINSURANCE ACT)

IL0033 01/15 IL00330115 1, 4, 5 DISCLOSURE OF PREMIUM THROUGHEND OF YEAR FOR CERTIFIED ACTS OFTERRORISM COVERAGE (PURSUANT TOTERRORISM RISK INSURANCE ACT)

MO

IL0985 01/15 IL09850115 DISCLOSURE PURSUANT TOTERRORISM RISK INSURANCE ACT OF2002

AK , AL , AR , AZ , CA , CO , CT , DC ,DE , FL , GA , GU , HI , IA , ID , IL ,IN , KS , KY , LA , MA , MD , ME ,MI , MN , MS , MT , NC , ND , NE ,NH , NJ , NM , NV , NY , OH , OK ,


CA0140 10/13 CA01401013 DISTRICT OF COLUMBIA CHANGES DCCA0263 10/13 CA02631013 DISTRICT OF COLUMBIA CHANGES -

CANCELLATION AND NONRENEWALDC

CA9909 10/13 CA99091013 DISTRICT OF COLUMBIA EMPLOYEESUSING AUTOS IN GOVERNMENTBUSINESS - MARYLAND

MD

CA9963 02/18 CA99630218 1, 2, 3, 5, F DISTRICT OF COLUMBIA EMPLOYEESUSING AUTOS IN GOVERNMENTBUSINESS - VIRGINIA

VA

CA2251 10/13 CA22511013 DISTRICT OF COLUMBIA PERSONALINJURY PROTECTION COVERAGE

DC

CA9910 03/10 CA99100310 1, 2, 3, 4, 5, F DRIVE OTHER CAR COVERAGE -BROADENED COVERAGE FOR NAMEDINDIVIDUALS

AL , AR , AZ , CO , DC , GA , IA ,ID , KY , MD , MI , MO , MS ,MT , ND , NE , NM , OK , SD ,TN , UT , VT , WA , WV , WY

CA9910 10/13 CA99101013 1, 2, 3, 4, 5, F DRIVE OTHER CAR COVERAGE -BROADENED COVERAGE FOR NAMEDINDIVIDUALS

AK , AL , AR , AZ , CO , DC , DE , GA ,HI , IA , ID , IL , IN , KY , LA , MI , MO ,MS , MT , NC , ND , NE , NH , NM , NV ,

NY , OH , OK , OR , PR , RI , SC , SD ,TN , TX , UT , VT , WA , WI , WV , WY

CA1084 B 09/02 CA99100902[HI]

1, 2, 3, 5, F DRIVE OTHER CAR COVERAGE -BROADENED COVERAGE FOR NAMEDINDIVIDUALS

HI

CA715 03/92 TE9910B0392 1, 2, 3 DRIVE OTHER CAR COVERAGE—BROADENED COVERAGE FOR NAMEDINDIVIDUAL

TX

CA661 03/92 TE2005A0392 1 DRIVE-AWAY CONTRACTORS TXCA832 12/93 CA20051293 1, 4 DRIVE-AWAY CONTRACTORS HI , NV , WVCA1012 12/93 CA20051293(HI) 1, 4, F DRIVE-AWAY CONTRACTORS HICA1013 12/93 CA20061293(HI) 1, F DRIVE-AWAY CONTRACTORS HICA685 03/92 TE2033A0392 1, 3 DRIVE-AWAY CONTRACTORS—NAMED

OPERATORTX

A1744 07/98 DRIVER EXCLUSION ENDORSEMENT NMCA833 12/93 CA20061293 1 DRIVING SCHOOLS NV , WVCA660 03/92 TE2006A0392 1 DRIVING SCHOOLS (OTHER THAN

PUBLIC SCHOOLS)TX

(E)CA688 03/92 TE2030A0392 1 EMERGENCY USE EXCLUDED TXCA1014 12/93 CA20071293(HI) F EMERGENCY VEHICLES—FELLOW

VOLUNTEER FIREFIGHTERS ANDWORKERS INJURIES EXCLUSIONBUYBACK

HI

CA659 03/92 TE2007A0392 1 EMERGENCY VEHICLES—VOLUNTEERFIREFIGHTERS AND WORKERS'INJURIES

TX

CA1025 12/93 CA20301293(HI) 1, F HI




EMERGENCY VEHICLES—VOLUNTEERFIREFIGHTERS AND WORKERSINJURIES EXCLUDED

CA818 12/93 CA20301293 1 EMERGENCY VEHICLES—VOLUNTEERFIREFIGHTERS' AND WORKERS'INJURIES EXCLUDED

AK , AL , AR , AZ , CA , CT , DC ,DE , GA , HI , IA , ID , IL , IN , KS ,KY , LA , MD , ME , MI , MN , MO ,MS , MT , NC , ND , NE , NH , NJ ,NM , NV , OH , OK , OR , PA , RI ,SD , TN , UT , VA , VT , WA , WV

CA819 12/93 CA20071293 F EMERGENCY VEHS-VOLUNTEERFIREFIGHTERS&WORKERS INJ

HI , VA

CA950 07/97 CA99470797 1, 2, 3, 5, F EMPLOYEE AS LESSOR VACA1098 07/97 CA99470797(HI) 1, 2, 3, 5, F EMPLOYEE AS LESSOR HICA795 12/93 CA99471293 1, 2, 3, 5 EMPLOYEE AS LESSOR AK , AL , AR , AZ , CA , CO , CT , DC ,


TX , UT , VA , VT , WA , WI , WV , WYCA2548 10/13 CA25481013 EMPLOYEE BENEFITS LIABILITY

COVERAGEAK , AL , AR , AZ , CA , DC , DE ,FL , GA , HI , IA , ID , IL , IN , KS ,KY , LA , ME , MI , MN , MO , MS ,ND , NE , NJ , NM , NV , NY , OH ,OK , OR , PA , PR , RI , SC , SD ,

TN , TX , UT , VT , WA , WI , WVCA2098 10/13 CA20981013 1, 2, 3, 4, 5 EMPLOYEE HIRED AUTOS LACA1031 A 10/01 CA20541001(HI) 1, 2, 3, 4, 5 EMPLOYEE HIRED AUTOS HICA989 02/99 CA99330299 1, 2, 3 EMPLOYEES AS INSUREDS AL , AR , AZ , CO , DC , DE , FL , GA ,



CA1093 02/99 CA99330299(HI) 1, 3, 5, F EMPLOYEES AS INSUREDS HICA731 03/92 TE99330392 1, 2, 3 EMPLOYEES AS INSUREDS TXCA948 07/97 CA99330797 1, 3, 5, F EMPLOYEES AS INSUREDS AK , AL , AR , AZ , CA , CO , CT , DC ,


TX , UT , VA , VT , WA , WI , WV , WYCA803 12/93 CA99331293 1, 2, 3, 5 EMPLOYEES AS INSUREDS AK , AL , AR , AZ , CA , CO , CT , DC ,

DE , FL , GA , HI , IA , ID , IL , IN , KS ,KY , LA , MD , ME , MI , MN , MO ,

MS , MT , NC , ND , NE , NH , NJ , NM ,NV , NY , OH , PA , RI , SC , SD , TN ,

TX , UT , VA , VT , WA , WI , WV , WYCA682 03/92 TE2036A0392 1, 3 ERRORS, OMISSIONS AND INTERIM

BINDER—AUTOMOBILE PHYSICALDAMAGE INSURANCE

TX

CA1146 11/02 CA23631102(HI) 1, 2, 3, 4, 5 EXCEPTION TO TERRORISMEXCLUSION FOR CERTIFIED ACTS OFTERRORISM; CAP ON LOSSES FROMCERTIFIED ACTS OF TERRORISM

HI

CA796 12/93 CA99401293 1, 2, 3, 5 EXCL. OR EXCESS COVERAGEHAZARDS OTHERWISE INSURED

AL , AR , AZ , CO , DC , DE , GA ,GU , IA , ID , IL , IN , KS , KY , LA ,MD , ME , MI , MN , MO , MS , MT ,NC , ND , NE , NH , NJ , NM , NV ,OH , OK , PA , RI , SC , SD , TN ,

TX , UT , VT , WA , WI , WV , WYCA2563 10/13 CA25631013




EXCLUSION - ACTS, ERRORS OROMISSIONS LIABILITY COVERAGES




CA2550 10/13 CA25501013 EXCLUSION - DAMAGE TO RENTEDPREMISES




CA2551 10/13 CA25511013 EXCLUSION - DESIGNATED PRODUCTS AK , AL , AR , AZ , CA , CO , CT , DC ,DE , FL , GA , HI , IA , ID , IL , IN , KS ,



CA2556 10/13 CA25561013 EXCLUSION - DESIGNATED WORK YOUPERFORMED




CA2552 10/13 CA25521013 EXCLUSION - LOCATIONS ANDOPERATIONS MEDICAL PAYMENTS




CA2553 10/13 CA25531013 EXCLUSION - NEWLY ACQUIRED ORFORMED AUTO DEALERSHIP




CA2554 10/13 CA25541013 EXCLUSION - PERSONAL ANDADVERTISING INJURY LIABILITYCOVERAGE




CA2555 10/13 CA25551013 EXCLUSION - PRODUCTS AND WORKYOU PERFORMED




TE9987 04/03 TE99870403 1, 2, 3 EXCLUSION OF ACTS OF TERRORISMAS DEFINED IN THE TERRORISM RISKINSURANCE ACT OF 2002

TX

CA1145 12/02 CA23571202(HI) 1, 2, 3, 4, 5 EXCLUSION OF CERTIFIED ACTS OFTERRORISM

HI

CA1148 12/02 CA23651202(HI) 1, 2, 3, 4, 5 EXCLUSION OF CERTIFIED ACTSOF TERRORISM ABOVE MINIMUMSTATUTORY LIMITS

HI

CA1156 12/02 CA23611202(HI) 1, 2, 3, 4, 5 EXCLUSION OF CERTIFIED ACTS OFTERRORISM AND OTHER ACTS OFTERRORISM

HI

CA1160 12/02 CA23691202(HI) 1, 2, 3, 4, 5 EXCLUSION OF CERTIFIED ACTSOF TERRORISM AND OTHER ACTS

HI




OF TERRORISM ABOVE MINIMUMSTATUTORY LIMITS

CA1155 12/02 CA23601202(HI) 1, 2, 3, 4, 5 EXCLUSION OF CERTIFIED ACTS OFTERRORISM AND OTHER NUCLEAR,BIOLOGICAL OR CHEMICAL ACTS OFTERRORISM

HI

CA1159 12/02 CA23681202(HI) EXCLUSION OF CERTIFIED ACTS OFTERRORISM; AND OTHER NUCLEAR,BIOLOGICAL OR CHEMICAL ACTSOF TERRORISM ABOVE MINIMUMSTATUTORY LIMITS

HI

CA676 03/92 TE2045A0392 1, 3 EXCLUSION OF EQUIPMENT,SPECIALLY CONSTRUCTED VEHICLESAND VEHICLES WITH PERMANENTLYMOUNTED SPECIAL EQUIPMENT

TX

CA0442 03/10 CA04420310 1, 2, 5 EXCLUSION OF FEDERAL EMPLOYEESUSING AUTOS IN GOVERNMENTBUSINESS

AL , AR , AZ , CO , DC , DE , FL , GA ,GU , IA , ID , IN , KY , LA , MD , MI ,MO , MS , MT , NC , ND , NE , NH ,

NM , NV , OH , OK , RI , SC , SD , TN ,TX , UT , VT , WA , WI , WV , WY

CA0442 10/13 CA04421013 1, 2, 5 EXCLUSION OF FEDERAL EMPLOYEESUSING AUTOS IN GOVERNMENTBUSINESS

AK , AL , AR , AZ , CA , CO , CT , DC ,DE , GA , HI , IA , ID , IL , IN , KS , KY ,LA , ME , MI , MN , MO , MS , MT , NC ,ND , NE , NH , NJ , NM , NV , NY , OH ,


CA726 03/92 TE9941B0392 1, 2, 3 EXCLUSION OF NAMED DRIVER ANDPARTIAL REJECTION OF COVERAGE

TX

CA739 03/92 TE9942B 03/92 1, 2, 3 EXCLUSION OF NAMED DRIVER ANDPARTIAL REJECTION OF COVERAGE—LIMITED

TX

CA1157 11/02 CA23621102(HI) EXCLUSION OF PUNITIVE DAMAGESRELATED TO A CERTIFIED ACT OFTERRORISM

HI

CA2564 10/13 CA25641013 EXCLUSION OF SPECIFIED ACTS,ERRORS OR OMISSIONS LIABILITYCOVERAGES




CA2384 10/13 CA23841013 EXCLUSION OF TERRORISM AL , AR , AZ , CA , CO , DC , DE ,IA , ID , IL , IN , LA , MD , ME , MI ,MN , MO , MS , MT , NC , ND , NE ,NH , NM , NV , OH , PA , RI , SC ,

SD , TN , TX , UT , VT , WI , WV , WYCA2386 10/13 CA23861013 1, 2, 3, 4, 5 EXCLUSION OF TERRORISM ABOVE

MINIMUM STATUTORY LIMITSCT , KS , KY , NJ , OK , OR

CA2385 10/13 CA23851013 1, 2, 3, 4, 5 EXCLUSION OF TERRORISMINVOLVING NUCLEAR, BIOLOGICAL ORCHEMICAL TERRORISM

AL , AR , AZ , CA , DC , DE , IA , ID ,IL , IN , LA , MD , ME , MI , MN ,

MO , MS , MT , NC , ND , NE , NH ,NM , NV , OH , PA , RI , SC , SD ,TN , TX , UT , VT , WI , WV , WY

CA2387 10/13 CA23871013 1, 2, 3, 4, 5 EXCLUSION OF TERRORISMINVOLVING NUCLEAR, BIOLOGICALOR CHEMICAL TERRORISM ABOVEMINIMUM STATUTORY LIMITS

CT , KS , KY , NJ , OK , OR

IL0193 09/07 IL01930907 EXCLUSION OF TRUSTOR AS NAMEDINSURED

OK

CA727 03/92 TE9940A0392 1, 2, 3 EXCLUSION OR EXCESS COVERAGE(HAZARDS OTHERWISE INSURED)

TX

CA9980 12/00 CA99801200 1, 2, 3, 5, F TX




EXCLUSION OR EXCESS COVERAGE(HAZARDS OTHERWISE INSURED)

CA1096 12/93 CA99401293(HI) 1, 2, 3, 5, F EXCLUSION OR EXCESS COVERAGEHAZARDS OTHERWISE INSURED

HI

CA965 09/98 CA25180998 2, F EXCLUSION—YEAR 2000 COMPUTER-RELATED AND OTHER ELECTRONICPROBLEMS


MD , ME , MI , MN , MO , MS , MT ,NC , ND , NE , NH , NJ , NM , NV ,OH , OK , OR , PA , RI , SC , SD ,

TN , UT , VT , WA , WI , WV , WYCA1072 09/98 CA25180998(HI) 2, F EXCLUSION—YEAR 2000 COMPUTER-

RELATED AND OTHER ELECTRONICPROBLEMS

HI

CA1073 09/98 CA25190998(HI) 2, F EXCLUSION—YEAR 2000 COMPUTER-RELATED AND OTHER ELECTRONICPROBLEMS—PRODUCTS/WORK YOUPERFORMED

HI

CA1075 09/98 CA25240998(HI) 2, F EXCLUSION—YEAR 2000 COMPUTER-RELATED AND OTHER ELECTRONICPROBLEMS—WITH EXCEPTION FORBODILY INJURY ON YOUR PREMISES

HI

CA966 09/98 CA25190998 2, F EXCL-YEAR 2000 COMP REL & OTHERELECT PROB-PROD/WK


MD , ME , MI , MN , MO , MS , MT ,NC , ND , NE , NH , NJ , NM , NV ,OH , OK , OR , PA , RI , SC , SD ,

TN , UT , VT , WA , WI , WV , WYCA968 09/98 CA25240998 2, F EXCL-YEAR 2000 COMP-REL & OTHER

ELEC PRB W/EXCEPTAL , AR , AZ , CO , DC , DE , GA ,

IA , ID , IL , IN , KS , KY , LA ,MD , ME , MI , MN , MO , MS , MT ,NC , ND , NE , NH , NJ , NM , NV ,OH , OK , OR , PA , RI , SC , SD ,

TN , UT , VT , WA , WI , WV , WYCA2561 10/13 CA25611013 EXPANDED COVERAGE TERRITORY

FOR GENERAL LIABILITY COVERAGES -ADDITIONAL SCHEDULED COUNTRIES




CA735 A 09/98 TE9925B0998 EXPERIENCE MODIFICATION CHANGE TXCA736 A 09/98 TE9924B0998 EXPERIENCE MODIFICATION CHANGE TXCA850 10/93 EXPLANATION OF PERSONAL INJURY

PROTECTION (PIP) COVERAGECO

CA817 12/93 CA23011293 1, 3, 5 EXPLOSIVES FL , VACA2567 10/13 CA25671013 EXTENDED REPORTING PERIOD

ENDORSEMENT FOR EMPLOYEEBENEFITS LIABILITY COVERAGE

AK , AL , AR , AZ , CA , DC , DE ,FL , GA , HI , IA , ID , IL , IN , KS ,KY , LA , ME , MI , MN , MO , MS ,ND , NE , NJ , NM , NV , NY , OH ,

OK , OR , PA , PR , RI , SC , SD , TN ,TX , UT , VT , WA , WI , WV , WY

(F)CA2503 03/10 CA25030310 2 FALSE PRETENSE COVERAGE AL , AR , AZ , CO , DC , DE , GA , IA , ID ,

IN , KY , LA , MD , MI , MO , MS , MT ,ND , NE , NH , NM , OH , OK , RI , SC ,SD , TN , UT , VT , WA , WI , WV , WY

CA725 03/92 TE25030392 2 FALSE PRETENSE COVERAGE TXCA939 07/97 CA25030797 2 FALSE PRETENSE COVERAGE CT , VACA2503 10/13 CA25031013 2 FALSE PRETENSE COVERAGE AK , AL , AR , AZ , CA , CO , CT , DC ,

DE , GA , HI , IA , ID , IL , IN , KS , KY ,LA , ME , MI , MN , MO , MS , MT , NC ,ND , NE , NH , NJ , NM , NV , NY , OH ,





CA809 12/93 CA25031293 2 FALSE PRETENSE COVERAGE AK , AL , AR , AZ , CA , CO , CT , DC ,DE , FL , GA , HI , IA , ID , IL , IN , KS ,


TX , UT , VA , VT , WA , WI , WV , WYCA696 03/92 TE24010392 1 FARM LABOR CONTRACTORS TXCA811 12/93 CA24011293 1 FARM LABOR CONTRACTORS NV , WVCA1057 12/93 CA24011293(HI) 1, 2, 3, 5, F FARM LABOR CONTRACTORS HICA698 03/92 TE2329A0392 1 FARM OR RANCH VEHICLES—TRAILER

COVERAGETX

CA207 01/87 CA20080187 1, 4 FARM TRACTORS AND FARMTRACTORS EQUIPMENT



TX , UT , VA , VT , WA , WI , WV , WYCA658 03/92 TE20080392 1 FARM TRACTORS AND FARM

TRACTORS EQUIPMENTTX

CA834 12/93 CA20081293 1, 4, F FARM TRACTORS AND FARMTRACTORS EQUIPMENT

AK , AL , AR , AZ , CO , DC , DE , FL ,GA , GU , IA , ID , IL , IN , KS , KY , LA ,

MD , ME , MI , MN , MO , MS , MT ,NC , ND , NE , NH , NJ , NM , NV , OH ,OK , OR , PA , RI , SC , SD , TN , TX ,

UT , VA , VI , VT , WA , WI , WV , WYCA1015 12/93 CA20081293(HI) 1, 4, F FARM TRACTORS AND FARM

TRACTORS EQUIPMENTHI

CA714 03/92 TE9912A0392 1 FEDERAL EMPLOYEES USING AUTOS INGOVERNMENT BUSINESS

TX

CA985 02/99 CA20550299 1, 2, 3, 5 FELLOW EMPLOYEE COVERAGE AK , AL , AR , AZ , CA , CO , CT , DC ,DE , FL , GA , HI , IA , ID , IL , IN , KS ,


TX , UT , VA , VT , WA , WI , WV , WYCA2055 10/01 CA20551001 1, 2, 3, 5, F FELLOW EMPLOYEE COVERAGE AL , AR , AZ , CO , DC , DE , GA ,

IA , ID , IL , IN , KY , LA , MD , MI ,MO , MS , MT , NC , ND , NE , NH ,


CA2055 10/13 CA20551013 1, 2, 3, 5, F FELLOW EMPLOYEE COVERAGE AK , AL , AR , AZ , CA , CO , CT , DC ,DE , GA , HI , IA , ID , IL , IN , KS , KY ,


TN , TX , UT , VT , WA , WI , WV , WYCA1032 A 10/01 CA20551001(HI) 1, 2, 3, 5, F FELLOW EMPLOYEE COVERAGE HICA1033 02/99 CA20560299(HI) 1, 2, 3, 5, F FELLOW EMPLOYEE COVERAGE FOR

DESIGNATED EMPLOYEES/POSITIONSHI

CA945 07/97 CA99130797 1, F FIDUCIARY LIABILITY OF BANKS AL , AR , AZ , CO , DC , DE , GA ,GU , IA , ID , IL , IN , KS , KY , LA ,MD , ME , MI , MN , MO , MS , MT ,NC , ND , NE , NH , NJ , NM , NV ,OH , OK , PA , RI , SC , SD , TN ,

TX , UT , VT , WA , WI , WV , WYCA1085 07/97 CA99130797(HI) 1, F FIDUCIARY LIABILITY OF BANKS HICA779 12/93 CA99131293 1, F FIDUCIARY LIABILITY OF BANKS AK , AL , AR , AZ , CA , CO , CT , DC ,

DE , FL , GA , HI , IA , ID , IL , IN , KS ,KY , LA , MD , ME , MI , MN , MO , MS ,




MT , NC , ND , NE , NH , NJ , NM , NV ,NY , OH , OR , PA , RI , SC , SD , TN ,

TX , UT , VA , VT , WA , WI , WV , WYCA746 A 11/97 TE9982B1197 1, 2, 3 FINANCIAL RESPONSIBILITY

CERTIFICATIONTX

CA369 A 06/94 CA03040694 1, 2, 3, 4 FIRE & THEFT, FIRE, THEFT &WINDSTORM LIMITED SPECIFIC CAUSE- SOUTH CAROLINA

SC

CA1067 A 10/01 CA25101001(HI) 2, F FIRE LEGAL LIABILITY COVERAGE -GARAGES

HI

CA2504 03/10 CA25040310 2 FIRE, FIRE AND THEFT AND LIMITEDSPECIFIED CAUSES OF LOSSCOVERAGE FOR DEALERS


CA724 03/92 TE25040392 2 FIRE, FIRE AND THEFT AND LIMITEDSPECIFIED CAUSES OF LOSSCOVERAGE FOR DEALERS

TX

CA2504 10/13 CA25041013 2 FIRE, FIRE AND THEFT AND LIMITEDSPECIFIED CAUSES OF LOSSCOVERAGE FOR DEALERS



CA1086 12/93 CA99141293(HI) 1, 2, 3, 4, 5, F FIRE, FIRE AND THEFT, FIRE,THEFT AND WINDSTORM ANDLIMITED SPECIFIED CAUSES OF LOSSCOVERAGES

HI

CA780 12/93 CA99141293 1, 2, 3 FIRE, FIRE AND THEFT, THEFT ANDWINDSTORM AND LIMITED SPECIFIEDCAUSES OF LOSS

MI

CA742 03/92 TE9914A0392 1, 2, 3 FIRE, FIRE AND THEFT, WINDSTORM,FLOOD, RIOT OR CIVIL COMMOTIONAND LIMITED SPECIFIED CAUSES OFLOSS COVERAGE

TX

CA808 12/93 CA25041293 2 FIRE,FIRE&THEFT&LMTD.SPEC.CAUSESOF LOSS COV.DLRS.

AK , CT , GU , LA , NH , NY , VA

CA752 03/92 TE9976B0392 1, 2, 3 FLEET SCHEDULE—LIABILITY ANDPHYSICAL DAMAGE

TX

CA2028 06/17 CA20280617 1, F FLORIDA - EMERGENCY VEHICLES- VOLUNTEER FIREFIGHTERS ANDWORKERS INJURIES

FL

CA0447 06/17 CA04470617 1 FLORIDA - EMRGENCY SERVICES -VOLUNTEER FIREFIGHTER'S ANDWORKERS' INJURIES EXCLUSION

FL

CA2630 08/18 CA26300818 FLORIDA AMENDMENT OF SINGLEINTEREST POLICY PROVISIONS -PUBLIC OR LIVERY PASSENGERCONVEYANCE AND ON-DEMANDDELIVERY SERVICES EXCLUSION

FL

CA0128 06/17 CA01280617 1, 2, 3, 4, 5, F FLORIDA CHANGES FLCA0267 06/17 CA02670617 1 FLORIDA CHANGES - CANCELLATION

AND NONRENEWALFL

IL0112 11/18 IL01121118 2, 4 FLORIDA CHANGES - MEDIATIONOR APPRAISAL (COMMERCIALRESIDENTIAL PROPERTY)

FL

CA2250 02/18 CA22500218 +, 1, 2, 3, F FLORIDA EXTENDED PERSONALINJURY PROTECTION

FL

CA2210 02/18 CA22100218 +, 1, 2, 3, F FLORIDA PERSONAL INJURYPROTECTION

FL

CA0503 08/18 CA05030818 FLORIDA PUBLIC OR LIVERYPASSENGER CONVEYANCE AND

FL




TRANSPORTATION NETWORKSERVICES EXCLUSION

CA0504 08/18 CA05040818 FLORIDA PUBLIC OR LIVERYPASSENGER CONVEYANCE,TRANSPORTATION NETWORK ANDON-DEMAND DELIVERY SERVICESEXCLUSION

FL

CA2172 06/17 CA21720617 1, 2, 3, 5, F FLORIDA UNINSURED MOTORISTSCOVERAGE - NONSTACKED

FL

CA2147 06/17 CA21470617 1, 2, 3, 5, F FLORIDA UNINSURED MOTORISTSCOVERAGE - STACKED

FL

CA728 03/92 TE9935A0392 1, 2 FOREIGN MADE AND DISCONTINUEDMAKES OF AUTOMOBILES LIMITINGPHYSICAL DAMAGE COVERAGES

TX

CA697 A 02/96 TE2330C0296 1, 2 FORM F-1—UNIFORM COMMERCIALMOTOR VEHICLE BODILY INJURYAND PROPERTY DAMAGE LIABILITYINSURANCE ENDORSEMENT

TX

CA706 03/92 TE2316A0392 1, 3 FORM F—UNIFORM MOTOR CARRIERBODILY INJURY AND PROPERTYDAMAGE LIABILITY INSURANCEENDORSEMENT

TX

UG134 C 01/11 INS0100 FRAUD DIVISION REPORTING FORM—OHIO

OH

UG125 A 01/01 FRAUD NOTICE—CALIFORNIA/WARNING (STICKER)

CA

UG131 A 08/97 FRAUD NOTICE—PENNSYLVANIA(STICKER)

PA

UG104 FRAUD PREVENTION WARNING—OHIO(STICKER)

OH

UG149 A 08/97 FRAUD STICKER—ARKANSAS ARUG145 B 03/98 FRAUD WARNING (GENERIC TEXT FOR

USE ON INSURANCE APPLICATIONFORMS WHEN STATE PRESCRIBEDLANGUAGE IS NOT MANDATORY)(STICKER)


LA , MA , ME , MI , MN , MO , MS ,MT , NC , ND , NE , NH , NJ , NM , NV ,NY , OH , OK , OR , RI , SC , SD , TN ,

TX , UT , VA , VT , WA , WI , WV , WYUG151 03/98 FRAUD WARNING (STICKER FOR USE

ON ALL NEW MEXICO INSURANCEAPPLICATIONS AND CLAIM FORMS)

NM

UG117 09/93 FRAUD WARNING ENDORSEMENT OKUG143 A 08/99 FRAUD WARNING—COLORADO

(STICKER)CO

CA464 A 06/98 CA99310698 1, 2, 3, 4, 5 FULL COVERAGE WINDOW GLASS NYCA9931 08/14 CA99310814 FULL COVERAGE WINDOW GLASS –

NEW YORKNY

CA2515 10/13 CA25151013 FULL COVERED AUTOS LIABILITYLIMIT FOR CUSTOMERS

AK , AL , AZ , CA , CO , CT , DC ,DE , GA , HI , IA , ID , IN , KY , LA ,MI , MO , MS , MT , NC , ND , NE ,NH , NM , NY , OH , PR , RI , SC ,SD , TX , VT , WA , WI , WV , WY

CA9974 10/13 CA99741013 1, 2, 3, 5, F FULL SAFETY GLASS COVERAGE -MINNESOTA

MN

CA2537 03/06 CA25370306 2, F FUNGI OR BACTERIA EXCLUSION -GARAGE OPERATIONS - OTHER THANCOVERED AUTOS

AL , AR , AZ , CO , DC , DE , GA , IA , ID ,IN , KY , MD , MI , MO , MS , MT , NC ,ND , NE , NH , NM , NV , OH , OK , RI ,SC , TN , TX , UT , VT , WI , WV , WY

CA2537 10/13 CA25371013 2, F FUNGI OR BACTERIA EXCLUSION -GENERAL LIABILITY COVERAGES


KY , ME , MI , MN , MO , MS , MT ,NC , ND , NE , NH , NJ , NM , NV ,




NY , OH , OK , OR , PA , PR , RI , SC ,SD , TN , TX , UT , VT , WI , WV , WY

(G)CA2516 10/01 CA25161001 2, F GARAGE COVERAGE FORM - OTHER

THAN COVERED AUTO EXPOSURE -TOTAL POLLUTION EXCLUSION

SC

CA1071 A 10/01 CA25161001(HI) 2, F GARAGE COVERAGE FORM - OTHERTHAN COVERED AUTO EXPOSURE -TOTAL POLLUTION EXCLUSION

HI

CA2536 03/06 CA25360306 2, F GARAGE COVERAGE FORM - OTHERTHAN COVERED AUTO EXPOSURE- TOTAL POLLUTION EXCLUSIONWITH A BLDG HEATING EQUIPMENTEXCEPTION AND A HOSTILE FIREEXCEPTION

AL , AR , AZ , CO , DC , DE , GA ,IA , ID , IN , KY , MD , ME , MI ,MO , MS , MT , NC , ND , NE ,

NH , NM , NV , OH , OK , RI , SC ,SD , TN , UT , WA , WI , WV , WY

CA163-2 12/90 CA00081290(PG2) GARAGE COVERAGE FORM—NON-DEALERS' AND TRAILER DEALERS'SUPPLEMENTARY SCHEDULE(CONTINUED)

LA

CADS09 03/10 CADS090310 2 GARAGE DECLARATIONS AL , AR , AZ , CA , CO , DC , DE , GA ,HI , IL , IN , KS , KY , LA , MD , ME ,

MI , MN , MO , MS , MT , ND , NE , NH ,NJ , NM , NY , OH , OK , OR , PA , RI ,SC , SD , TN , UT , VT , WA , WI , WY

CADS09 10/01 CADS091001 2 GARAGE DECLARATIONS MN , NYCA723 03/92 TE2505B0392 2 GARAGE LOCATION AND OPERATIONS

MEDICAL PAYMENTS INSURANCETX

CA9959 03/10 CA99590310 1, 2, 3, 5, F GARAGEKEEPERS COV-CUSTOMERSSOUND RECEIVING EQUIP

AL , AR , AZ , CO , DC , DE , GA ,IA , ID , IN , KY , LA , MD , MI ,MN , MO , MS , MT , ND , NE ,

NH , NM , OH , OK , RI , SC , SD ,TN , UT , VT , WA , WI , WV , WY


AK , GU , LA , NH , NY , VA


AK , AL , AR , AZ , CA , CO , CT , DC ,DE , GA , HI , IA , ID , IL , IN , KS ,KY , LA , ME , MI , MO , MS , MT ,

NC , ND , NE , NH , NJ , NM , NV , NY ,OH , OK , OR , PA , PR , RI , SC , SD ,

TN , TX , UT , VT , WA , WI , WV , WYCA9937 03/10 CA99370310 1, 3, 5, F GARAGEKEEPERS COVERAGE AL , AR , AZ , CO , DC , DE , GA ,

IA , ID , IN , KY , LA , MD , MI ,MN , MO , MS , MT , ND , NE ,


CA949 07/97 CA99370797 1, 3, 5, F GARAGEKEEPERS COVERAGE AK , AL , AR , AZ , CA , CO , CT , DC ,DE , FL , GA , HI , IA , ID , IL , IN , KS ,


TX , UT , VA , VT , WA , WI , WV , WYCA9937 10/13 CA99371013 1, 3, 5, F GARAGEKEEPERS COVERAGE AK , AL , AR , AZ , CA , CO , CT , DC ,

DE , GA , HI , IA , ID , IL , IN , KS , KY ,LA , ME , MI , MO , MS , MT , NC ,

ND , NE , NH , NJ , NM , NV , NY , OH ,OK , OR , PA , PR , RI , SC , SD , TN ,

TX , UT , VA , VT , WA , WI , WV , WYCA815 12/93 CA99371293 1, 3, 5 GARAGEKEEPERS COVERAGE AK , AL , AR , AZ , CA , CO , CT , DC ,

DE , FL , GA , HI , IA , ID , IL , IN , KS ,KY , LA , MD , ME , MI , MN , MO , MS ,MT , NC , ND , NE , NH , NJ , NM , NV ,





CA991 02/99 CA99590299 1, 2, 3, 5, F GARAGEKEEPERS COVERAGE—CUSTOMERS' SOUND RECEIVINGEQUIPMENT

AK , AL , AR , AZ , CA , CO , CT ,DC , DE , FL , GA , GU , HI , IA , ID ,IL , IN , KS , KY , LA , MD , ME , MI ,MN , MO , MS , MT , NC , ND , NE ,NH , NJ , NM , NV , NY , OH , OK ,


CA952 07/97 CA99590797 1, 2, 3, 5, F GARAGEKEEPERS COVERAGE—CUSTOMERS' SOUND RECEIVINGEQUIPMENT



TX , UT , VA , VT , WA , WI , WV , WYCA771 12/93 CA99591293 1, 2, 3, 5 GARAGEKEEPERS COVERAGE—

CUSTOMERS' SOUND RECEIVINGEQUIPMENT



TX , UT , VA , VT , WA , WI , WV , WYCA9971 02/18 CA99710218 1, 3, 5, F GARAGEKEEPERS INSURANCE VACA729 03/92 TE9937B0392 1, 2 GARAGEKEEPERS INSURANCE TXCA9971 10/11 CA99711011 1, 3, 5, F GARAGEKEEPERS INSURANCE VACA717 03/92 TE9904A0392 GENERAL CHANGE ENDORSEMENT TXCA0109 10/13 CA01091013 1, 3, 4, 5, F GEORGIA CHANGES GACA0163 10/13 CA01631013 2, F GEORGIA CHANGES - AUTO DEALERS

COVERAGE FORMGA

CA2542 10/13 CA25421013 2, F GEORGIA LIMITED FUNGI ORBACTERIA COVERAGE FOR GENERALLIABILITY COVERAGES - SMALLBUSINESS

GA

CA2111 10/13 CA21111013 1, 2, 3, 5, F GEORGIA UNINSURED MOTORISTSCOVERAGE

GA

CA9939 10/13 CA99391013 1, 2, 3, 4, 5, F GLASS COVERAGE – CONNECTICUT CTCA0445 03/10 CA04450310 1, 4, 5 GOLF CARTS AND LOW-SPEED

VEHICLESAL , AR , AZ , CO , DC , DE , GA ,GU , IA , ID , IN , KY , LA , MD ,

MI , MO , MS , MT , NC , ND ,NE , NM , NV , OK , RI , SD , TN ,TX , UT , VT , WA , WI , WV , WY

CA0445 10/13 CA04451013 1, 4, 5 GOLF CARTS AND LOW-SPEEDVEHICLES



CA741 03/92 TE9915A0392 1 GOVERNMENTAL BODIESAMENDATORY ENDORSEMENT

TX

CA782 12/93 CA99151293 1, F GOVERNMENTAL BODIESAMENDATORY ENDORSEMENT

AK , AL , AR , AZ , CA , CO , CT ,DC , DE , FL , GA , GU , HI , IA , ID ,

IL , IN , KS , KY , LA , MD , ME ,MI , MN , MO , MS , MT , NC , ND ,NE , NH , NJ , NM , NV , NY , OH ,


CA1087 12/93 CA99151293(HI) 1, F GOVERNMENTAL BODIESAMENDATORY ENDORSEMENT

HI

CA748 03/92 TE9980B0392 1 GOVERNMENTAL UNITS TXCA0171 10/01 CA01711001 GUAM CHANGES GUCA0278 10/01 CA02781001 GUAM CHANGES - CANCELLATION

AND NONRENEWALGU




CA2169 03/03 CA21690303 GUAM UNINSURED MOTORISTSCOVERAGE

GU

(H)CA2335 04/17 CA23350417 1, F HAWAII - MOTOR CARRIERS -

INSURANCE FOR NON-TRUCKING USEHI

CA2266 04/17 CA22660417 1, 3, 5, F HAWAII ADDED PERSONAL INJURYPROTECTION COVERAGE

HI

CA0127 04/17 CA01270417 1, 2, 3, 4, 5, F HAWAII CHANGES HICA0201 04/17 CA02010417 HAWAII CHANGES - CANCELLATION

AND NONRENEWALHI

IL0149 01/12 IL01490112 HAWAII CHANGES - CIVIL UNION HICA0306 04/17 CA03060417 1, 2, 3, 5, F HAWAII DEDUCTIBLE LIABILITY

INSURANCEHI

CA9953 04/17 CA99530417 HAWAII HIRED AUTOS SPECIFIED ASCOVERED AUTOS YOU OWN

HI

CA2060 04/17 CA20600417 1, 3, 5, F HAWAII LEASING OR RENTALCONCERNS - CONTINGENT COVERAGE

HI

CA2053 04/17 CA20530417 1, 3, 5, F HAWAII LEASING OR RENTALCONCERNS - EXCLUSION OF CERTAINLEASED AUTOS

HI

CA2057 04/17 CA20570417 1, 3, 5, F HAWAII LEASING OR RENTALCONCERNS - SCHEDULE OF LIMITS FOROWNED AUTOS

HI

CA2058 04/17 CA20580417 1, 3, 5, F HAWAII LEASING OR RENTALCONCERNS - SECOND LEVELCOVERAGE

HI

CA2329 04/17 CA23290417 1, F HAWAII MOTOR CARRIERENDORSEMENT

HI

CA2512 04/17 CA25120417 2, F HAWAII OFFICIAL INSPECTIONSTATIONS

HI

CA2267 04/17 CA22670417 HAWAII OPTIONAL BENEFITSCOVERAGE

HI

CA2383 04/17 CA23830417 1, 3, 5, F HAWAII SILICA OR SILICA-RELATEDDUST EXCLUSION FOR COVEREDAUTOS EXPOSURE

HI

CA3122 04/17 CA31220417 F HAWAII SPLIT UNDERINSUREDMOTORISTS COVERAGE LIMITS -STACKED

HI

CA3121 04/17 CA31210417 F HAWAII SPLIT UNINSURED MOTORISTSCOVERAGE LIMITS - STACKED

HI

CA740 03/92 TE99160392 1 HIRED AUTOS SPECIFIED AS COVEREDAUTOS YOU OWN

TX

CA775 12/93 CA99161293 1, 2, 3 HIRED AUTOS SPECIFIED AS COVEREDAUTOS YOU OWN

AK , AL , AR , AZ , CA , CO , CT , DC ,DE , GA , IA , ID , IL , IN , KY , LA ,MD , ME , MI , MN , MO , MS , MT ,NC , ND , NE , NH , NJ , NM , NV ,

NY , OH , OK , OR , PA , RI , SC , SD ,TN , TX , UT , VT , WA , WI , WV , WY

UA102 05/90 HOW TO LOWER RATES AK , AL , AR , AZ , CA , CO , CT ,DC , DE , FL , GA , HI , IA , ID , IL ,IN , KS , KY , LA , MA , MD , ME ,MI , MN , MO , MS , MT , NC , ND ,NE , NH , NJ , NM , NV , NY , OH ,OR , PA , RI , SC , SD , TN , TX ,

UT , VA , VT , WA , WI , WV , WY(I)

CA2626 11/16 CA26261116 IDAHO AMENDMENT OF SINGLEINTEREST POLICY PROVISIONS -CANCELLATION

ID

CA0118 11/13 CA01181113 1, 2, 3, 5, F IDAHO CHANGES IDCA0271 10/13 CA02711013 ID




IDAHO CHANGES - SUSPENSION OFINSURANCE PRIVATE PASSENGERAUTOS

CA3118 10/13 CA31181013 1, 2, 3, 5, F IDAHO UNDERSINAURED MOTORISTSCOVERAGE

ID

CA3115 10/13 CA31151013 1, 2, 3, 5, F IDAHO UNINSURED MOTORISTSCOVERAGE

ID

CA9994 03/06 CA99940306 1, 2, 3, 4, 5, F ILLINOIS AUDIO, VISUAL AND DATAELECTRONIC EQUIPMENT COVERAGE

IL

CA0120 01/15 CA01200115 1, 2, 3, 4, 5, F ILLINOIS CHANGES ILCA0270 01/18 CA02700118 1, 2, 3, 4, 5, F ILLINOIS CHANGES - CANCELLATION

AND NONRENEWALIL

IL0147 09/11 IL01470911 ILLINOIS CHANGES - CIVIL UNION ILCA0104 01/15 CA01040115 2, F ILLINOIS CHANGES - GARAGE

COVERAGE FORMIL

CA539 A 08/94 CA02700894 1, 2, 3, 4, 5, F ILLINOIS CHANGES-CANCELLATION &NONRENEWAL

IL

CA2584 10/13 CA25841013 ILLINOIS CUSTOMER COMPLAINTLEGAL DEFENSE COVERAGE

IL

CA2586 10/13 CA25861013 ILLINOIS CUSTOMER COMPLAINTLEGAL DEFENSE COVERAGE WITH NOCOVERAGE FOR NEWLY ACQUIRED ORFORMED AUTO DEALERSHIP

IL

CA2585 10/13 CA25851013 ILLINOIS CUSTOMER COMPLAINTLEGAL DEFENSE COVERAGE WITH NOCOVERAGE FOR NEWLY ACQUIRED ORFORMED AUTO DEALERSHIP

IL

CA2583 10/13 CA25831013 ILLINOIS EXCLUSION - NEWLYACQUIRED OR FORMED AUTODEALERSHIP

IL

CA2587 10/13 CA25871013 ILLINOIS EXTENDED REPORTINGPERIOD ENDORSEMENT FOREMPLOYEE BENEFITS LIABILITYCOVERAGE WITH NO COVERAGE FORNEWLY ACQUIRED OR FORMED AUTODEALERSHIP

IL

CA9985 09/17 CA99850917 ILLINOIS LEASING OR RENTALCONCERNS – CONTINGENT COVERAGE

IL

CA2004 10/01 CA20041001 1, 2, 3, 4, 5, F ILLINOIS MOBILE HOMES CONTENTSCOVERAGE

IL

CA2004 10/13 CA20041013 1, 2, 3, 4, 5, F ILLINOIS MOBILE HOMES CONTENTSCOVERAGE

IL

CA9981 10/13 CA99811013 1, 2, 3, 4, 5, F ILLINOIS STATED AMOUNTINSURANCE

IL

CA2138 10/13 CA21381013 1, 2, 3, 5, F ILLINOIS UNDERINSURED MOTORISTSCOVERAGE

IL

CA2130 01/15 CA21300115 1, 2, 3, 5, F ILLINOIS UNINSURED MOTORISTSCOVERAGE

IL

CA2153 10/13 CA21531013 1, 2, 3, 5 ILLINOIS UNINSURED MOTORISTSCOVERAGE - PROPERTY DAMAGE

IL

ILU003 01/15 ILU0030115 ILLINOIS UNINSURED MOTORISTSCOVERAGE AND UNDERINSUREDMOTORISTS COVERAGE SELECTION/REJECTION

IL

UA194 06/96 IMPORTANT INFORMATION – CARRIERRENEWAL NOTICE

VT

UA193 06/96 IMPORTANT INFORMATION – CARRIERRENEWAL NOTICE

NH

UA190 10/95 IMPORTANT INFORMATIONCONCERNING YOUR MOTOR VEHICLELIABILITY INSURANCE POLICY

MD




(NONPAYMENT OF RENEWALPREMIUM NOTICE)

UG128 11/94 IMPORTANT INFORMATION/INSURANCE GUARANTEEASSOCIATION—CALIFORNIA

CA

A964 B 04/00 1 IMPORTANT NOTICE PAUA162 B 07/15 IMPORTANT NOTICE WVUG152 04/98 IMPORTANT NOTICE –

ACKNOWLEDGEMENT OFARBITRATION AGREEMENT

AL

UA133 A 06/97 IMPORTANT NOTICE (FOR USEWITH GARAGE COVERAGE FORMCONTAINING AGGREGATE LIMIT)(STICKER)

NJ

A632 B 12/02 IMPORTANT NOTICE CONCERNINGTHE WAIVER OF PERSONAL INJURYPROTECTION (PIP) COVERAGE—COMMERCIAL AUTOMOBILE LIABILITYINSURANCE

MD

UA218 A 07/15 IMPORTANT NOTICE FOR EXCESS/UMBRELLA LINES

WV

UA223 09/01 IMPORTANT NOTICE RELATING TO ACANCELLATION OR NONRENEWAL OFAUTOMOBILE INSURANCE

MD

UA141 A 06/99 IMPORTANT NOTICE–CONTAINSSTATEMENT THAT POLICY PROVIDESCOLLISION COVERAGE ON RENTALVEHICLES (STICKER)

PA

UA200 03/99 IMPORTANT NOTICE—UNINSUREDMOTORISTS COVERAGE

SC

UA142 A 01/00 IMPORTANT NOTICE—WARNING THATPOLICY DOES NOT PROVIDE COLLISIONCOVERAGE ON RENTAL VEHICLES(STICKER)

PA

UG108 A 06/96 IMPORTANT POLICYHOLDERINFORMATION—ARKANSAS

AR

CA761 03/92 TE9943A0392 1, 2, 3 INCREASED LIMITS—OTHER THANDESIGNATED DRIVER

TX

IL0158 09/08 IL01580908 INDIANA CHANGES INCA0119 10/13 CA01191013 1, 2, 3, 5, F INDIANA CHANGES INCA0434 10/13 CA04341013 1, 2, 3, 5, F INDIANA CHANGES - AMENDMENT OF

DEFINITION OF POLLUTANTSIN

IL0156 11/17 IL01561117 INDIANA CHANGES - CONCEALMENT,MISREPRESENTATION OR FRAUD

IN

CA0433 10/13 CA04331013 1, 2, 3, 5, F INDIANA CHANGES - POLLUTIONEXCLUSION

IN

IL0117 12/10 IL01171210 INDIANA CHANGES - WORKERS'COMPENSATION EXCLUSION

IN

CA3116 12/15 CA31161215 1, 2, 3, 5, F INDIANA UNDERINSURED MOTORISTSCOVERAGE

IN

CA2144 12/15 CA21441215 1, 2, 3, 5, F INDIANA UNINSURED MOTORISTSCOVERAGE

IN

CA9917 03/06 CA99170306 1, 2, 3, 4 INDIVIDUAL NAMED INSURED AL , AR , AZ , CO , DC , DE , GA ,IA , ID , IN , KY , LA , MD , MI ,

MO , MS , MT , NC , ND , NE , NH ,NM , NV , OH , OK , RI , SC , SD ,TN , UT , VT , WA , WI , WV , WY

CA9917 10/13 CA99171013 1, 2, 3, 4 INDIVIDUAL NAMED INSURED AK , AL , AR , AZ , CO , CT , DC , DE ,FL , GA , HI , IA , ID , IL , IN , KS , KY ,

LA , ME , MI , MN , MO , MS , MT ,NC , ND , NE , NH , NJ , NM , NV , NY ,




OH , OK , OR , PA , RI , SC , SD , TN ,UT , VA , VT , WA , WI , WV , WY

CA738 B 02/03 TE9917H0203 1, 2, 3, F INDIVIDUAL NAMED INSURED TXCA1089 12/93 CA99181293(HI) 2, F INDIVIDUAL NAMED INSURED

(DEALERS ONLY)HI

UA101 05/90 INSTRUCTION SHEET (YOU MUSTRETURN)

PA

GU510 04/98 IL09130498 INSURANCE INSPECTION SERVICESEXEMPTION FROM LIABILITY

ME

UA214 02/01 INSURANCE WARNING NOTICE(ENGLISH/SPANISH)

CA

A3850 INTER-COMPANY REIMBURSEMENTNOTIFICATION

PA

A3963 INTER-COMPANY REIMBURSEMENTNOTIFICATION

AR

A3968 01/73 PIP4(NJ) INTER-COMPANY REIMBURSEMENTNOTIFICATION

NJ

A3982 01/74 INTER-COMPANY REIMBURSEMENTNOTIFICATION

UT


MN

A3959 01/76 PIP-4 INTER-COMPANY REIMBURSEMENTNOTIFICATION

DE


GA

A3994 07/75 NF140775 INTER-COMPANY REIMBURSEMENTNOTIFICATION

KY

A3990 B 09/85 INTER-COMPANY REIMBURSEMENTNOTIFICATION

NY

A3825 B 12/76 PIP51276 INTER-COMPANY REIMBURSEMENTNOTIFICATION

MA

CA759 03/92 TE9949A0392 1, 2, 3 INTERIM PREMIUM ADJUSTMENT TXCA0160 10/13 CA01601013 1, 2, 3, 5, F IOWA CHANGES IACA0182 10/13 CA01821013 2, F IOWA GARAGE LIABILITY COVERAGE

CHANGESIA

CA2112 10/13 CA21121013 1, 2, 3, 5, F IOWA UNINSURED ANDUNDERINSURED MOTORISTSCOVERAGE

IA

(K)CA2215 10/13 CA22151013 +, 1, 2, 3, F KANSAS ADDED PERSONAL INJURY

PROTECTIONKS

CA0446 10/13 CA04461013 F KANSAS ADDITIONAL INSURED –GENERAL LIABILITY COVERAGES –GRANTOR OF FRANCHISE

KS

CA9901 10/13 CA99011013 1, 2, 3, 5, F KANSAS ADDITIONAL NAMEDINSURED

KS

CA419 A 12/95 CA99011295 1, 2, 3, 5, F KANSAS ADDITIONAL NAMEDINSURED

KS

CA0122 06/19 CA01220619 1, 2, 3, 4, 5, F KANSAS CHANGES KSCA0265 01/16 CA02650116 1, 2, 3, 4, 5, F KANSAS CHANGES - CANCELLATION

AND NONRENEWALKS

CA2321 10/13 CA232110013 1, 3, 5, F KANSAS EXPLOSIVES KSCA2214 10/13 CA22141013 KANSAS PERSONAL INJURY

PROTECTIONKS

CA2041 10/13 CA20411013 F KANSAS REPOSSESSED AUTOS KSCA2137 02/20 CA21370220 1, 2, 3, 5, F KANSAS UNINSURED MOTORISTS

COVERAGEKS

CA2217 10/13 CA22171013 KENTUCKY ADDED PERSONAL INJURYPROTECTION

KY

CA0125 10/13 CA01251013 1, 2, 3, 5, F KENTUCKY CHANGES KYCA0164 10/13 CA01641013 2, F KY




KENTUCKY CHANGES - AUTO DEALERSCOVERAGE FORM

CA2216 10/13 CA22161013 1, 2, 3, 5, F KENTUCKY PERSONAL INJURYPROTECTION

KY

CA440 A 03/94 CA22180394 1, 2, 3, 5 KENTUCKY PERSONAL INJURYPROTECTION CHANGED FORMOTORCYCLES

KY

CA2395 10/13 CA23951013 1, 2, 3, 5, F KENTUCKY SILICA OR SILICA-RELATED DUST EXCLUSION FORCOVERED AUTOS EXPOSURE

KY

CA3114 10/13 CA31141013 F KENTUCKY SPLIT UNDERINSUREDMOTORISTS COVERAGE LIMITS

KY

CA2135 10/13 CA21351013 F KENTUCKY SPLIT UNINSUREDMOTORISTS COVER. LIMITS

KY

CA2179 10/13 CA21791013 1, 2, 3, 5, F KENTUCKY UNDERINSUREDMOTORISTS COVERAGE

KY

CA2176 10/13 CA21761013 1, 2, 3, 5, F KENTUCKY UNINSURED MOTORISTSCOVERAGE

KY

(L)CA971 09/98 CA31200998 F LA ECONOMIC LOSS SPLIT UNINSD

MOT COV LIM-BOD INJLA

CA692 03/92 TE2405A0392 1 LABOR AGENT LIABILITYENDORSEMENT

TX

CA925 07/97 CA20090797 1, 3 LEASING OR RENTAL CONCERNS -CONTINGENT COVERAGE

AK , AL , AR , AZ , CO , CT , DC , DE ,FL , GA , GU , IA , ID , IL , IN , KS ,KY , MD , ME , MI , MN , MO , MS ,MT , NC , ND , NE , NH , NM , NV ,

OH , OK , PA , PR , RI , SC , SD , TN ,TX , UT , VA , VT , WA , WI , WV , WY

CA2011 03/06 CA20110306 1, 3, 5, F LEASING OR RENTAL CONCERNS -EXCLUSION OF CERTAIN LEASEDAUTOS

AL , AR , AZ , CO , DC , DE , GA ,GU , IA , ID , IN , KY , LA , MD , MI ,MO , MS , MT , NC , ND , NE , NH ,


CA2011 10/13 CA20111013 1, 3, 5, F LEASING OR RENTAL CONCERNS -EXCLUSION OF CERTAIN LEASEDAUTOS

AK , AL , AR , AZ , CA , CO , CT , DC ,DE , FL , GA , IA , ID , IL , IN , KS , KY ,

LA , ME , MI , MN , MO , MS , MT ,NC , ND , NE , NH , NM , NV , NY , OH ,


CA1034 B 09/02 CA20570902(HI) 1, 3, 5, F LEASING OR RENTAL CONCERNS -SCHEDULE OF LIMITS FOR OWNEDAUTOS

HI

CA2014 10/13 CA20141013 LEASING OR RENTAL CONCERNS -SECOND LEVEL COVERAGE

AK , AL , AR , AZ , CA , CO , CT , DC ,DE , FL , GA , IA , ID , IL , IN , KS , KY ,

LA , ME , MI , MN , MO , MS , MT ,NC , ND , NE , NJ , NM , NV , NY , OH ,


CA672 03/92 TE2009C0392 1, 2, 3 LEASING OR RENTAL CONCERNS—CONTINGENT COVERAGE

TX

CA835 12/93 CA20091293 1, 3, 5 LEASING OR RENTAL CONCERNS—CONTINGENT COVERAGE



TX , UT , VA , VT , WA , WI , WV , WYCA681 03/92 TE2038A0392 1, 2, 3 LEASING OR RENTAL CONCERNS—

CONTINGENT PHYSICAL DAMAGEINSURANCE

TX

CA671 03/92 TE2010A0392 1, 2, 3 TX




LEASING OR RENTAL CONCERNS—CONVERSION, EMBEZZLEMENT ORSECRETION COVERAGE

CA1016 12/93 CA20101293(HI) 1, 3, 4, 5, F LEASING OR RENTAL CONCERNS—CONVERSION, EMBEZZLEMENT ORSECRETION COVERAGE

HI

CA836 12/93 CA20101293 1, 3, 4 LEASING OR RENTAL CONCERNS-CONVERSION, EMBEZZLEMNT

AL , AR , AZ , CO , DC , DE , GA ,GU , IA , ID , IL , IN , KS , KY , LA ,MD , ME , MI , MN , MO , MS , MT ,NC , ND , NE , NH , NJ , NM , NV ,

OH , OK , OR , PA , RI , SC , SD , TN ,TX , UT , VI , VT , WA , WI , WV , WY

CA667 03/92 TE2014B0392 1, 2, 3 LEASING OR RENTAL CONCERNS—EXCESS COVERAGE—OWNER ONLY

TX

CA842 12/93 CA20111293 1, 3, 5, F LEASING OR RENTAL CONCERNS—EXCLUSION OF CERTAIN LEASEDAUTOS

CT , HI , NC , NJ , VA , WY

CA670 03/92 TE2011B0392 1, 2, 3 LEASING OR RENTAL CONCERNS—EXCLUSIONS OF CERTAIN LEASEDAUTOS

TX

CA1017 A 10/01 CA20121001(HI) 1, 3, 5, F LEASING OR RENTAL CONCERNS—RENT-IT THERE/LEAVE IT HERE AUTOS

HI

CA668 03/92 TE2012A0392 1, 2, 3 LEASING OR RENTAL CONCERNS—RENT-IT-HERE/LEAVE-IT-THERE AUTOS

TX

CA2012 10/01 CA20121001 1, 3 LEASING OR RENTAL CONCERNS-RENT-IT-THERE/LEAVE-IT-HERE AUTOS

AL , AR , AZ , CO , CT , DC , DE , GA ,IA , ID , IL , IN , KY , LA , MD , MI ,MO , MS , MT , NC , ND , NE , NH ,


CA2012 10/13 CA20121013 1, 3 LEASING OR RENTAL CONCERNS-RENT-IT-THERE/LEAVE-IT-HERE AUTOS




CA669 03/92 TE2013A0392 1, 2, 3 LEASING OR RENTAL CONCERNS—SCHEDULE OF LIMITS FOR OWNEDAUTOS

TX

CA844 12/93 CA20131293 1, 3, 4, 5 LEASING OR RENTAL CONCERNS—SCHEDULE OF LIMITS FOR OWNEDAUTOS



TX , UT , VA , VT , WA , WI , WV , WYCA2013 10/01 CA20131001 1, 3, 4 LEASING.OR RENTAL CONCERNS-

SCHED.LMTS.FOR OWNED AUTOAL , AR , AZ , CA , CO , DC , DE ,

GA , GU , IA , ID , IN , KS , KY , LA ,MD , ME , MI , MN , MO , MS , MT ,NC , ND , NE , NH , NJ , NM , NV ,


CA2013 10/13 CA20131013 1, 3, 4 LEASING.OR RENTAL CONCERNS-SCHED.LMTS.FOR OWNED AUTO

AK , AL , AR , AZ , CA , CO , CT , DC ,DE , FL , GA , IA , ID , IL , IN , KS , KY ,LA , ME , MI , MN , MO , MS , MT , NC ,ND , NE , NH , NJ , NM , NV , NY , OH ,


CA2059 04/17 CA20590417 1, 2, 3, 4, 5, F LESSOR - ADDITIONAL INSURED ANDLOSS PAYEE

HI

CA2001 10/13 CA20011013 1, 2, 3, 4, 5, F LESSOR - ADDITIONAL INSURED ANDLOSS PAYEE

AK , AR , AZ , CA , CO , CT , DC ,DE , FL , GA , IA , ID , IL , IN , KY ,ME , MI , MN , MO , MS , MT , NC ,




ND , NE , NH , NJ , NM , NV , NY ,OH , OK , OR , PA , PR , RI , SC , SD ,

UT , VA , VT , WA , WI , WV , WYMM2026 10/06 MM20261006 1, 2, 3, F LESSOR—ADDITIONAL INSURED AND

LOSS PAYEEMA

CA2547 10/13 CA25471013 LIMITED CONTRACTUAL LIABILITYCOVERAGE FOR PERSONAL ANDADVERTISING INJURY




CA2538 03/06 CA25380306 2, F LIMITED FUNGI OR BACTERIACOVERAGE FOR GARAGE OPERAITONS- OTHER THAN COVERED AUTOS

AL , AR , AZ , CO , DC , DE , GA ,IA , ID , IN , KY , MD , MI , MO ,

MS , MT , NC , ND , NE , NH ,NM , NV , OH , OK , RI , SC , SD ,TN , TX , UT , VT , WI , WV , WY

CA2538 10/13 CA25381013 2, F LIMITED FUNGI OR BACTERIACOVERAGE FOR GARAGE OPERAITONS- OTHER THAN COVERED AUTOS


KY , ME , MI , MN , MO , MS , MT ,NC , ND , NE , NH , NJ , NM , NV ,

NY , OH , OK , OR , PA , PR , RI , SC ,SD , TN , TX , UT , VT , WI , WV , WY

CA979 02/99 CA01210299 1, 2, 3, 4, 5, F LIMITED MEXICO COVERAGE AK , AL , AR , CA , CO , CT , DC ,DE , FL , GA , GU , HI , IA , ID , IL ,IN , KS , KY , LA , MD , ME , MI ,


OR , PA , PR , RI , SC , SD , TN , TX ,UT , VA , VT , WA , WI , WV , WY

CA2549 10/13 CA25491013 LIMITED PRODUCT WITHDRAWALEXPENSE ENDORSEMENT

AK , AL , AR , AZ , CA , CO , CT , DC ,DE , FL , GA , HI , IA , ID , IL , IN , KS ,KY , LA , ME , MI , MN , MS , MT , NC ,ND , NE , NH , NJ , NM , NV , NY , OH ,


CA1158 12/02 CA23661202(HI) 1, 2, 3, 4, 5 LIMITED TERRORISM EXCLUSION(OTHER THAN CERTIFIED ACTSOF TERRORISM) ABOVE MINIMUMSTATUTORY LIMITS; CAP ON LOSSESFROM CERTIFIED ACTS OF TERRORISM

HI

CA1153 12/02 CA23581202(HI) 1, 2, 3, 4, 5 LIMITED TERRORISM EXCLUSION(OTHER THAN CERTIFIED ACTS OFTERRORISM); CAP ON LOSSES FROMCERTIFIED ACTS OF TERRORISM

HI

CA700 03/92 TE2326A0392 1, 2, 3 LIQUEFIED PETROLEUM GAS LICENSEEMOTOR VEHICLE ENDORSEMENT—TEXAS RAILROAD COMMISSION FORM

TX

CA704 03/92 TE2319A0392 1, 3 LOANED OR RENTED TRAILERS TXCA722 03/92 TE2507A0392 2 LOCATIONS AND OPERATIONS NOT

COVEREDTX

CA807 12/93 CA25071293 2 LOCATIONS AND OPERATIONS NOTCOVERED

AL , AR , AZ , CO , DC , DE , GA ,IA , ID , IL , IN , KS , KY , LA , MD ,ME , MI , MN , MO , MS , MT , NC ,ND , NE , NH , NJ , NM , NV , OH ,OK , OR , PA , RI , SC , SD , TN ,

TX , UT , VT , WA , WI , WV , WYCA1064 12/93 CA25071293(HI) 2, F LOCATIONS AND OPERATIONS NOT

COVEREDHI

CA750 03/92 TE9978A0392 1, 2, 3 LOSS PAYABLE CLAUSE TXCA801 12/93 CA99441293 1, 2, 3, 4, 5 LOSS PAYABLE CLAUSE AL , AR , AZ , CO , DC , DE , GA , IA ,

ID , IL , IN , KS , KY , LA , MD , MI ,




MN , MS , MT , NC , NE , NH , NM , NV ,OH , OK , SC , TX , UT , WI , WV , WY

CA1097 12/93 CA99441293(HI) 1, 2, 3, 4, 5, F LOSS PAYABLE CLAUSE HICA272 B 09/94 CA99500994 1, 2, 3, 4, 5, F LOSS PAYABLE CLAUSE WACA1105 12/93 CA99611293(HI) 1, 2, 3, 4, 5, F LOSS PAYABLE CLAUSE—AUDIO,

VISUAL AND DATA ELECTRONICEQUIPMENT

HI

CA683 03/92 TE2035A0392 1, 2, 3 LOSS PAYABLE CLAUSE—MODIFIED TXA4204 B LOSS PAYABLE ENDORSEMENT (FORM

49A)CA

CA2540 03/06 CA25400306 2, F LOUISIANA - FUNGI OR BACTERIAEXCLUSION - GARAGE OPERATIONS -OTHER THAN COVERED AUTOS

LA

CA2540 10/13 CA25401013 2, F LOUISIANA - FUNGI OR BACTERIAEXCLUSION - GENERAL LIABILITYCOVERAGES

LA

CA0413 10/13 CA04131013 1, 2, 3, 4, 5 LOUISIANA - LESSOR - ADDITIONALINSURED AND LOSS PAYEE

LA

CA2541 10/13 CA25411013 2, F LOUISIANA - LIMITED FUNGI ORBACTERIA COVERAGE FOR GARAGEOPERATIONS - OTHER THAN COVEREDAUTOS

LA

CA2616 03/12 CA26160312 LOUISIANA AMENDMENT OF SINGLEINTEREST AUTOMOBILE PHYSICALDAMAGE INSURANCE POLICY

LA

CA2617 03/12 CA26170312 LOUISIANA AMENDMENT OF SINGLEINTEREST AUTOMOBILE PHYSICALDAMAGE INSURANCE POLICY

LA

CA0103 10/13 CA01031013 1, 2, 3, 4, 5 LOUISIANA CHANGES LACA0147 10/13 CA01471013 + LOUISIANA CHANGES - AUTO DEALERS

COVERAGE FORMLA

IL0277 10/20 IL02771020 LOUISIANA CHANGES -CANCELLATION AND NONRENEWAL

LA

CA0178 10/13 CA01781013 LOUISIANA CHANGES - COVERAGE -COVERAGE EXTENSION FOR RENTALVEHICLES

LA

CA537 A 05/96 CA01780596 1, 2, 3, 4, 5 LOUISIANA CHANGES-COVERAGEEXTENSION FOR RENTAL VE

LA

CA3119 10/13 CA31191013 1, 2, 3, 5, F LOUISIANA ECONOMIC LOSSUNINSURED MOTORISTS COVERAGE-BODILY INJURY

LA

CA2097 10/13 CA20971013 1, 3, 5 LOUISIANA LEASING OR RENTALCONCERNS - CONTINGENT COVERAGE

LA

CA2148 10/13 CA21481013 1, 2, 3, 5, F LOUISIANA UNINSURED MOTORISTSCOVERAGE-BODILY INJURY

LA

CA2181 10/13 CA21811013 1, 2, 3, 5, F LOUISIANA UNINSURED MOTORISTSCOVERAGE-PROPERTY DAMAGE

LA

(M)CA2611 11/16 CA26111116 MAINE AMENDMENT OF SINGLE

INTEREST POLICY PROVISIONS -CANCELLATION

ME

CA0134 10/13 CA01341013 1, 3, 4, 5, F MAINE CHANGES MECA0176 10/13 CA01761013 2, F MAINE CHANGES - GARAGE

COVERAGE FORMME

CA2174 10/13 CA21741013 MAINE UNINSURED MOTORISTSCOVERAGE

ME

IL0136 02/96 IL01360296 MANDATORY PREMIUM & COVERAGECONDITIONS ENDORSEMENT

PR

IL0136 05/04 IL01360504 MANDATORY PREMIUM & COVERAGECONDITIONS ENDORSEMENT

PR

CA324 A 03/94 CA01060394 1, 2, 3, 4, 5 CO




MARYLAND & COLORADO CHANGES-COLLISION COVERAGE IN MEXICO

CA0215 12/17 CA02151217 1, 2, 3, 4, 5, F MARYLAND CANCELLATION CHANGES MDCA0170 10/13 CA01701013 1, 2, 3, 4, 5, F MARYLAND CHANGES MDCA0106 10/13 CA01061013 1, 2, 3, 4, 5 MARYLAND CHANGES - COLLISION

COVERAGE IN MEXICOMD

CA0101 10/13 CA01011013 2, F MARYLAND CHANGES - GARAGECOVERAGE FORM

MD

CA2219 10/13 CA22191013 1, 2, 3, 5, F MARYLAND PERSONAL INJURYPROTECTION ENDORSEMENT

MD

CA2113 10/13 CA21131013 1, 2, 3, 5, F MARYLAND UNINSURED MOTORISTSCOVERAGE

MD

M-0099-S 04/07 M0099S0407 MASSACHUSETTS MANDATORYENDORSEMENT

MA

CA653 03/92 TE0408B0392 1, 2, 3 MEXICO COVERAGE TXCA655 03/92 TE0406B0392 1, 2, 3 MEXICO COVERAGE—LIMITED TXCA654 03/92 TE0407B0392 1, 2, 3 MEXICO TOURISTS COVERAGE—

LIMITEDTX

CA2628 11/16 CA26281116 MICHIGAN AMENDMENT OF SINGLEINTEREST POLICY PROVISIONS -CANCELLATION

MI

CA2222 10/13 CA22221013 1, 2, 3, 5 MICHIGAN BROADENED COLLISIONCOVERAGE

MI

CA0110 09/16 CA01100916 1, 2, 3, 4, 5, F MICHIGAN CHANGES MICA0217 07/17 CA02170717 F MICHIGAN CHANGES - CANCELLATION

AND NONRENEWALMI

CA2318 10/13 CA23181013 F MICHIGAN CHANGES - TRUCKERSENDORSEMENT

MI

CA2221 07/20 CA22210720 F MICHIGAN COORDINATION OFPERSONAL INJURY PROTECTION

MI

CA2223 10/13 CA22221013 1, 2, 3, 5 MICHIGAN LIMITED COLLISIONCOVERAGE

MI

CA2310 10/13 CA23101013 1 MICHIGAN MOTOR CARRIER -INSURANCE FOR NON-TRUCKING USE

MI

CA2311 10/13 CA23111013 1, 2, 3, 5 MICHIGAN MOTOR CARRIERAMENDATORY ENDORSEMENT

MI

CA9943 10/13 CA99431013 1, 2, 3, 5, F MICHIGAN MOTORCYCLE MEDICALPAYMENTS COVERAGE

MI

CA2220 07/20 CA22200720 1, 2, 3, 5, F MICHIGAN PERSONAL INJURYPROTECTION

MI

CA9941 07/20 CA99410720 MICHIGAN PROPERTY DAMAGELIABILITY COVERAGE BUYBACK

MI

CA2224 07/20 CA22240720 1, 2, 3, 5, F MICHIGAN PROPERTY PROTECTIONCOVERAGE

MI

CA0511 08/17 CA05110817 MICHIGAN PUBLIC OR LIVERYPASSENGER CONVEYANCE ANDTRANSPORTATION NETWORKSERVICES EXCLUSION

MI

CA2377 08/17 CA23770817 MICHIGAN PUBLIC OR LIVERYPASSENGER CONVEYANCE,TRANSPORTATION NETWORK ANDON-DEMAND DELIVERY SERVICESEXCLUSION

MI

CA2131 10/13 CA21311013 1, 2, 3, 5, F MICHIGAN UNINSURED MOTORISTSCOVERAGE

MI

CA348 A 05/96 CA99200596 1, 2, 3, 5, F MILITARY BASES (LOUISIANA) ANDPUERTO RICE

LA

CA0194 10/13 CA01941013 MINNESOTA - GARAGEKEEPERSENDORSEMENT

MN

CA2226 01/15 CA22260115 1, 2, 3, 5, F MINNESOTA ADDED PERSONAL INJURYPROTECTION

MN




CA9946 05/20 CA99460520 MINNESOTA BUSINESS INTERRUPTIONCOVERAGE

MN

CA0138 05/20 CA01380520 1, 3, 4, 5, F MINNESOTA CHANGES MNCA0133 05/20 CA01330520 2, F MINNESOTA CHANGES - AUTO

DEALERS COVERAGE FORMMN

CA0218 10/13 CA02181013 1, 2, 3, 4, 5, F MINNESOTA CHANGES -CANCELLATION AND NONRENEWAL

MN

CA9993 10/13 CA99931013 1, 2, 3, 5, F MINNESOTA CHANGES -GARAGEKEEPERS COVERAGE -CUSTOMERS' SOUND - RECEIVINGEQUIPMENT

MN

CA0174 10/13 CA01741013 1, 2, 3, 5, F MINNESOTA CHANGES - RENTALVEHICLE AND TEMPORARY LOANEDVEHICLE COVERAGE

MN

CA2594 10/13 CA25941013 MINNESOTA CUSTOMER COMPLAINTLEGAL DEFENSE COVERAGE

MN

CA2582 10/13 CA25821013 1, 2, 3, 5, F MINNESOTA EMPLOYEE BENEFITSLIABILITY COVERAGE

MN

CA2593 10/13 CA25931013 1, 2, 3, 5, F MINNESOTA LIMITED PRODUCTWITHDRAWAL EXPENSEENDORSEMENT

MN

CA2340 10/13 CA23401013 1, 2, 3, 5, F MINNESOTA MOTOR CARRIERENDORSEMENT

MN

CA2225 05/20 CA22250520 1, 2, 3, 5, F MINNESOTA PERSONAL INJURYPROTECTION

MN

CA2227 10/13 CA22271013 1, 2, 3, 5, F MINNESOTA PERSONAL INJURYPROTECTION COVERAGE CHANGEDFOR MOTORCYCLES

MN

CA2124 05/20 CA21240520 1, 2, 3, 5, F MINNESOTA UNINSURED ANDUNDERINSURED MOTORISTSCOVERAGE

MN

CA2625 11/16 CA26251116 MISSISSIPPI AMENDMENT OF SINGLEINTEREST POLICY PROVISIONS -CANCELLATION

MS

IL0282 09/08 IL02820908 MISSISSIPPI CHANGES -CANCELLATION AND NONRENEWAL

MS

CA2161 10/13 CA21611013 MISSISSIPPI SPLIT UNINSUREDMOTORISTS COVERAGE LIMITS

MS

CA2129 10/13 CA21291013 1, 2, 3, 5, F MISSISSIPPI UNINSURED MOTORISTSCOVERAGE - BODILY INJURY

MS

CA2182 10/13 CA21821013 1, 2, 3, 5, F MISSISSIPPI UNINSURED MOTORISTSCOVERAGE BODILY INJURY -NONSTACKED

MS

CA2128 10/13 CA21281013 1, 2, 3, 5, F MISSISSIPPI UNINSURED MOTORISTSCOVERAGE BODILY INJURY ANDPROPERTY DAMAGE

MS

CA2180 10/13 CA21801013 1, 2, 3, 5, F MISSISSIPPI UNINSURED MOTORISTSCOVERAGE BODILY INJURY ANDPROPERTY DAMAGE - NONSTACKED

MS

CA0502 04/16 CA05020416 MISSOURI ALTERNATE LOSS PAYMENT- PHYSICAL DAMAGE COVERAGES

MO

CA2615 07/17 CA26150717 MISSOURI AMENDMENT OF SINGLEINTEREST POLICY PROVISIONS

MO

CA0165 07/16 CA01650716 MISSOURI CHANGES MOCA0436 10/08 CA04361008 MISSOURI CHANGES - AMENDMENT MOCA0219 01/16 CA02190116 1, 2, 3, 4, 5, F MISSOURI CHANGES - CANCELLATION

AND NONRENEWALMO

CA0219 10/13 CA02191013 1, 2, 3, 4, 5, F MISSOURI CHANGES - CANCELLATIONAND NONRENEWAL

MO

CA0166 10/13 CA01661013 1, 2, 3, 5, F MISSOURI CHANGES - POLLUTIONEXCLUSION

MO




CA2349 11/16 CA23491116 MISSOURI PUBLIC OR LIVERYPASSENGER CONVEYANCE ANDON-DEMAND DELIVERY SERVICESEXCLUSION

MO

CA2348 11/16 CA23481116 MISSOURI PUBLIC OR LIVERYPASSENGER CONVEYANCE EXCLUSION

MO

CA2156 10/13 CA21561013 F MISSOURI SPLIT UNINSUREDMOTORISTS LIMITS

SC

CA3104 02/18 CA31040218 1, 2, 3, 5, F MISSOURI UNDERINSURED MOTORISTSCOVERAGE

MO

CA2104 10/13 CA21041013 1, 2, 3, 5, F MISSOURI UNINSURED MOTORISTSCOVERAGE

MO

CA634 A 03/94 CA31050394 1, 2, 3 MO SPLIT UNDERINSURED MOTORISTSCOVERAGE LIMITS

MD

CA666 03/92 TE2015A0392 1, 3 MOBILE EQUIPMENT TXCA2079 09/02 CA20790902 1, 3, 4, 5, F MOBILE EQUIPMENT TXCA2015 10/01 CA20151001 1, 3, 4, 5 MOBILE EQUIPMENT NHCA2015 10/13 CA20151013 1, 3, 4, 5 MOBILE EQUIPMENT AK , AL , AR , AZ , CA , CO , CT , DC ,

DE , FL , GA , HI , IA , ID , IL , IN , KS ,KY , LA , ME , MI , MN , MO , MS , MT ,NC , ND , NE , NH , NJ , NM , NV , NY ,OH , OK , OR , PA , PR , RI , SC , SD ,

TN , TX , UT , VT , WA , WI , WV , WYCA2015 12/04 CA20151204 1, 3, 4, 5 MOBILE EQUIPMENT AK , AL , AR , AZ , CO , DC , DE , GA ,

GU , IA , ID , IN , KY , LA , MD , MI ,MO , MS , MT , NC , ND , NE , NM ,

NV , OH , OK , RI , SC , SD , TN , TX ,UT , VI , VT , WA , WI , WV , WY

CA821 12/93 CA20151293 1, 3, 4, 5 MOBILE EQUIPMENT AK , AL , AR , AZ , CA , CO , CT , DC ,DE , FL , GA , HI , IA , ID , IL , IN , KS ,


TX , UT , VA , VT , WA , WI , WV , WYCA1018 A 10/01 CA20151001(HI) 1, 3, 4, 5, F MOBILE EQUIPMENT HICA665 03/92 TE20160392 1, 2, 3 MOBILE HOMES CONTENTS COVERAGE TXCA2016 10/01 CA20161001 1, 2, 3, 4, 5 MOBILE HOMES CONTENTS COVERAGE AL , AR , AZ , CO , DC , DE , GA ,

GU , IA , ID , IN , KY , LA , MD , MI ,MO , MS , MT , NC , ND , NE , NH ,

NM , NV , OH , OK , RI , SC , SD , TN ,UT , VI , VT , WA , WI , WV , WY

CA2016 10/13 CA20161013 1, 2, 3, 4, 5 MOBILE HOMES CONTENTS COVERAGE AK , AL , AR , AZ , CA , CO , CT , DC ,DE , FL , GA , HI , IA , ID , IN , KS , KY ,


TN , UT , VA , VT , WA , WI , WV , WYCA820 12/93 CA20161293 1, 2, 3, 4, 5 MOBILE HOMES CONTENTS COVERAGE AK , AL , AR , AZ , CA , CO , CT , DC ,


TX , UT , VA , VT , WA , WI , WV , WYCA1019 A 10/01 CA20161001(HI) 1, 2, 3, 4, 5, F MOBILE HOMES CONTENTS COVERAGE HICA827 12/93 CA20171293 1, 2, 3, 4, 5 MOBILE HOMES CONTENTS NOT

COVEREDAL , AR , AZ , CO , DC , DE , GA ,



CA1020 12/93 CA20171293(HI) HI




++, 1, 2,3, 4, 5, F

MOBILE HOMES CONTENTS NOTCOVERED

CA918 A 08/96 TE2017A0896 1, 2, 3 MOBILE HOMES EXCLUSION OFWINDSTORM, HURRICANE, HAIL ANDFLOOD

TX

CA678 03/92 TE2043A0392 1, 2, 3 MOBILE HOMES—FEDERAL FLOODDISASTER PROTECTION ACT OF 1973(PUBLIC LAW 93-234)

TX

CA679 03/92 TE2042A0392 1, 2, 3 MOBILE HOME—TRIP COLLISION TXCA680 03/92 TE2014A0392 1, 2, 3 MODIFIED HAIL DEDUCTIBLE AK , AL , AR , AZ , CA , CO , CT , DC ,


TX , UT , VA , VT , WA , WI , WV , WYCA2627 11/16 CA26271116 MONTANA AMENDMENT OF SINGLE

INTEREST AUTOMOBILE PHYSICALDAMAGE INSURANCE POLICY(FINANCE MASTER POLICY FORM)

MI , MT

CA2624 11/16 CA26241116 MONTANA AMENDMENT OF SINGLEINTEREST AUTOMOBILE PHYSICALDAMAGE INSURANCE POLICY(INDIVIDUAL POLICY FORM)

MI , MT

CA0172 10/13 CA01721013 F MONTANA CHANGES - AUTO MEDICALPAYMENTS COVERAGE

MT

CA0220 10/13 CA02201013 1, 2, 3, 4, 5 MONTANA CHANGES-CANCELLATIONAND NONRENEWAL

MT

CA2568 10/13 CA25681013 MONTANA EMPLOYEE BENEFITSLIABILITY COVERAGE

MT

CA2569 10/13 CA25691013 MONTANA EXTENDED REPORTINGPERIOD ENDORSEMENT FOREMPLOYEE BENEFITS LIABILITYCOVERAGE

MT

IL1208 11/12 IL12081112 MONTANA POLICY CHANGES MTCA3134 10/13 CA31341013 F MONTANA SPLIT UNDERINSURED

MOTORISTS COVERAGE LIMITS - NON-STACKED

MT

CA3132 10/13 CA31321013 F MONTANA SPLIT UNDERINSUREDMOTORISTS COVERAGE LIMITS -STACKED

MT

CA3130 10/13 CA31301013 F MONTANA SPLIT UNINSUREDMOTORISTS COVERAGE LIMITS

MT

CA3136 10/13 CA31361013 F MONTANA SPLIT UNINSUREDMOTORISTS COVERAGE LIMITS - NON-STACKED

MT

CA3133 06/17 CA31330617 F MONTANA UNDERINSUREDMOTORISTS COVERAGE - NON-STACKED

MT

CA3131 06/17 CA31310617 F MONTANA UNDERINSUREDMOTORISTS COVERAGE - STACKED

MT

CA2152 06/17 CA21520617 1, 2, 3, 5, F MONTANA UNINSURED MOTORISTSCOVERAGE

MT

CA3135 06/17 CA31350617 F MONTANA UNINSURED MOTORISTSCOVERAGE - NON-STACKED

MT

CA694 A 02/96 TE2403B0296 1 MOTOR BUS ENDORSEMENT—TEXASDEPARTMENT OF TRANSPORTATION

TX

CA693 03/92 TE2404A0392 1 MOTOR BUS ENDORSEMENT—TEXASINDEMNITY FORM

TX

CA2330 10/13 CA23301013 MOTOR CARRIER ENDORSEMENT AK , AL , AR , AZ , CA , CO , CT , DC ,DE , FL , GA , IA , ID , IL , IN , KS ,

KY , LA , ME , MI , MO , MS , MT , NC ,





TX , UT , VA , VT , WA , WI , WV , WYCA2312 10/13 CA23121013 1, 3, 5 MOTOR CARRIERS - NAMED LESSEE AS

INSUREDAK , AL , AR , AZ , CA , CO , CT , DC ,DE , FL , GA , HI , IA , ID , IL , IN , KS ,


TN , TX , UT , VA , VT , WI , WV , WYGU599 B 05/09 TA016 MOTOR VEHICLE LAW ENFORCEMENT

FEE OF THE STATE OF NEW YORKNY

UA185 A 04/04 DI45070700 MOTOR VEHICLE PRE-INSPECTIONFORM

FL

CA711 03/92 TE2306A0392 1, 3 MOVING VANS OR TRUCKS—AGENT TXCA673 03/92 TE23030392 1, 3 MULTI-PURPOSE EQUIPMENT TXCA816 12/93 CA23031293 1, 3, 5 MULTI-PURPOSE EQUIPMENT AL , AZ , CO , DC , DE , GA , GU ,

IA , ID , IL , IN , KS , MD , MI ,MS , MT , NC , ND , NE , NH , NJ ,NM , NV , OH , OK , OR , PA , RI ,SD , TX , UT , VT , WA , WI , WV

CA1046 12/93 CA23031293(HI) 1, 3, 5, F MULTI-PURPOSE EQUIPMENT HI(N)

CA721 03/92 TE25110392 2 NAMED DRIVER COLLISION COVERAGE TXCA794 12/93 CA25111293 2 NAMED DRIVER COLLISION COVERAGE VACA1068 12/93 CA25111293(HI) 2, F NAMED DRIVER COLLISION COVERAGE HIA836 01/78 CA22070178 +, ++ NAMED INDIVIDUAL—BROADENED

BASIC REPARATIONS BENEFITSENDORSEMENT


UT , VA , VT , WA , WI , WV , WYCA295 01/87 CA22010187 NAMED INDIVIDUALS - BROADENED

PERSONAL INJURY PROTECTIONCOVERAGE

FL , KS , KY , MI , MN ,ND , NJ , NY , OR , UT

AP1052 03/05 NAMED NONOWNER POLICYADVISORY POLICY DECLARATIONS -NEW JERSEY

NJ

CA745 03/92 TE9984A0392 1 NAMED OPERATOR COVERAGE (ANYAUTO)

TX

CA744 03/92 TE9985A0392 1 NAMED OPERATOR COVERAGE (NON-OWNED AUTOS ONLY)

TX

CA531 A 03/94 CA01730394 1, 2, 3, 5 ND CHANGES-RENTAL VEHICLECOVER.-PRIVATE PASS.AUTO

ND

CA9935 11/13 CA99351113 2, F NEBRASKA AUTO MEDICAL PAYMENTSCOVERAGE

NE

CA0156 11/13 CA01561113 NEBRASKA CHANGES NECA0221 12/17 CA02211217 1, 2, 3, 4, 5 NEBRASKA CHANGES -

CANCELLATIONNE

CA0193 10/13 CA01931113 2, F NEBRASKA CHANGES - GARAGECOVERAGE FORM

NE

CA2175 10/13 CA21751013 NEBRASKA SPLIT UNINSUREDAND UNDERINSURED MOTORISTSCOVERAGE LIMITS

NE

CA2170 10/13 CA21701013 1, 2, 3, 5, F NEBRASKA UNINSURED ANDUNDERINSURED MOTORISTSCOVERAGE

NE

CA0136 10/13 CA01361013 1, 2, 3, 5, F NEVADA CHANGES NVCA0192 10/13 CA01921013 NEVADA CHANGES - AUTO DEALERS

COVERAGE FORMNV

IL0115 01/10 IL01150110 NV




NEVADA CHANGES DOMESTICPARTNERSHIP

CA323 01/87 CA99490187 1, 2, 3 NEVADA SPLIT LIABILITY LIMITS NVCA323 A 08/91 CA99490891 1, 2, 3 NEVADA SPLIT LIABILITY LIMITS NVCA3101 10/13 CA31011013 NEVADA SPLIT UNINSURED

MOTORISTS COVERAGE LIMITSNV

CA2127 10/13 CA21271013 1, 2, 3, 5, F NEVADA UNINSURED MOTORISTSCOVERAGE

NV

CA0262 01/19 CA02620119 1, 2, 3, 4, 5, F NEW HAMPSHIRE CHANGES -CANCELLATION AND NONRENEWAL

NH

CA0111 12/19 CA01111219 1, 2, 3, 4, 5, F NEW HAMPSHIRE CHANGES IN POLICY NHCA2572 10/13 CA25721013 NEW HAMPSHIRE EMPLOYEE BENEFITS

LIABILITY COVERAGENH

CA0409 08/15 CA040900815 1, 2, 3, 4, 5, F NEW HAMPSHIRE HIRED AUTOSSPECIFIED AS COVERED AUTOS YOUOWN

NH

CA2066 08/15 CA20660815 1, 2, 3, 4, 5, F NEW HAMPSHIRE LEASING CONCERNS- CONTINGENT COVERAGE

NH

CA2067 08/15 CA20670815 1, 2, 3, 4, 5, F NEW HAMPSHIRE LEASING CONCERNS- EXCLUSION OF CERTAIN LEASEDAUTOS

NH

CA2069 08/15 CA20690815 1, 2, 3, 4, 5, F NEW HAMPSHIRE LEASING CONCERNS- SECOND LEVEL COVERAGE

NH

CA2068 08/15 CA20680815 1, 2, 3, 4, 5, F NEW HAMPSHIRE LEASING OR RENTALCONCERNS - SCHEDULE OF LIMITS FOROWNED AUTOS

NH

CA2065 08/15 CA20650815 1, 2, 3, 4, 5, F NEW HAMPSHIRE LESSOR -ADDITIONAL INSURED AND LOSSPAYEE

NH

CA0432 10/13 CA04321013 1, 2, 3, 4, 5 NEW HAMPSHIRE LOSS PAYABLECLAUSE

NH

CA2020 10/13 CA20201013 1, 2, 3, 5 NEW HAMPSHIRE SNOWMOBILES NHCA2197 10/13 CA21971013 F NEW HAMPSHIRE SPLIT UNINSURED

MOTORISTS COVERAGE LIMITSNH

CA2573 10/13 CA25731013 NEW HAMPSHIRE SUPPLEMENTALEXTENDED REPORTING PERIODENDORSEMENT FOR EMPLOYEEBENEFITS LIABILITY COVERAGE

NH

CA2231 10/13 CA22311013 F NEW JERSEY ADDED PERSONALINJURY PROTECTION

NJ

CA0188 10/13 CA01881013 1, 3, 4, 5 NEW JERSEY CHANGES NJCA0108 10/13 CA01081013 2 NEW JERSEY CHANGES - AUTO

DEALERS COVERAGE FORMNJ

CA0187 10/13 CA01871013 2, F NEW JERSEY CHANGES - LOSSINFORMATION

NJ

CA0184 11/16 CA01841116 1, 2, 3, 4, 5, F NEW JERSEY CHANGES - PHYSICALDAMAGE INSPECTION

NJ

CA2034 10/13 CA20341013 1, 3, 5, F NEW JERSEY LEASING OR RENTALCONCERNS - EXCLUSION OF CERTAINLEASED AUTOS

NJ

CA2259 10/13 CA22591013 1, 2, 3, 5, F NEW JERSEY MEDICAL EXPENSEBENEFITS COVERAGE - MOTOR BUSPASSENGERS

PA

CA2230 01/20 CA22300120 1, 2, 3, 5, F NEW JERSEY PERSONAL INJURYPROTECTION

NJ

CA2268 10/13 CA22681013 NEW JERSEY PERSONAL INJURYPROTECTION - OPTIONAL WAIVEROF SCHEDULED MEDICAL EXPENSEBENEFITS DEDUCTIBLE AND CO-PAYMENT

NJ

CA0509 09/17 CA05090917 NJ




NEW JERSEY PUBLIC OR LIVERYPASSENGER CONVEYANCE ANDTRANSPORTATION NETWORKSERVICES EXCLUSION

CA0510 09/17 CA05100917 NEW JERSEY PUBLIC OR LIVERYPASSENGER CONVEYANCE,TRANSPORTATION NETWORK ANDON-DEMAND DELIVERY SERVICESEXCLUSION

NJ

CA2114 10/16 CA21141016 1, 2, 3, 5, F NEW JERSEY UNINSURED ANDUNDERINSURED MOTORISTSCOVERAGE

NJ

CA2177 10/13 CA21771013 NEW JERSEY UNINSURED ANDUNDERINSURED MOTORISTSCOVERAGE LIMITS

NJ

CA3129 10/13 CA31291013 1, 2, 3, 5 NEW MEXICO - UNINSUREDMOTORISTS COVERAGE -NONSTACKED

NM

CA2115 10/13 CA21151013 1, 2, 3, 5 NEW MEXICO - UNINSUREDMOTORISTS COVERAGE - STACKED

NM

CA0139 10/13 CA01391013 1, 3, 4, 5, F NEW MEXICO CHANGES NMCA0250 05/15 CA02500515 NEW MEXICO CHANGES -

CANCELLATION AND NONRENEWALNM

CA0250 10/13 CA02501013 NEW MEXICO CHANGES -CANCELLATION AND NONRENEWAL

NM

CA2132 07/05 CA21320705 NEW MEXICO SPLIT UNINSUREDMOTORISTS COVER LIMITS

NM

CA2635 11/18 CA26351118 NEW YORK AMENDMENT OF SINGLEINTEREST POLICY PROVISIONS

NY

CA2633 11/18 CA26331118 NEW YORK AMENDMENT OF SINGLEINTEREST POLICY PROVISIONS- TRANSPORTATION NETWORKSERVICES EXCLUSION

NY

CA9956 02/14 CA99560214 NEW YORK BUSINESS INTERRUPTIONCOVERAGE

NY

IL0185 08/08 IL01850808 1, 3, 4, 5, F NEW YORK CHANGES - CALCULATIONOF PREMIUM

NY

CA0225 06/20 CA02250620 1, 2, 3, 4, 5 NEW YORK CHANGES - CANCELLATION NYCA961 04/98 CA01020498 1, F NEW YORK CHANGES - FIRE HIRE

AUTOSNY

CA0102 06/20 CA01020620 NEW YORK CHANGES – FOR HIREAUTOS

NY

CA0167 11/18 CA01671118 1, 2, 3, 5 NEW YORK CHANGES - RENTALVEHICLE COVERAGE

NY

CA0112 12/15 CA01121215 1, 3, 4, 5, F NEW YORK CHANGES IN BUSINESSAUTO, BUSINESS AUTO PHYSICALDAMAGE, MOTOR CARRIER ANDTRUCKERS COVERAGE FORMS

NY

CA0152 12/15 CA01521215 2, F NEW YORK CHANGES IN GARAGECOVERAGE FORM

NY

CA2595 01/15 CA25950115 NEW YORK CHANGES TO THEBANKRUPTCY OR INSOLVENCYEXCLUSION FOR ACTS, ERRORS OROMISSIONS LIABILITY COVERAGES

NY

CA2075 08/14 CA20750814 1, 2, 3, 5, F NEW YORK COVERAGE FOR CERTAINOPERATIONS IN CONNECTION WITHRAILROADS

NY

CA2052 08/14 CA20520814 1 NEW YORK EMERGENCY SERVICES- VOLUNTEER FIREFIGHTERS' ANDWORKERS' INJURIES EXCLUDED

NY

CA2249 01/15 CA22490115 NY




NEW YORK EXCLUSION OF MEDICALEXPENSE FROM MANDATORYPERSONAL INJURY PROTECTIONENDORSEMENT

CA2031 08/14 CA20310814 NEW YORK LEASING OR RENTALCONCERNS – CONTINGENT COVERAGE

NY

CA2232 11/18 CA22321118 F NEW YORK MANDATORY PERSONALINJURY PROTECTION ENDORSEMENT

NY

CA2248 11/13 CA22481113 F NEW YORK MANDATORY PERSONALINJURY PROTECTION ENDORSEMENT -MOTORCYCLES

NY

CA2024 08/14 CA20240814 1, 3, 4, 5 NEW YORK MOBILE EQUIPMENT NYCA2025 08/14 CA20250814 1, 2, 3, 5 NEW YORK MUTUAL AID

ENDORSEMENTNY

CA632 04/92 CA22600492 F NEW YORK OPTIONAL BASICECONOMIC LOSS COVERAGE

NY

CA2082 11/11 CA20821111 1, F NEW YORK PHYSICAL DAMAGECOVERAGE - AUTOS HELD FOR SALEBY NON-DEALERS

NY

CA2050 08/14 CA20500814 +, ++, +++, 1,2, 3, 5, A, B, C,D, E, F, G, H, M

NEW YORK SNOWMOBILES NY

CA3108 11/18 CA31081118 NEW YORK SPLIT SUPPLEMENTARYUNINSURED/UNDERINSUREDMOTORISTS LIMITS

NY

CA0420 08/14 CA04200814 1, 2, 3, 5, F NEW YORK SUPPLEMENTAL SPOUSALLIABILITY COVERAGE

NY

CA3107 11/18 CA31071118 NEW YORK SUPPLEMENTARYUNINSURED/UNDERINSUREDMOTORISTS ENDORSEMENT

NY

CA0242 08/14 CA02420814 NEW YORK SUSPENSION OFINSURANCE

NY

CA457 A 06/98 CA02420698 1, 2, 3, 4, 5 NEW YORK SUSPENSION OFINSURANCE

NY

CA2596 01/15 CA2560115 NEW YORK TOTAL BANKRUPTCY ORINSOLVENCY EXCLUSION FOR ACTS,ERRORS OR OMISSIONS LIABILITYCOVERAGES WITH A GOVERNMENTBODY EXCEPTION

NY

CA2045 08/14 CA20450814 NEW YORK TOW TRUCKS NYCA478 A 06/98 CA20450698 1, 3, 5 NEW YORK TOW TRUCKS NYCA2399 11/11 CA23991111 1 NEW YORK TRAILER INTERCHANGE

COVERAGENY

CA0514 11/18 CA05141118 NEW YORK TRANSPORTATIONNETWORK SERVICES EXCLUSION

NY

CA2322 08/14 CA23220814 1 NEW YORK TRUCKERS - INSURANCEFOR NON-TRUCKING USE

NY

A3938 B 01/03 NO FAULT KYUA221 01/01 NFV1 P&C NO-FAULT REJECTION VERIFICATION

REQUESTKY

CA0126 10/13 CA01261013 1, 2, 3, 4, 5, F NORTH CAROLINA CHANGES NCCA2632 10/17 CA26321017 NORTH CAROLINA EMPLOYEE

BENEFITS LIABILITY COVERAGENC

CA2577 10/17 CA25771017 NORTH CAROLINA EXTENDEDREPORTING PERIOD ENDORSEMENTFO EMPLOYEE BENEFITS LIABILITYCOVERAGE

NC

CA2116 10/13 CA21161013 1, 2, 3, 5, F NORTH CAROLINA UNINSUREDMOTORISTS COVERAGE

NC

CA2235 10/13 CA22351013 NORTH DAKOTA ADDED PERSONALINJURY PROTECTION ENDORSEMENT

ND




CA0161 10/13 CA01611013 1, 2, 3, 5, F NORTH DAKOTA CHANGES NDPA0205 10/13 PA02051013 1, 3, 5, F NORTH DAKOTA CHANGES -

CANCELLATION AND NONRENEWALND

CA0173 10/13 CA01731013 NORTH DAKOTA CHANGES - RENTALVEHICLE COVERAGE PRIVATEPASSENGER AUTOS

ND

CA2234 10/13 CA22341013 1, 2, 3, 5, F NORTH DAKOTA PERSONAL INJURYPROTECTION ENDORSEMENT

ND

CA2186 10/13 CA21861013 1, 2, 3, 5, F NORTH DAKOTA UNDERINSUREDMOTORISTS COVERAGE

ND

CA2183 10/13 CA21831013 1, 2, 3, 5, F NORTH DAKOTA UNINSUREDMOTORISTS COVERAGE

ND

IL0179 04/94 IL01790494 NOTICE OKIL0179 10/02 IL01791002 NOTICE OKGU211 A 08/00 NOTICE (STICKER FOR ATTACHMENT

TO POLICIES TO COMPLY WITHMINNESOTA POLICY READABILITYREQUIREMENTS)

MN

UG106 D 04/16 NOTICE CONCERNING POLICYHOLDERRIGHTS IN AN INSOLVENCY UNDERTHE MINNESOTA INSURANCEGUARANTY ASSOCIATION LAW

MN

UA208 02/00 NOTICE FOR PAYMENT FORAFTERMARKET CRASH PARTS—IOWA

IA

UA207 02/00 NOTICE FOR PAYMENT FORAFTERMARKET CRASH PARTS—IOWA(STICKER)

IA

UA183 A 04/04 DI45050700 NOTICE OF MANDATORY PRE-INSPECTION REQUIREMENT

FL

UG179 05/00 NOTICE OF PROHIBITION OF UNFAIRDISCRIMINATION (STICKER)

GA

A1743 03/99 NOTICE OF RIGHT TO CANCEL(STICKER)

SC

UG114 A 09/12 NOTICE OF RIGHT TO FILE ACOMPLAINT

WI

UA184 A 04/04 DI45060700 NOTICE OF SUSPENDED INSURANCECOMPANY-IMMEDIATE ACTIONREQUIRED

FL

A316 11/88 NOTICE REGARDING UNINSURED/UNDERINSURED COVERAGE

IA

A1734 B 04/07 NOTICE TO CLAIMANTS REGARDINGMOTOR VEHICLE REPAIRS

TX

UA203 05/99 NOTICE TO MOTORCYCLEPOLICYHOLDERS–PERSONAL INJURYPROTECTION COVERAGE

MN

UA202 05/99 NOTICE TO MOTORCYCLEPOLICYHOLDERS–PERSONAL INJURYPROTECTION COVERAGE (STICKER)

MN

UG102 B 02/05 NOTICE TO POLICYHOLDERS INA1785 07/03 NOTICE TO POLICYHOLDERS

(APPLICABLE TO POLICIES EFFECTIVEPRIOR TO JULY 1, 2003) (CUSTOMONLY)

CO

A1784 07/03 NOTICE TO POLICYHOLDERS(APPLICABLE TO POLICIES WRITTENTO BECOME EFFECTIVE ON OR AFTERJULY 1, 2003) (CUSTOM ONLY)

CO

CAP002 04/06 CAP0020406 4, F NOTICE TO POLICYHOLDERS 2006COMMERICAL AUTO MULTISTATEFORMS REVISION







CA1163 03/04 NOTICE TO POLICYHOLDERSBROADENINGS, RESTRICTIONS ANDCLARIFICATIONS OF COVERAGELOUISIANA COMMERCIALAUTOMOBILE

LA

CA1162 04/04 NOTICE TO POLICYHOLDERSBROADENINGS, RESTRICTIONS ANDCLARIFICATIONS OF COVERAGEMINNESOTA COMMERCIALAUTOMOBILE (FILING CA-99-098FO)

MN

GU234 01/83 NOTICE TO POLICYHOLDERSCONCERNING COMPULSORYINSURANCE LAW

OK

CA1166 05/04 NOTICE TO POLICYHOLDERSPOTENTIAL RESTRICTIONS OFTERRORISM COVERAGE FORUSE WITH CA2376 CONDITIONALEXCLUSION OF TERRORISM (RELATINGTO DISPOSITION OF FEDERALTERRORISM RISK INSURANCE ACTOF 2002) CONTAINS CERTIFIED ACTSEXCLUSION




CA1170 05/04 NOTICE TO POLICYHOLDERSPOTENTIAL RESTRICTIONS OFTERRORISM COVERAGE FORUSE WITH CA2376 CONDITIONALEXCLUSION OF TERRORISM (RELATINGTO DISPOSITION OF FEDERALTERRORISM RISK INSURANCE ACTOF 2002) CONTAINS CERTIFIED ACTSEXCLUSION AND EXCLUSION OF NBCOTHER ACTS




CA1169 05/04 NOTICE TO POLICYHOLDERSPOTENTIAL RESTRICTIONS OFTERRORISM COVERAGE FOR USE WITHCA2376 CONDITIONAL EXCLUSIONOF TERRORISM (RELATING TODISPOSITION OF FEDERAL TERRORISMRISK INSURANCE ACT OF 2002)CONTAINS EXCLUSION OF CERTIFIEDACTS AND OTHER ACTS




CA1164 05/04 NOTICE TO POLICYHOLDERSPOTENTIAL RESTRICTIONS OFTERRORISM COVERAGE FOR USE WITHCA2376 CONDITIONAL EXCLUSIONOF TERRORISM (RELATING TODISPOSITION OF FEDERAL TERRORISMRISK INSURANCE ACT OF 2002)CONTAINS NO TERRORISM EXCLUSIONAND NO CAP ON CERTIFIED LOSSES




CA1165 05/04 NOTICE TO POLICYHOLDERSPOTENTIAL RESTRICTIONS OFTERRORISM COVERAGE FOR USE WITHCA2376 CONDITIONAL EXCLUSIONOF TERRORISM (RELATING TODISPOSITION OF FEDERAL TERRORISMRISK INSURANCE ACT OF 2002)CONTAINS NO TERRORISM EXCLUSION







BUT CAP CERTIFIED LOSSES INACCORDANCE WITH FEDERAL ACT

CA1167 05/04 NOTICE TO POLICYHOLDERSPOTENTIAL RESTRICTIONS OFTERRORISM COVERAGE FOR USE WITHCA2376 CONDITIONAL EXCLUSIONOF TERRORISM (RELATING TODISPOSITION OF FEDERAL TERRORISMRISK INSURANCE ACT OF 2002)CONTAINS ''OTHER ACTS'' (SO-CALLEDDOMESTIC EXCLUSION




CA1168 05/04 NOTICE TO POLICYHOLDERSPOTENTIAL RESTRICTIONS OFTERRORISM COVERAGE FOR USE WITHCA2376 CONDITIONAL EXCLUSIONOF TERRORISM (RELATING TODISPOSITION OF FEDERAL TERRORISMRISK INSURANCE ACT OF 2002)CONTAINS ''OTHER ACTS'' EXCLUSIONLIMITED TO NUCLEAR-BIOLOGICAL-CHEMICAL (NBC) EVENTS




CA1177 05/04 NOTICE TO POLICYHOLDERSPOTENTIAL RESTRICTIONS OFTERRORISM COVERAGE FOR USE WITHCA2378 CONDITIONAL EXCLUSIONOF TERRORISM (RELATING TODISPOSITION OF FEDERAL TERRORISMRISK INSURANCE ACT OF 2002)CONTAINS ACTS EXCLUSION ANDEXCLUSION OF NBC OTHER ACTS




CA1173 05/04 NOTICE TO POLICYHOLDERSPOTENTIAL RESTRICTIONS OFTERRORISM COVERAGE FORUSE WITH CA2378 CONDITIONALEXCLUSION OF TERRORISM (RELATINGTO DISPOSITION OF FEDERALTERRORISM RISK INSURANCE ACTOF 2002) CONTAINS CERTIFIED ACTSEXCLUSION




CA1176 05/04 NOTICE TO POLICYHOLDERSPOTENTIAL RESTRICTIONS OFTERRORISM COVERAGE FOR USE WITHCA2378 CONDITIONAL EXCLUSIONOF TERRORISM (RELATING TODISPOSITION OF FEDERAL TERRORISMRISK INSURANCE ACT OF 2002)CONTAINS EXCLUSION OF CERTIFIEDACTS AND OTHER ACTS




CA1171 05/04 NOTICE TO POLICYHOLDERSPOTENTIAL RESTRICTIONS OFTERRORISM COVERAGE FOR USE WITHCA2378 CONDITIONAL EXCLUSIONOF TERRORISM (RELATING TODISPOSITION OF FEDERAL TERRORISMRISK INSURANCE ACT OF 2002)CONTAINS NO TERRORISM EXCLUSIONAND NO CAP ON CERTIFIED LOSSES




CA1172 05/04 NOTICE TO POLICYHOLDERSPOTENTIAL RESTRICTIONS OFTERRORISM COVERAGE FOR USE WITHCA2378 CONDITIONAL EXCLUSION






OF TERRORISM (RELATING TODISPOSITION OF FEDERAL TERRORISMRISK INSURANCE ACT OF 2002)CONTAINS NO TERRORISM EXCLUSIONBUT CAPS CERTIFIED LOSSES INACCORDANCE WITH FEDERAL ACT


CA1174 05/04 NOTICE TO POLICYHOLDERSPOTENTIAL RESTRICTIONS OFTERRORISM COVERAGE FOR USE WITHCA2378 CONDITIONAL EXCLUSIONOF TERRORISM (RELATING TODISPOSITION OF FEDERAL TERRORISMRISK INSURANCE ACT OF 2002)CONTAINS ''OTHER ACTS'' (SO CALLEDDOMESTIC) EXCLUSION




CA1175 05/04 NOTICE TO POLICYHOLDERSPOTENTIAL RESTRICTIONS OFTERRORISM COVERAGE FOR USE WITHCA2378 CONDITIONAL EXCLUSIONOF TERRORISM (RELATING TODISPOSITION OF FEDERAL TERRORISMRISK INSURANCE ACT OF 2002)CONTAINS ''OTHER ACTS'' EXCLUSIONLIMITED TO NUCLEAR-BIOLOGICAL-CHEMICAL (NBC) EVENTS




GU648 01/04 NOTICE TO POLICYHOLDERS U.S.TREASURY DEPARTMENT'S OFFICE OFFOREIGN ASSETS CONTROL (''OFAC'')


UT , VA , VT , WA , WI , WV , WYCAP003 01/06 CAP0030106 NOTICE TO POLICYHOLDERS UPDATE

ON TERRORISM ENDORSEMENTSAK , AL , AR , AZ , CA , CO , CT , DC ,DE , FL , GA , HI , IA , ID , IL , IN , KS ,


TX , UT , VA , VT , WA , WI , WV , WYGU649 05/04 1, 3, 4, 5 NOTICE TO POLICYHOLDERS UPDATE

ON TERRORISM ENDORSEMENTSAK , AL , AR , AZ , CA , CO , CT , DC ,

DE , FL , GA , GU , HI , IA , ID , IL ,IN , KS , KY , LA , MA , MD , ME , MI ,



CA972 09/98 NOTICE TO POLICYHOLDERS YEAR2000 PROBLEM AND YOUR INSURANCECOVERAGE (FOR USE WITH CA 25 18 0998)



TX , UT , VA , VT , WA , WI , WV , WYCA973 09/98 NOTICE TO POLICYHOLDERS YEAR

2000 PROBLEM AND YOUR INSURANCECOVERAGE (FOR USE WITH CA 25 19 0998)











CA975 09/98 NOTICE TO POLICYHOLDERS YEAR2000 PROBLEM AND YOUR INSURANCECOVERAGE (FOR USE WITH CA 25 24 0998)







TX , UT , VA , VT , WA , WI , WV , WYCA1110 02/01 NOTICE TO POLICYHOLDERS—

BROADENINGS AND CLARIFICATIONSOF COVERAGE

NY

CA1149 08/03 NOTICE TO POLICYHOLDERS—BROADENINGS, RESTRICTIONS ANDCLARIFICATIONS OF COVERAGE

TX

CA1142 01/02 NOTICE TO POLICYHOLDERS—RESTRICTIONS AND CLARIFICATIONSOF COVERAGE

KY

CA1150 12/02 NOTICE TO POLICYHOLDERS—RESTRICTIONS OF COVERAGE



TX , UT , VA , VT , WA , WI , WV , WYCA1140 01/02 NOTICE TO POLICYHOLDERS—

RESTRICTIONS OF COVERAGE(COMMERCIAL AUTO WAR, MILITARYACTION AND TERRORISM EXCLUSION)

OR

CA1129 01/02 NOTICE TO POLICYHOLDERS—RESTRICTIONS OF COVERAGE (WAR,MILITARY ACTION AND TERRORISMEXCLUSION)



TX , UT , VA , VT , WA , WI , WV , WYGU517 03/98 IL00210398 F NUCLEAR ENERGY LIABILITY

EXCLUSION ENDORSEMENTAK , AL , AR , AZ , CA , CO , CT ,


UT , VA , VT , WA , WI , WV , WYGU453 03/92 IL00210392 NUCLEAR ENERGY LIABILITY

EXCLUSION ENDORSEMENT (BROADFORM)

TX

IL0021 09/08 IL00219S F NUCLEAR ENERGY LIABILITYEXCLUSION ENDORSEMENT (BROADFORM)



GU481 11/94 IL00211194 F NUCLEAR ENERGY LIABILITYEXCLUSION ENDORSEMENT (BROADFORM)






IL0198 09/08 IL01980908 NUCLEAR ENERGY LIABILTIYEXCLUSION ENDORSEMENT

WA

CA1161 12/02 CA23671202(HI) 1, 2, 3, 4, 5 NUCLEAR, BIOLOGICAL OR CHEMICALTERRORISM EXCLUSION (OTHER THANCERTIFIED ACTS OF TERRORISM

HI

CA1154 12/02 CA23591202(HI) 1, 2, 3, 4, 5 NUCLEAR, BIOLOGICAL OR CHEMICALTERRORISM EXCLUSION (OTHER THANCERTIFIED ACTS OF TERRORISM); CAPON LOSSES FROM CERTIFIED ACTS OFTERRORISM

HI

CA463 A 04/92 CA22490492 F NY EXCLUSION OF MED.EXPENSEFROM MANDATORY PIP END

NY

CA527 A 06/98 CA20310698 1, 3, 5 NY LEASING OR RENTAL CONCERNS-CONTINGENT COVERAGE

NY

CA641 C 11/98 CA31081198 +++ NY SPLIT SUPP UNINSD/UNDERINSDMOTORISTS LIMITS

NY

(O)PA0209 10/13 PA02091013 1, 2, 3, 4, 5, F OHIO CHANGES - CANCELLATION AND

NONRENEWALOH

CA0145 10/13 CA01451013 2, F OHIO GARAGE LIABILITY COVERAGECHANGES

OH

CA2133 08/17 CA21330817 1, 2, 3, 5, F OHIO UNINSURED ANDUNDERINSURED MOTORISTSCOVERAGE - BODILY INJURY

OH

CA0132 10/13 CA01321013 OKLAHOMA CHANGES OKCA2142 01/15 CA21420115 F OKLAHOMA SPLIT UNINSURED

MOTORISTS COVERAGE LIMITS.OK

CA3143 06/15 CA31430615 F OKLAHOMA UNINSURED MOTORISTSCOVERAGE - NON-STACKED

OK

CA2118 06/15 CA21180615 1, 2, 3, 4, 5, F OKLAHOMA UNINSURED MOTORISTSCOVERAGE - STACKED

OK

UA215 06/01 OPERATOR'S POLICY NOTICE (LONGVERSION) (LABEL)

NV

UA216 06/01 OPERATOR'S POLICY NOTICE (SHORTVERSION) (LABEL)

NV

CA9990 03/10 CA99900310 1, 2, 3, 4, 5, F OPTIONAL LIMITS - LOSS OF USEEXPENSES


CA9990 10/13 CA99901013 1, 2, 3, 4, 5, F OPTIONAL LIMITS - LOSS OF USEEXPENSES



CA0149 10/13 CA01491013 1, 2, 3, 4, 5, F OREGON CHANGES ORIL0142 09/08 IL01420908 OREGON CHANGES - DOMESTIC

PARTNERSHIPOR

CA2073 10/13 CA20731013 1, 3, 5, F OREGON LEASING OR RENTALCONCERNS - CONTINGENT COVERAGE

OR

CA9986 10/17 CA99861017 OREGON MARIJUANA EXCLUSION FORGENERAL LIABILITY COVERAGES

OR

CA2236 11/16 CA22361116 1, 2, 3, 5, F OREGON PERSONAL INJURYPROTECTION

OR

CA2105 01/16 CA21050116 1, 2, 3, 5, F OREGON UNINSURED MOTORISTSCOVERAGE - BODILY INJURY

OR

CA2187 10/13 CA21871013 1, 2, 3, 5, F OREGON UNINSURED MOTORISTSCOVERAGE - PROPERTY DAMAGEPRIVATE PASSENGER TYPES

OR




CA806 12/93 CA25091293 2 OWNERS OF GARAGE PREMISES AL , AR , AZ , CO , DC , DE , GA ,IA , ID , IL , IN , KS , KY , LA , MD ,ME , MI , MN , MO , MS , MT , NC ,ND , NE , NH , NJ , NM , NV , OH ,OK , OR , PA , RI , SC , SD , TN ,

TX , UT , VT , WA , WI , WV , WYCA1066 12/93 CA25091293(HI) 2, F OWNERS OF GARAGE PREMISES HI

(P)CA2167 10/13 CA21671013 F PA SPLIT UNINSURED MOTORISTS

COVER.LIMITS-STACKEDPA

CA2254 10/13 CA22541013 F PENNSYLVANIA - NAMEDINDIVIDUALS - BROADENED FIRST-PARTY BENEFITS

PA

CA2238 10/13 CA22381013 F PENNSYLVANIA ADDED ANDCOMBINATION FIRST-PARTY BENEFITSENDORSEMENT

PA

CA2237 10/13 CA22371013 1, 2, 3, 5, F PENNSYLVANIA BASIC FIRST-PARTYBENEFIT

PA

CA0180 06/16 CA01800616 1, 2, 3, 5, F PENNSYLVANIA CHANGES PACA0157 06/16 CA01570616 PENNSYLVANIA CHANGES - AUTO

DEALERS COVERAGE FORMPA

IL0120 10/13 IL01201013 PENNSYLVANIA CHANGES - DEFENSECOSTS

PA

CA2256 10/13 CA22561013 F PENNSYLVANIA EXTRAORDINARYMEDICAL BENEFITS COVERAGE

PA

CA2258 10/13 CA22581013 F PENNSYLVANIA PEDESTRIAN BASICFIRST-PARTY BENEFIT

PA

CA644 10/97 CA20511097 1, 2, 3, 4, 5, F PENNSYLVANIA SNOWMOBILES PACA2194 10/13 CA21941013 F PENNSYLVANIA SPLIT UNDERINSURED

MOTORIST COVERAGE LIMITS -STACKED

PA

CA2196 10/13 CA21961013 F PENNSYLVANIA SPLIT UNDERINSUREDMOTORIST COVERAGE LIMITS FORFLEET POLICIES - NONSTACKED

PA

CA2191 10/13 CA21911013 1, 2, 3, 5, F PENNSYLVANIA SPLIT UNINSUREDMOTORIST COVERAGE LIMITS -STACKED

PA

CA2195 10/13 CA12951013 F PENNSYLVANIA SPLIT UNINSUREDMOTORIST COVERAGE LIMITS FORFLEET POLICIES - NONSTACKED

PA

CA2193 10/13 CA21931013 1, 2, 3, 5, F PENNSYLVANIA UNDERINSUREDMOTORIST COVERAGE - NONSTACKED

PA

CA2192 10/13 CA21921013 1, 2, 3, 5, F PENNSYLVANIA UNINSUREDMOTORIST COVERAGE - NONSTACKED

PA

CA2106 10/13 CA21061013 1, 2, 3, 5, F PENNSYLVANIA UNINSUREDMOTORIST COVERAGE - STACKED

PA

CA514 01/89 CA01990189 1, 2, 3 PERSONAL AUTO COVERAGE NCCA2265 02/18 CA22650218 1, 2, 3, 5, F PERSONAL INJURY PROTECTION

COVERAGEHI

CA656 03/92 TE0401C0392 1, 2, 3 PERSONAL INJURY PROTECTIONENDORSEMENT

TX

CA0435 10/11 CA04351011 1, 3, 5, F PHYSICAL DAMAGE COVERAGE -AUTOS HELD FOR SALE BY NON-DEALERS

VA

CA2078 03/06 CA20780306 1, F PHYSICAL DAMAGE COVERAGE -AUTOS HELD FOR SALE BY NON-DEALERS'

AK , CO , CT , IL , KS ,NH , NV , RI , TN , TX


AL , AR , AZ , CA , CO , DC , DE ,FL , GA , HI , IA , ID , IL , IN , KS ,

KY , LA , MD , ME , MI , MN , MO ,MS , MT , ND , NE , NH , NJ , NM ,




OH , OK , OR , PA , PR , RI , SC , SD ,TN , UT , VT , WA , WI , WV , WY


AK , LA , NH , VA

CA751 03/92 TE9977A0392 1, 2, 3 POLICY CHANGE TXA1770 02/95 TAIPA0295 POLICY CHANGE FORM—TEXAS

AUTOMOBILE INSURANCE PLANASSOCIATION

TX

GU501 01/97 IL12020197 POLICY CHANGES KYIL1206 04/03 IL12060403 POLICY CHANGES TXIL1203 04/06 IL12030406 POLICY CHANGES LAIL1205 07/02 IL12050702 POLICY CHANGES SDIL1207 07/02 IL12070702 POLICY CHANGES FLGU269 11/85 IL12011185 POLICY CHANGES AK , AL , AR , AZ , CA , CO , CT , DC ,

DE , GA , GU , HI , IA , ID , IN , KS ,MA , MD , ME , MI , MN , MO , MS ,

NC , ND , NE , NH , NJ , NM , NV , NY ,OH , OK , OR , PA , PR , RI , SC , TN ,

UT , VA , VI , VT , WA , WI , WV , WYGU524 12/98 IL12041298 POLICY CHANGES ILUG189 03/02 POLICYHOLDER NOTIFICATION

REGARDING ILLINOIS TERRORISMENDORSEMENT

IL

CA9948 03/06 CA99480306 1, 3, 5, F POLLUTION LIABILITY - BROADENEDCOVERAGE FOR COVERED AUTOS -BUSINESS AUTO, MOTOR CARRIER ANDTRUCKERS COVERAGE FORMS

AL , AR , AZ , CO , DC , DE , GA ,IA , ID , IN , KY , LA , MD , MI ,

MO , MS , MT , NC , ND , NE , NH ,NM , NV , OH , OK , RI , SC , SD ,TN , TX , UT , WA , WI , WV , WY


AK , AL , AR , AZ , CA , CO , DC , DE ,FL , GA , IA , ID , IL , IN , KS , KY ,LA , ME , MI , MN , MS , MT , ND ,

NE , NH , NJ , NM , NV , OH , OK , OR ,PA , RI , SD , TN , UT , WA , WV , WY




TX , UT , VA , VT , WA , WI , WV , WYCA9948 10/13 CA99481013 1, 3, 5, F POLLUTION LIABILITY - BROADENED

COVERAGE FOR COVERED AUTOS -BUSINESS AUTO, MOTOR CARRIER ANDTRUCKERS COVERAGE FORMS


KY , LA , ME , MI , MN , MO , MS ,MT , NC , ND , NE , NH , NJ , NM , NV ,NY , OH , OK , OR , PA , PR , RI , SC ,SD , TN , TX , UT , VT , WI , WV , WY

CA9955 10/13 CA99551013 2, F POLLUTION LIABILITY - BROADENEDCOVERAGE FOR COVERED AUTOS -GARAGE COVERAGE FORM


KY , LA , ME , MI , MN , MO , MS ,MT , NC , ND , NE , NH , NJ , NM ,

NV , NY , OH , OK , OR , PA , PR , RI ,SC , SD , TN , TX , UT , WI , WV , WY

CA760 03/92 TE99480392 1, 2, 3 POLLUTION LIABILITY—BROADENEDCOVERAGE FOR COVERED AUTOS

TX

CA563 12/90 CA99481290 1, 3 POLLUTION LIABILITY—BROADENEDCOVERAGE FOR COVERED AUTOS—BUSINESS AUTO AND TRUCKERSCOVERAGE FORMS



TX , UT , VA , VT , WA , WI , WV , WYUG174 12/99 PREMIUM TAX NOTICE—NEVADA NV




CA0449 11/16 CA04491116 PRIMARY AND NONCONTRIBUTORY -OTHER INSURANCE CONDITION

AK , AL , AR , AZ , CA , CO , CT , DC ,DE , HI , IA , ID , IL , IN , KS , KY ,LA , MD , ME , MI , MN , MO , MS ,

MT , NC , ND , NE , NJ , NM , NV , OH ,OK , OR , PA , RI , SC , SD , TN , TX ,

UT , VA , VT , WA , WI , WV , WYCA664 03/92 TE20180392 1 PROFESSIONAL SERVICES NOT

COVEREDTX

CA828 12/93 CA20181293 1 PROFESSIONAL SERVICES NOTCOVERED

AL , AR , AZ , CO , DC , DE , GA ,GU , IA , ID , IL , IN , KS , KY , LA ,MD , ME , MI , MN , MO , MS , MT ,NC , ND , NE , NH , NJ , NM , NV ,


CA1021 12/93 CA20181293(HI) 1, F PROFESSIONAL SERVICES NOTCOVERED

HI

A3828 PROPERTY PROTECTION INSURANCEFORM LETTER

MA

CA691 03/92 TE2409A0392 1 PUBLIC AUTO—PASSENGER HAZARDEXCLUDED

TX

CA2345 11/16 CA23451116 PUBLIC OR LIVERY PASSENGERCONVEYANCE AND ON-DEMANDDELIVERY SERVICES EXCLUSION

AL , AR , AZ , CA , CO , CT , DC ,DE , GU , HI , IA , ID , IL , IN , KY ,LA , MD , ME , MN , MO , MS , MT ,NC , ND , NE , NH , NM , NV , OH ,

OK , OR , PA , RI , SC , SD , TN ,UT , VI , VT , WA , WI , WV , WY

CA2344 11/16 CA23441116 PUBLIC OR LIVERY PASSENGERCONVEYANCE EXCLUSION

AL , AR , AZ , CA , CO , CT , DC ,DE , GU , HI , IA , ID , IL , IN , KS ,

KY , LA , MD , ME , MN , MO , MS ,MT , NC , ND , NE , NH , NM , OH ,

OK , OR , PA , PR , RI , SC , SD , TN ,UT , VI , VT , WA , WI , WV , WY

CA695 03/92 TE24020392 1 PUBLIC TRANSPORTATION AUTOS TXCA562 12/90 CA24021290 1 PUBLIC TRANSPORTATION AUTOS AK , AL , AR , AZ , CA , CO , CT , DC ,


TX , UT , VA , VT , WA , WI , WV , WYCA797 12/93 CA24021293 1 PUBLIC TRANSPORTATION AUTOS AL , AR , AZ , CO , DC , DE , GA ,

IA , ID , IL , IN , KS , KY , LA , MD ,ME , MI , MN , MO , MS , MT , NC ,ND , NE , NH , NJ , NM , NV , OH ,OK , OR , PA , RI , SC , SD , TN ,

TX , UT , VT , WA , WI , WV , WYCA1058 12/93 CA24021293(HI) 1, F PUBLIC TRANSPORTATION AUTOS HICA9920 09/14 CA99200914 1, 2 PUERTO RICO - MILITARY BASES PRCA2631 04/17 CA26310417 PUERTO RICO AMENDMENT OF SINGLE

INTEREST POLICY PROVISIONS –PUBLIC OR LIVERY PASSENGERCONVEYANCE AND ON-DEMANDDELIVERY SERVICES EXCLUSION

PR

CA0114 09/14 CA01140914 1, 2 PUERTO RICO CHANGES PRCA0508 04/17 CA05080417 PUERTO RICO PUBLIC OR LIVERY

PASSENGER CONVEYANCE ANDON-DEMAND DELIVERY SERVICESEXCLUSION

PR

CA2198 12/11 CA21981211 1, 2 PUERTO RICO SPLIT UNINSUREDMOTORISTS COVERAGE LIMITS

PR

CA9929 09/14 CA99290914 PUERTO RICO STATEMENT OF LOANS PRCA2117 11/17 CA21171117 1, 2 PR




PUERTO RICO UNINSURED MOTORISTSCOVERAGE

(R)CA981 02/99 CA20270299 1, 2, 3, 5 REGISTRATION PLATES NOT ISSUED

FOR A SPECIFIC AUTOAK , AL , AR , AZ , CO , DC , DE , FL ,

GA , HI , IA , ID , IL , IN , KS , KY ,LA , MD , ME , MI , MN , MO , MS ,MT , NC , ND , NE , NH , NJ , NM ,

NV , OH , OK , OR , PA , RI , SC , SD ,TN , TX , UT , VT , WA , WI , WV , WY

CA1024 02/99 CA20270299(HI) 1, 2, 3, 5, F REGISTRATION PLATES NOT ISSUEDFOR A SPECIFIC AUTO

HI

CA689 03/92 TE2027A0392 1, 2, 3 REGISTRATION PLATES NOT ISSUEDFOR A SPECIFIC AUTO

TX

CA931 07/97 CA20270797 1, 2, 3, 5, F REGISTRATION PLATES NOT ISSUEDFOR A SPECIFIC AUTO



TX , UT , VA , VT , WA , WI , WV , WYCA2027 10/13 CA20271013 REGISTRATION PLATES NOT ISSUED

FOR A SPECIFIC AUTOAK , AL , AR , AZ , CA , CO , CT , DC ,DE , FL , GA , HI , IA , ID , IL , IN , KS ,


TN , TX , UT , VT , WA , WI , WV , WYCA639 03/92 TE0238A0392 1, 2 REINSTATEMENT OF INSURANCE TXCA837 12/93 CA02381293 1, 2, 3, 4, 5 REINSTATEMENT OF INSURANCE HI , NV , WVCA1147 11/02 CA23641102(HI) 1, 2, 3, 4, 5 REMOVAL OF TERROISM EXCLUSION;

CAP ON LOSSES FROM CERTIFIED ACTSOF TERRORISM

HI

CA737 03/92 TE9923A0392 1, 2, 3 RENTAL REIMBURSEMENT COVERAGE TXCA1090 12/93 CA99231293(HI) 1, 2, 3, 4, 5, F RENTAL REIMBURSEMENT COVERAGE HICA2019 03/10 CA20190310 1, 4 REPOSSESSED AUTOS AL , AR , AZ , CO , DC , DE , GA ,

IA , ID , IN , KS , KY , LA , MD ,MI , MO , MS , MT , ND , NE ,


CA663 03/92 TE2019A0392 1 REPOSSESSED AUTOS TXCA929 07/97 CA20190797 1, 4, F REPOSSESSED AUTOS AK , AL , AR , AZ , CA , CO , CT , DC ,

DE , GA , HI , IA , ID , IL , IN , KS ,KY , LA , MD , ME , MI , MN , MO ,

MS , MT , NC , ND , NE , NH , NJ , NM ,NV , NY , OH , OR , PA , RI , SC , SD ,

TN , TX , UT , VT , WA , WI , WV , WYCA1022 07/97 CA20190797(HI) 1, 4, F REPOSSESSED AUTOS HICA2019 10/13 CA20191013 1, 4 REPOSSESSED AUTOS AK , AL , AR , AZ , CA , CO , CT , DC ,

DE , GA , HI , IA , ID , IL , IN , KY , LA ,ME , MI , MN , MO , MS , MT , NC ,


TX , UT , VA , VT , WA , WI , WV , WYCA558 12/90 CA20191290 1, 4 REPOSSESSED AUTOS AK , AL , AR , AZ , CA , CO , CT , DC ,


TX , UT , VA , VT , WA , WI , WV , WYCA677 03/92 TE2044B0392 1 REPOSSESSED AUTOS—NAMED

OPERATORTX

GU268 11/85 IL09171185 RESIDENT AGENTCOUNTERSIGNATURE ENDORSEMENT

AL , AR , AZ , CA , CO , CT , DC ,DE , GA , GU , HI , ID , IN , KS , KY ,




LA , MD , ME , MI , MO , MS , MT ,NC , ND , NE , NH , NM , NV , NY ,

OH , OK , OR , PA , PR , RI , SC ,TN , TX , UT , VI , VT , WA , WI

GU463 10/93 IL09181093 RETRO PREM ENDORSEMENT-1 YRPLAN - MULTIPLE LINES

AK , AL , AR , AZ , CA , CO , CT ,DC , DE , FL , GA , GU , IA , ID , IL ,

IN , KS , KY , LA , MD , ME , MI ,MN , MO , MS , MT , NC , ND , NE ,NH , NJ , NM , NV , NY , OH , OK ,

OR , PA , PR , RI , SC , SD , TN , UT ,VA , VI , VT , WA , WI , WV , WY

GU246 04/84 IL09180484 RETRO PREMIUM ENDORSEMENT - 1 YRPLAN - MULTI LINE

PR

GU247 04/84 IL09190484 RETRO PREMIUM ENDORSEMENT - 3 YRPLAN - MULTI LINE

PR

GU248 04/84 IL09200484 RETRO PREMIUM ENDORSEMENT -LONG TERM CONSTRUCTION PROJECT- MULTI LINE

LA , PR

GU465 10/93 IL09201093 RETRO PREMIUM ENDORSEMENT -LONG TERM CONSTRUCTION PROJECT- MULTI LINES

DC , DE , GU , IA , ID , IL , MD , ME ,MI , MN , MO , MS , MT , ND , NE ,

NH , NJ , NM , NV , NY , OH , OK , OR ,RI , SD , UT , VT , WA , WI , WV , WY

GU249 04/84 IL09210484 RETRO PREMIUM ENDORSEMENT -SHORT FORM

DC , DE , HI , IA , ID , IL , KS ,KY , LA , MD , ME , MI , MN ,

MO , MS , MT , NE , NH , NJ , NM ,NV , NY , OH , OK , OR , PR , RI ,SD , UT , VT , WA , WI , WV , WY

GU251 04/84 IL09230484 RETRO PREMIUM ENDORSEMENTEXCLUSION OF RETRO DEVELOPMENTFACTOR

DC , DE , HI , IA , ID , IL , KS ,KY , LA , MD , ME , MI , MN ,

MO , MS , MT , NE , NH , NJ , NM ,NV , NY , OH , OK , OR , PR , RI ,SD , UT , VT , WA , WI , WV , WY

GU464 10/93 IL09191093 RETRO PREMIUM ENDORSEMENT-3 YRPLAN - MULTI LINE

AK , AL , AR , AZ , CA , CO , CT ,DC , DE , FL , GA , GU , IA , ID , IL ,

IN , KS , KY , LA , MD , ME , MI ,MN , MO , MS , MT , NC , ND , NE ,NH , NJ , NM , NV , NY , OH , OK ,

OR , PA , PR , RI , SC , SD , TN , UT ,VA , VI , VT , WA , WI , WV , WY

CA2620 08/10 CA26200810 F RHODE ISLAND AMENDMENT OFSINGLE INTEREST POLICY PROVISIONS

RI

CA0148 02/14 CA01480214 RHODE ISLAND CHANGES RICA0273 01/10 CA02730110 1, 2, 3, 4, 5 RHODE ISLAND CHANGES -

CANCELLATION AND NONRENEWALRI

CA0273 10/13 CA2731013 1, 2, 3, 4, 5 RHODE ISLAND CHANGES -CANCELLATION AND NONRENEWAL

RI

IL0161 03/12 IL01610312 RHODE ISLAND CHANGES - CIVILUNION

RI

CA2164 10/13 CA21641013 RHODE ISLAND SPLIT BODILY INJURYUNINSURED MOTORISTS COVERAGELIMITS

RI

CA2143 06/15 CA21430615 1, 2, 3, 5, F RHODE ISLAND UNINSUREDMOTORISTS COVERAGE

RI

CA3149 10/16 CA31491016 1, 2, 3, 5, F RHODE ISLAND UNINSUREDMOTORISTS COVERAGE – PROPERTYDAMAGE

RI

UA160 05/93 RIGHTS AND RESPONSIBILITIES OFTHE INSURED WHEN SUBMITTING ACLAIM (TO COMPLY WITH STATUTESORS 746-280 & 746-290)

OR

CA713 03/92 TE23040392 1, 3 ROLLING STORES TX




CA2304 10/01 CA23041001 1, 3, 5, F ROLLING STORES AL , AR , AZ , CO , DC , DE , GA ,IA , ID , IL , IN , KY , LA , MD , MI ,MO , MS , MT , NC , ND , NE , NH ,


CA2304 10/13 CA23041013 1, 3, 5, F ROLLING STORES AK , AL , AR , AZ , CA , CO , CT , DC ,DE , FL , GA , HI , IA , ID , IL , IN , KS ,



CA1047 A 10/01 CA23041001(HI) 1, 3, 5, F ROLLING STORES HICA757 03/92 TE9971A0392 1 RURAL ELECTRIFICATION

COOPERATIVE ENDORSEMENTTX

(S)CA674 03/92 TE2047A0392 1 SCHOOL (PUBLIC)—DRIVER TRAINING

STUDENTSTX

MM2593 10/06 MM25931006 2, J SILICA OR SILICA RELATED DUSTEXCLUSION FOR OTHER THANCOVERED AUTO EXPOSURE

MA

CA2394 03/06 CA23940306 1, 2, 3, 5, F SILICA OR SILICA-RELATED DUSTEXCLUSION FOR COVERED AUTOSEXPOSURE

AL , AR , AZ , CO , CT , DC , DE ,GA , IA , ID , IN , LA , MD , MI , MO ,MS , MT , NC , ND , NE , NH , NM ,NV , OH , OK , RI , SC , SD , TN ,

TX , UT , VT , WA , WI , WV , WYCA2394 10/13 CA23941013 1, 2, 3, 5, F SILICA OR SILICA-RELATED DUST

EXCLUSION FOR COVERED AUTOSEXPOSURE

AK , AL , AR , AZ , CA , CO , DC , DE ,FL , GA , HI , IA , ID , IL , IN , LA ,ME , MI , MN , MO , MS , MT , NC ,ND , NE , NH , NJ , NM , NV , NY ,

OH , OK , OR , PA , PR , RI , SC , SD ,TN , TX , UT , VT , WA , WI , WV , WY

CA2539 10/13 CA25391013 2, F SILICA OR SILICA-RELATED DUSTEXCLUSION FOR GENERAL LIABILITYCOVERAGES



TN , TX , UT , VT , WA , WI , WV , WYCA2539 03/06 CA25390306 2, F SILICA OR SILICA-RELATED DUST

EXCLUSION FOR OTHER THANCOVERED AUTOS EXPOSURE - GARAGECOVERAGE FORM

AL , AR , AZ , CO , DC , DE , GA ,IA , ID , IN , KY , LA , MD , MI , MO ,MS , MT , NC , ND , NE , NH , NM ,NV , OH , OK , RI , SC , SD , TN ,

TX , UT , VT , WA , WI , WV , WYCA2601 11/16 CA26011116 F SINGLE INTEREST AUTOMOBILE

PHYSICAL DAMAGE INSURANCEPOLICY

AK , AL , AR , AZ , CA , CO , CT , DC ,DE , GU , IA , ID , IL , IN , KS , KY , LA ,

MD , ME , MI , MN , MO , MS , MT ,NC , ND , NE , NH , NJ , NM , NV , NY ,OH , OK , OR , PA , PR , RI , SC , SD ,

TN , UT , VI , VT , WA , WI , WV , WYCA2602 11/16 CA26021116 F SINGLE INTEREST AUTOMOBILE

PHYSICAL DAMAGE INSURANCEPOLICY (FINANCE MASTER POLICYFORM)

AK , AL , AR , AZ , CA , CO , CT , DC ,DE , GU , HI , IA , ID , IL , IN , KS , KY ,LA , MD , ME , MI , MN , MO , MS , MT ,NC , ND , NE , NH , NJ , NM , NV , NY ,OH , OK , OR , PA , PR , RI , SC , SD ,

TN , UT , VI , VT , WA , WI , WV , WYCA1078 04/80 CA26050480(HI) F SINGLE INTEREST DEDUCTIBLE HICA1178 04/80 CA26040480 F SINGLE INTEREST DEDUCTIBLES DC , FL , GA , IN , NC ,

PA , SC , TN , TX , VACA930 07/97 CA20210797 1, 2, 3, 4, 5, F SNOWMOBILES AK , AL , AR , AZ , CA , CO , CT ,

DC , DE , GA , GU , HI , IA , ID , IL ,IN , KS , KY , LA , ME , MI , MN ,MO , MS , MT , NC , ND , NE , NJ ,




NM , NV , OH , OK , OR , RI , SC ,SD , TN , TX , UT , VI , VT , WA , WI

CA1023 07/97 CA20210797(HI) 1, F SNOWMOBILES HICA219 10/13 CA21891013 1, 2, 3, 4, 5, F SNOWMOBILES SCCA830 12/93 CA20211293 1, 2, 3, 4, 5 SNOWMOBILES AK , AL , AR , AZ , CA , CO , CT , DC ,


TX , UT , VA , VT , WA , WI , WV , WYCA802 12/93 CA99341293 1, 3 SOCIAL SERVICE AGENCIES -

VOLUNTEERS AS INSUREDSAL , AR , AZ , CO , DC , DE , GA ,

IA , ID , IL , IN , KS , KY , LA ,MD , ME , MI , MN , MO , MS , MT ,NC , ND , NE , NH , NJ , NM , NV ,OH , OK , PA , RI , SC , SD , TN ,

TX , UT , VT , WA , WI , WV , WYCA730 03/92 TE99340392 1, 2 SOCIAL SERVICE AGENCIES—

VOLUNTEERS AS INSUREDSTX

CA1094 12/93 CA99341293(HI) 1, 3, 5, F SOCIAL SERVICES AGENCIES-VOLUNTEERS AS INSURED

HI

CA716 03/92 TE9908C0392 1, 2, 3 SOUND RECEIVING ANDTRANSMITTING EQUIPMENTCOVERAGE

TX

CA1011 12/93 CA20021293(HI) 1, 4, F SOUND RECEIVING EQUIPMENTCOVERAGE—FIRE, POLICE ANDEMERGENCY VEHICLES

HI

CA823 12/93 CA20021293 1, 4 SOUND RECEIVING EQUIPMENTCOVERAGE—FIRE, POLICE, ANDEMERGENCY VEHICLES

HI , NV , WV

CA9958 04/14 CA99580414 SOUTH CAROLINA AUTO MEDICALPAYMENTS COVERAGE

SC

CA0150 05/17 CA01500517 1, 2, 3, 5, F SOUTH CAROLINA CHANGES SCCA0230 07/19 CA02300719 1, 2, 3, 4, 5 SOUTH CAROLINA CHANGES-

CANCELLATION AND NONRENEWALSC

CA2190 12/13 CA21901213 F SOUTH CAROLINA SPLITUNDERINSURED MOTORISTS LIMITS

SC

CA2188 12/13 CA21881213 1, 2, 3, 5, F SOUTH CAROLINA UNDERINSUREDMOTORISTS COVERAGE

SC

CA2119 12/13 CA21191213 1, 2, 3, 5, F SOUTH CAROLINA UNINSUREDMOTORISTS COVERAGE

SC

CA2621 10/10 CA26211010 F SOUTH DAKOTA AMENDMENT OFSINGLE INTEREST AUTOMOBILEPHYSICAL DAMAGE INSURANCEPOLICY

SD

CA2622 10/10 CA26221010 F SOUTH DAKOTA AMENDMENT OFSINGLE INTEREST AUTOMOBILEPHYSICAL DAMAGE INSURANCEPOLICY

SD

CA2243 11/16 CA22431116 1, 2, 3, 5 SOUTH DAKOTA AUTO DEATHBENEFITS AND DISABILITYCOVERAGES

SD

CA0123 10/13 CA01231013 SOUTH DAKOTA CHANGES SDCA2029 10/13 CA20291013 2 SOUTH DAKOTA EMERGENCY

SERVICES - VOLUNTEER FIREFIGHTER'AND WORKERS' INJURIES EXCLUDED

SD

CA2141 10/18 CA21411018 1, 2, 3, 5, F SOUTH DAKOTA UNINSUREDAND UNDERINSURED MOTORISTSCOVERAGE

SD

CA684 03/92 TE2034A0392 1, 2, 3 SPECIAL LOSS PAYABLE ANDCANCELLATION ENDORSEMENT

TX

CA743 03/92 TE9986A0392 1 SPECIFIED NON-OWNED AUTO TX




CA2151 10/13 CA21511013 SPLIT BODILY INJURY UNDERINSUREDMOTORISTS COVERAGE LIMITS

AR , AZ , HI , IA , ID , IL , IN ,MN , MO , ND , OH , SD , UT , WI

CA2102 11/06 CA21021106 1, 2, 3, 5, F SPLIT BODILY INJURY UNINSUREDMOTORISTS COVERAGE LIMITS

AR , AZ , CA , CO , FL , ID , IN ,KS , LA , MI , MN , MS , ND ,OH , OR , SD , TN , UT , WI

CA733 03/92 TE9927B0392 1, 2 SPLIT LIABILITY LIMITS TXCA1107 12/99 CA99751299(HI) 1, 3, 5, F SPLIT LIABILITY LIMITS HICA257 A 01/87 CA99270187 1, 3 SPLIT LIABILITY LIMITS AK , AL , AR , AZ , CA , CO , CT , DC ,

DE , FL , GA , IA , ID , IL , IN , KS ,KY , MD , ME , MI , MN , MO , MS ,MT , NC , ND , NE , NH , NJ , NM ,

NV , NY , OK , OR , PA , RI , SC , SD ,TN , UT , VT , WA , WI , WV , WY

CA9938 06/05 CA99380605 2 SPLIT LIABILITY LIMITS - GARAGES -VIRGINIA

VA

CA9927 06/05 CA99270605 1, 3 SPLIT LIABILITY LIMITS - VIRGINIA VACA9942 10/13 CA99421013 1, F SPLIT LIABILITY LIMITS FOR

GOVERNMENTAL SUBDIVISIONS -OKLAHOMA

OK

CA1108 12/99 CA99761299(HI) 2, F SPLIT LIABILITY LIMITS-GARAGES HICA263 A 01/87 CA99380187 2 SPLIT LIMITS-GARAGES AK , AL , AR , AZ , CA , CO , CT , DC ,

DE , FL , GA , IA , ID , IL , IN , KS ,KY , LA , MD , ME , MI , MN , MO ,

MS , MT , NC , ND , NE , NH , NJ , NM ,NV , NY , OK , OR , PA , PR , RI , SC ,

SD , TN , UT , VT , WA , WI , WV , WYCA793 12/93 CA21461293 SPLIT UNDERINSURED MOTORISTS

COVERAGE LIMITSWA

CA1039 12/93 CA21461293(HI) F SPLIT UNDERINSURED MOTORISTSCOVERAGE LIMITS

HI

CA289 01/87 CA21070187 1, 2, 3 SPLIT UNINSURED MOTORISTSCOVERAGE LIMITS



TX , UT , VA , VT , WA , WI , WV , WYCA792 12/93 CA21071293 F SPLIT UNINSURED MOTORISTS

COVERAGE LIMITSCA , CT , DC , DE , HI , IL , IN , MD ,

ME , MN , MS , NC , NJ , NM , OR , TNCA1038 12/93 CA21071293(HI) F SPLIT UNINSURED MOTORISTS

COVERAGE LIMITSHI

CA594 A 03/94 CA31030394 F SPLIT UNINSURED MOTORISTSCOVERAGE LIMITS

GA

CA2173 04/01 CA21730401 F SPLIT UNINSURED MOTORISTSCOVERAGE LIMITS - STACKED

FL

A1786 A 01/04 OIRB115710104 STANDARD DISCLOSURE ANDACKNOWLEDGEMENT FORMPERSONAL INJURY PROTECTION—INITIAL TREATMENT OR SERVICEPROVIDED

FL

CA756 03/92 TE9972A0392 1 STATE DEPARTMENTS ENDORSEMENT TXCA947 07/97 CA99280797 1, 2, 3, 4, 5, F STATED AMOUNT COVERAGE AK , AL , AR , AZ , CA , CO , CT , DC ,


TX , UT , VA , VT , WA , WI , WV , WYCA988 02/99 CA99280299 1, 2, 3, 4, 5, F STATED AMOUNT INSURANCE AK , AL , AR , AZ , CA , CO , CT , DC ,

DE , FL , GA , IA , ID , IL , IN , KS , KY ,LA , MD , ME , MN , MO , MS , MT ,

NC , ND , NE , NH , NJ , NM , NV , NY ,




OH , OK , OR , PA , RI , SC , SD , TN ,TX , UT , VA , VT , WA , WI , WV , WY

CA9928 03/10 CA99280310 1, 2, 3, 4, 5, F STATED AMOUNT INSURANCE AL , AR , AZ , CO , DC , DE , GA , IA , ID ,IN , KY , LA , MD , MI , MO , MS , MT ,ND , NE , NH , NM , OH , OK , RI , SC ,SD , TN , UT , VT , WA , WI , WV , WY

CA9928 10/13 CA99281013 1, 2, 3, 4, 5, F STATED AMOUNT INSURANCE AK , AL , AR , AZ , CA , CO , CT , DC ,DE , GA , HI , IA , ID , IL , IN , KS , KY ,


TN , UT , VA , VT , WA , WI , WV , WYCA805 12/93 CA99281293 1, 2, 3, 4, 5 STATED AMOUNT INSURANCE AK , AL , AR , AZ , CA , CO , CT , DC ,


TX , UT , VA , VT , WA , WI , WV , WYCA1091 A 10/01 CA99281001(HI) 1, 2, 3, 4, 5, F STATED AMOUNT INSURANCE HIA3979 A 04/00 STATEMENT OF EARNINGS WAGE AND

SALARY VERIFICATIONKS

CA0478 09/19 CA04780919 STOP GAP - EMPLOYERS LIABILITYCOVERAGE ENDORSEMENT - NORTHDAKOTA

ND

CA0475 09/19 CA04750919 STOP GAP - EMPLOYERS LIABILITYCOVERAGE ENDORSEMENT - OHIO

OH

CA0476 09/19 CA04760919 STOP GAP - EMPLOYERS LIABILITYCOVERAGE ENDORSEMENT -WASHINGTON

WA

CA0477 09/19 CA04770919 STOP GAP - EMPLOYERS LIABILITYCOVERAGE ENDORSEMENT -WYOMING

WY

GU285 11/85 IL09111185 SUPPLEMENT TO RETROSPECTIVEPREMIUM ENDORSEMENT - FINALPREMIUM COMPUTATION


OR , PA , PR , RI , SC , SD , TN , TX ,UT , VA , VT , WA , WI , WV , WY

A3995 B 01/03 SUPPLEMENT TO THE APPLICATIONFOR BENEFITS

KY

UA225 12/02 SUPPLEMENTAL SPOUSAL LIABILITYCOVERAGE NOTIFICATION

NY

CA758 03/92 TE9960A0392 SUPPLEMENTARY DEATH BENEFIT TXCA638 03/92 TE0240A0392 1, 2 SUSPENSION OF INSURANCE TXCA1008 A 10/01 CA02401001(HI) 1, 2, 3, 4, 5, F SUSPENSION OF INSURANCE HI

(T)CA732 03/92 TE99300392 1, 2, 3 TAPES AND RECORDS COVERAGE TXCA9930 03/10 CA99300310 1, 2, 3, 4 TAPES, RECORDS AND DISCS

COVERAGEAL , AR , AZ , CO , DC , DE , GA , IA , ID ,

IN , KY , LA , MD , MI , MO , MS , MT ,ND , NE , NH , NM , OH , OK , RI , SC ,SD , TN , UT , VT , WA , WI , WV , WY

CA9930 10/13 CA99301013 1, 2, 3, 4 TAPES, RECORDS AND DISCSCOVERAGE



CA778 12/93 CA99301293 1, 2, 3, 4, 5 TAPES, RECORDS AND DISCSCOVERAGE


KY , LA , MD , ME , MI , MN , MO , MS ,




MT , NC , ND , NE , NH , NJ , NM , NV ,NY , OH , OR , PA , RI , SC , SD , TN ,

TX , UT , VA , VT , WA , WI , WV , WYCA1092 A 10/01 CA99301001(HI) 1, 2, 3, 4, 5, F TAPES, RECORDS AND DISCS

COVERAGEHI

CA0146 10/13 CA01461013 1, 2, 3, 4, 5, F TENNESSEE CHANGES TNUG186 07/01 TENNESSEE FRAUD WARNING

(STICKER)TN

CA0430 10/13 CA04301013 1, 2, 3, 4, 5, F TENNESSEE LESSOR - ADDITIONALINSURED AND LOSS PAYEE

TN

CA9987 10/13 CA99871013 1, 2, 3, 4, 5, F TENNESSEE LOSS PAYABLE CLAUSE TNCA2120 11/17 CA21201117 1, 2, 3, 5, F TENNESSEE UNINSURED MOTORISTS

COVERAGETN

CA2576 10/13 CA25761013 TEXAS ABUSE OR MOLESTATIONEXCLUSION FOR GENERAL LIABILITYCOVERAGES

TX

CA2607 12/18 CA26071218 TEXAS AMENDMENT OF SINGLEINTEREST POLICY PROVISIONS -PUBLIC OR LIVERY PASSENGERCONVEYANCE, TRANSPORTATIONNETWORK AND ON-DEMANDDELIVERY SERVICES EXCLUSION

TX

CA0196 10/13 CA01961013 1, 3, 4, 5, F TEXAS CHANGES TXCA0243 11/13 CA02431113 1, 2, 3, 4, 5, F TEXAS CHANGES - CANCELLATION

AND NONRENEWALTX

CA0197 10/13 CA01971013 2, F TEXAS CHANGES - GARAGE COVERAGEFORM

TX

CA0199 10/13 CA01991013 1, 2, 3 TEXAS CHANGES - MEXICO COVERAGE- BROAD

TX

CA0198 10/13 CA01981013 1, 2, 3, 5, F TEXAS CHANGES - MEXICO TOURISTCOVERAGE - LIMITED

TX

CA755 03/92 TE9973A0392 1 TEXAS DEPARTMENT OFCORRECTIONS ENDORSEMENT

TX

CA0407 06/04 CA04070604 TEXAS DEPARTMENT OFTRANSPORTATION ENDORSEMENT (TOCOMPLY WITH TEX. TRANSP. CODEANN. SEC. 201.106)

TX

CA2336 10/13 CA23361013 1, 2, F TEXAS FORM F-1 - UNIFORMCOMMERCIAL MOTOR VEHICLEBODILY INJURY AND PROPERTYDAMAGE LIABILITY INSURANCEENDORSEMENT

TX

CA754 03/92 TE9974A0392 1 TEXAS HIGHWAY DEPARTMENTENDORSEMENT

TX

CA0418 10/13 CA04181013 TEXAS INCREASED LIMITS - OTHERTHAN DESIGNATED DRIVER

TX

CA9988 10/13 CA99881013 1, 2, 3, 5, F TEXAS INDIVIDUAL NAMED INSURED TXCA2081 10/13 CA20811013 1, 2, 3, 4, 5, F TEXAS MOBILE HOMES CONTENTS

COVERAGETX

CA2264 10/13 CA22641013 1, 2, 3, 5, F TEXAS PERSONAL INJURYPROTECTION ENDORSEMENT

TX

CA749 03/92 TE9979A0392 1, 2, 3 TEXAS PREMIUM DISCOUNT TXCA0505 12/18 CA05051218 TEXAS PUBLIC OR LIVERY PASSENGER

CONVEYANCE AND TRANSPORTATIONNETWORK SERVICES EXCLUSION

TX

CA0506 12/18 CA05061218 TEXAS PUBLIC OR LIVERY PASSENGERCONVEYANCE, TRANSPORTATIONNETWORK AND ON-DEMANDDELIVERY SERVICES EXCLUSION

TX

CA0405 06/04 CA04050604 TEXAS RURAL ELECTRIFICATIONCOOPERATIVE ENDORSEMENT

TX




CA2612 12/18 CA26121218 TEXAS SINGLE INTEREST AUTOMOBILEPHYSICAL DAMAGE INSURANCEPOLICY (INDIVIDUAL POLICY FORM)

TX

CA2613 12/18 CA26131218 TEXAS SINGLE INTEREST AUTOMOBILEPHYSICAL DAMAGE INSURANCEPOLICY (MASTER POLICY REPORTINGFORM)

TX

CA3125 02/01 CA31250201 TEXAS SPLIT UNINSURED/UNDERINSURED MOTORISTSCOVERAGE LIMITS

TX

CA0401 10/13 CA04011013 1, 2, 3, 4, 5, F TEXAS STATE AMOUNT INSURANCE TXCA9995 10/13 CA99951013 +, F TEXAS SUPPLEMENTARY DEATH

BENEFITTX

CA2333 03/10 CA23330310 1, F TEXAS TRUCKERS ENDORSEMENT TXCA2109 10/13 CA21091013 1, 2, 3, 5, F TEXAS UNINSURED/UNDERINSURED

MOTORISTS COVERAGETX

CA2565 10/13 CA25651013 TOTAL BANKRUPTCY OR INSOLVENCYEXCLUSION FOR ACTS, ERRORS OROMISSIONS LIABILITY COVERAGES




CA903 07/95 CA25160795 2, F TOTAL POLLUTION EXCLUSIONGARAGE COVERAGE FORM NON-AUTOEXPOSURE

SC

CA2398 03/10 CA23980310 1 TRAILER INTERCHANGE COVERAGE AL , AR , AZ , CO , DC , DE , GA , IA , ID ,IN , KY , LA , MD , MI , MO , MS , MT ,ND , NE , NH , NM , OH , OK , RI , SC ,SD , TN , UT , VT , WA , WI , WV , WY

CA2398 10/13 CA23981013 1 TRAILER INTERCHANGE COVERAGE AK , AL , AR , AZ , CA , CO , CT , DC ,DE , GA , HI , IA , ID , IL , IN , KS , KY ,LA , ME , MI , MN , MO , MS , MT , NC ,ND , NE , NH , NJ , NM , NV , NY , OH ,


CA1052 12/93 CA23131293(HI) 1, 3, 5, F TRAILER INTERCHANGE FIRE AND FIREAND THEFT COVERAGES—INSUREDAND NAMED LESSORS FOR LEASEDAUTOS

HI

CA709 03/92 TE23130392 1, 3 TRAILER INTERCHANGE INSURANCE—FIRE AND THEFT COVERAGE

TX

CA987 02/99 CA23090299 1 TRUCKERS - INSURANCE FOR NON-TRUCKING USE

AL , AR , AZ , CO , DC , DE , FL , GA ,HI , IA , ID , IL , IN , KS , KY , LA ,

MD , ME , MI , MN , MO , MS , MT ,NC , ND , NE , NH , NJ , NM , NV ,


CA2317 10/13 CA23171013 1, 3, 5, F TRUCKERS - UNIFORM INTERMODALINTERCHANGE ENDORSEMENT FORMUIIE-1



TN , TX , UT , VA , VT , WI , WV , WYCA703 A 02/03 TE2320E0203 1, F TRUCKERS ENDORSEMENT TXCA705 A 09/02 TE2317A0902 1, 3, F TRUCKERS UNIFORM INTERMODAL

INTERCHANGE ENDORSEMENT (IANAFORM UIIE-1)

TX

CA825 12/93 CA23081293 1, 3 TRUCKERS-EXCESS COV.FOR NAMEDINSD.&NAMED LESSORS

AL , AR , AZ , CO , DC , DE , GA ,GU , IA , ID , IL , IN , KS , KY ,

LA , MD , ME , MI , MN , MO , MS ,MT , NC , ND , NE , NH , NJ , NM ,




NV , OH , OK , OR , PA , RI , SC ,SD , TN , VT , WA , WI , WV , WY

CA1049 12/93 CA23081293(HI) 1, 3, 5, F TRUCKERS—EXCESS COVERAGE FORTHE NAMED INSURER AND NAMEDLESSORS FOR LEASED AUTOS

HI

CA702 03/92 TE2321A0392 1, 3 TRUCKERS—HAULING EXCLUSIVELYFOR ONE CONCERN UNDER LONGTERM CONTRACT

TX

A702 A 03/83 CA22090383 ++ TRUCKERS—HAULING EXCLUSIVELYFOR ONE CONCERN UNDER LONGTERM CONTRACT

DE

CA710 03/92 TE23090392 1 TRUCKERS—INSURANCE FOR NON-TRUCKING USE

TX

CA559 12/90 CA23171290 1, 3 TRUCKERS—INTERMODALINTERCHANGE UNIFORMENDORSEMENT FORM UIIE-1



TX , UT , VA , VT , WA , WI , WV , WYCA1051 12/93 CA23121293(HI) 1, 3, 5, F TRUCKERS-NAMED LESSEE AS

INSUREDHI

(U)CA2185 04/17 CA21850417 1, 2, 3, 5, F UNDERINSURED MOTORISTS

COVERAGE (NON-STACKED)HI

CA3111 04/17 CA31110417 1, 2, 3, 5, F UNDERINSURED MOTORISTSCOVERAGE (STACKED)

HI

CA2157 03/16 CA21570316 1 UNINSURED AND UNDERINSUREDMOTORISTS COVERAGE

CT

CA287 01/87 CA21170187 1, 2, 3 UNINSURED MOTORISTS COVERAGE AK , AL , AR , AZ , CA , CO , CT , DC ,DE , FL , GA , HI , IA , ID , IL , IN , KS ,


TX , UT , VA , VT , WA , WI , WV , WYCA2149 10/13 CA21491013 1, 2, 3, 5, F UNINSURED MOTORISTS COVERAGE DCCA789 12/93 CA21171293 1, 2, 3, 5 UNINSURED MOTORISTS COVERAGE AK , AL , AR , AZ , CA , CO , CT , DC ,


TX , UT , VA , VT , WA , WI , WV , WYCA3137 10/13 CA31371013 F UNINSURED MOTORISTS COVERAGE

- ADD ON TO AT-FAULT LIABILITYLIMITS

GA

CA3117 10/13 CA31171013 1, 2, 3, 5, F UNINSURED MOTORISTS COVERAGE -PROPERTY DAMAGE

OH

CA2121 09/95 CA 21 21 F UNINSURED MOTORISTS COVERAGE -VIRGINIA

VA

CA2121 11/02 CA21211102 F UNINSURED MOTORISTS COVERAGE -VIRGINIA

VA

CA2184 04/17 CA21840417 1, 2, 3, 5, F UNINSURED MOTORISTS COVERAGE(NON-STACKED)

HI

CA3110 04/17 CA31100417 1, 2, 3, 5, F UNINSURED MOTORISTS COVERAGE(STACKED)

HI

UA220 A 07/15 FORM B-EXCESS

UNINSURED MOTORISTS COVERAGEOFFER/UNDERINSURED MOTORISTSCOVERAGE OFFER (SINGLE LIMIT)

WV

UA219 A 07/15 UNINSURED MOTORISTS COVERAGEOFFER/UNDERINSURED MOTORISTSCOVERAGE OFFER (SPLIT LIMITS)

WV

CA3113 11/18 CA31131118 NY




UNINSURED MOTORISTSENDORSEMENT - NEW YORK

CA846 A 09/96 CA31130996 F UNINSURED MOTORISTSENDORSEMENT - NEW YORK

NY

CA652 A 05/94 TE0409D0594 1, 2, 3, F UNINSURED/UNDERINSUREDMOTORISTS INSURANCE

TX

CA2245 10/13 CA22451013 UTAH ADDED PERSONAL INJURYPROTECTION

UT

CA9964 08/14 CA99340814 UTAH BUSINESS INTERRUPTIONCOVERAGE

UT

CA0159 05/17 CA01590517 1, 3, 4, 5, F UTAH CHANGES UTCA0124 05/17 CA01240517 2, F UTAH CHANGES - GARAGE COVERAGE

FORMUT

CA2579 10/13 CA25791013 UTAH FULL COVERED AUTOSLIABILITY LIMIT FOR CUSTOMERS

UT

CA2244 11/16 CA22441116 1, 2, 3, 5 UTAH PERSONAL INJURY PROTECTION UTCA2263 10/13 CA22631013 UTAH PERSONAL INJURY PROTECTION

- EXCLUSION OF LOSS OF INCOMEBENEFITS

UT

CA3106 07/19 CA31060719 1, 3, 4, 5, F UTAH UNDERINSURED MOTORISTSCOVERAGE

UT

CA2162 11/18 CA21621118 1, 2, 3, 5, F UTAH UNINSURED MOTORISTSCOVERAGE

UT

CA2136 10/13 CA21361013 1, 2, 3, 5 UTAH UNINSURED MOTORISTSCOVERAGE-PROPERTY DAMAGE

UT

(V)A1775 D 01/04 NYSNFAOBREV12004 VEHICLE NO-FAULT INSURANCE LAW

ASSIGNMENT OF BENEFITS FORMNY

A1649 J 01/04 NYSNF3REV12004 VERIFICATION OF TREATMENT BYATTENDING PHYSICIAN OR OTHERPROVIDER OF HEALTH SERVICE

NY

IL0219 06/15 IL02190615 VERMONT CHANGES - CANCELLATIONAND NONRENEWAL

VT

CA0129 10/13 CA01291013 VERMONT CHANGES IN BUSINESSAUTO AND MOTOR CARRIERCOVERAGE FORMS

VT

CA0185 10/13 CA01851013 VERMONT CHANGES IN BUSINESSAUTO AND MOTOR CARRIERCOVERAGE FORMS - POLLUTION

VT

CA0153 10/13 CA01531013 2, F VERMONT CHANGES IN GARAGECOVERAGE FORM

VT

CA0186 10/13 CA01861013 2, F VERMONT CHANGES IN GARAGECOVERAGE FORM-POLLUTION

VT

CA2165 10/13 CA21651013 VERMONT SPLIT UNINSUREDMOTORISTS COVERAGE LIMITS

VT

CA495 A 03/94 CA21650394 1, 2, 3 VERMONT SPLIT UNINSUREDMOTORISTS COVERAGE LIMITS

VT

CA2163 10/16 CA21631016 1, 2, 3, 5, F VERMONT UNINSURED MOTORISTSCOVERAGE

VT

CA9962 11/02 CA99621102 1, 2, 3, 5, F VIRGINIA - FEDERAL EMPLOYEESUSING AUTOS IN GOVERNMENTBUSINESS

VA

CA0428 03/07 CA04280307 1, 2, 3, 4, 5, F VIRGINIA - OPTIONAL LIMITS - LOSS OFUSE EXPENSES

VA

CA2323 10/11 CA23231011 1, F VIRGINIA - TRUCKERS ENDORSEMENT VACA2064 02/13 CA20640213 VIRGINIA AUTOS LEASED, HIRED,

RENTED OR BORROWED WITHDRIVERS – PHYSICAL DAMAGECOVERAGE

VA

CA2064 02/18 CA20640218 VIRGINIA AUTOS LEASED, HIRED,RENTED OR BORROWED WITH

VA




DRIVERS – PHYSICAL DAMAGECOVERAGE

CA2534 10/11 CA25341011 2, F VIRGINIA BROADENED COVERAGE -GARAGE

VA

CA0203 02/18 CA02030218 1, 2, 3, 4, 5, F VIRGINIA CANCELLATIONAND NONRENEWAL NOTICETO DESIGNATED PERSON ORORGANIZATION

VA

CA0116 02/18 CA01160218 1, F VIRGINIA CHANGES - BUSINESS AUTOCOVERAGE FORM

VA

CA0195 02/18 CA01950218 2, F VIRGINIA CHANGES - GARAGECOVERAGE FORM

VA

CA0155 02/18 CA01550218 VIRGINIA CHANGES - MOTOR CARRIERAND TRUCKERS COVERAGE FORMS

VA

CA0155 10/15 CA01551015 VIRGINIA CHANGES - MOTOR CARRIERAND TRUCKERS COVERAGE FORMS

VA

CA0268 02/18 CA02680218 1, 2, 3, 5, F VIRGINIA CHANGES IN POLICY -CANCELLATION AND NONRENEWAL

VA

CA0268 11/16 CA02681116 1, 2, 3, 5, F VIRGINIA CHANGES IN POLICY -CANCELLATION AND NONRENEWAL

VA

CA0410 02/18 CA04100218 1, 2, 3, 4, 5, F VIRGINIA DRIVE OTHER CARCOVERAGE - BROADENED COVERAGEFOR NAMED INDIVIDUALS

VA

CA2040 02/18 CA20400218 VIRGINIA EMERGENCY SERVICES– VOLUNTEER FIREFIGHTERS'AND WORKERS' INJURIES LIMITEDEXCLUSION

VA

CA2598 01/19 CA25980119 VIRGINIA EMPLOYEE BENEFITSLIABILITY COVERAGE

VA

CA0523 03/18 CA05230318 VIRGINIA EMPLOYEE HIRED AUTOS NYCA2599 01/19 CA25990119 VIRGINIA EXTENDED REPORTING

PERIOD ENDORSEMENT FOREMPLOYEE BENEFITS LIABILITYCOVERAGE

VA

CA9972 02/18 CA99720218 1, 3, 5, F VIRGINIA GARAGEKEEPERSCOVERAGE – CUSTOMERS SOUNDRECEIVING EQUIPMENT

VA

CA9972 10/11 CA99721011 1, 3, 5, F VIRGINIA GARAGEKEEPERSCOVERAGE – CUSTOMERS SOUNDRECEIVING EQUIPMENT

VA

CA9969 02/18 CA99690218 VIRGINIA INDIVIDUAL NAMEDINSURED

VA

CA0507 02/18 CA05070218 VIRGINIA LEASING OR RENTALCONCERNS - EXCLUSION OF CERTAINLEASED AUTOS

NY

CA2039 02/18 CA20390218 1, 2, 3, 4, 5, F VIRGINIA LESSOR - ADDITIONALINSURED AND LOSS PAYEE

VA

CA9952 02/18 CA99520218 1, 2, 3, 5, F VIRGINIA LIMITED SUBROGATIONRIGHTS

VA

CA9952 11/02 CA99521102 1, 2, 3, 5, F VIRGINIA LIMITED SUBROGATIONRIGHTS

VA

CA2246 11/16 CA22461116 1, 2, 3, 5, F VIRGINIA MEDICAL EXPENSEAND INCOME LOSS BENEFITSENDORSEMENT

VA

CA2043 02/18 CA20430218 1, 3, 4, 5, F VIRGINIA MOBILE EQUIPMENT VACA2043 08/07 CA20430807 1, 3, 4, 5, F VIRGINIA MOBILE EQUIPMENT VACA2307 02/18 CA23070218 VIRGINIA MOTOR CARRIER

ENDORSEMENTNY

CA2533 10/11 CA25331011 2, F VIRGINIA PERSONAL INJURYLIABILITY COVERAGE - GARAGES

VA

CA2513 02/18 CA25130218 2, F VA




VIRGINIA POLLUTION EXCLUSION FORGARAGE OPERATIONS OTHER THANCOVERED AUTO

CA0519 02/18 CA05190218 VIRGINIA PUBLIC OR LIVERYPASSENGER CONVEYANCE ANDON-DEMAND DELIVERY SERVICESEXCLUSION

VA

CA0519 03/18 CA05190318 VIRGINIA PUBLIC OR LIVERYPASSENGER CONVEYANCE ANDON-DEMAND DELIVERY SERVICESEXCLUSION

VA

CA0518 03/18 CA05180318 VIRGINIA PUBLIC OR LIVERYPASSENGER CONVEYANCE EXCLUSION

VA

CA2042 02/18 CA20420218 1, 2, 3, 5, F VIRGINIA REGISTRATION PLATES NOTISSURED FOR A SPECIFIC AUTO

VA

CA2044 02/18 CA20440218 1, 2, 3, 4, 5, F VIRGINIA SNOWMOBILES VACA2044 10/11 CA20441011 1, 2, 3, 4, 5, F VIRGINIA SNOWMOBILES VACA3127 12/05 CA31271205 F VIRGINIA SPLIT UNINSURED

MOTORISTS COVERAGE LIMITSVA

CA0274 11/02 CA02741102 1, 2, 3, 4, 5, F VIRGINIA SUSPENSION OF INSURANCE VACA623 A 03/94 CA01850394 1, 3, 5 VT CHGS.IN BUS.AUTO,TRKRS&MOTOR

CARRIER COV.-POLL.VT

CA333 D 03/94 CA01290394 VT CHGS.IN BUSINESSAUTO,TRKRS&MOTOR CARRIER COV.

VT

(W)A3958 PIP-3 WAGE AND SALARY VERIFICATION DEA3845 03/75 WAGE AND SALARY VERIFICATION GAA3978 09/73 WAGE AND SALARY VERIFICATION TXA3967 A 01/95 PIP3(NJ) WAGE AND SALARY VERIFICATION NJA3849 A 03/95 WAGE AND SALARY VERIFICATION PAA3983 A 04/00 WAGE AND SALARY VERIFICATION UTA3920 A 05/00 WAGE AND SALARY VERIFICATION NDA3953 A 05/00 WAGE AND SALARY VERIFICATION ORA3971 A 05/00 WAGE AND SALARY VERIFICATION MDA3838 A 11/94 WAGE AND SALARY VERIFICATION MNA3823 B PIP-3MA WAGE AND SALARY VERIFICATION MAA3962 B 01/96 WAGE AND SALARY VERIFICATION CTA3975 B 04/84 WAGE AND SALARY VERIFICATION MIA3939 B 05/00 WAGE AND SALARY VERIFICATION KYA3946 C 01/96 WAGE AND SALARY VERIFICATION FLMC1611 04/05 MC16110405 WAIVER ENDORSEMENT MICA0444 10/13 CA04441013 1, 2, 3, 4, 5 WAIVER OF TRANSFER OF RIGHTS OF

RECOVERY AGAINST OTHERS TO US(WAIVER OF SUBROGATION)



CA0045 03/03 CA00450303 1, 3, 4, 5 WAR EXCLUSION FLCA0046 03/03 CA00460303 1, 3, 4, 5 WAR EXCLUSION—GARAGE

COVERAGE FORMFL

CA2342 01/02 CA23420102 WAR, MILITARY ACTION ANDTERRORISM EXCLUSION

OR

CA2350 01/02 CA23500102 1, 3, 4, 5, F WAR, MILITARY ACTION ANDTERRORISM EXCLUSION

KY

CA2338 01/02 CA23380102 2, F WAR, MILITARY ACTION ANDTERRORISM EXCLUSION—GARAGECOVERAGE FORM



TX , UT , VA , VT , WA , WI , WV , WYCA2343 01/02 CA23430102 OR




WAR, MILITARY ACTION ANDTERRORISM EXCLUSION—GARAGECOVERAGE FORM

CA2351 01/02 CA23510102 2, F WAR, MILITARY ACTION ANDTERRORISM EXCLUSION—GARAGECOVERAGE FORM

KY

UA210 08/00 WARNING ABOUT RIGHT TO CLAIMBENEFITS (STICKER)

NH

UA112 05/90 WARNING NOTICE - MOTOR VEHCILEINSURANCE FRAUD - PENNSYLVANIA

PA

UG112 B 01/05 WARNING NOTICE - MOTOR VEHICLEINSURANCE FRAUD - PENNSYLVANIA

CA

CA9951 10/13 CA99511013 1, 5, F WASHINGTON - AUTO LOANCOVERAGE - PRIVATE PASSENGERAUTOS

WA

CA2711 09/19 CA27110919 WASHINGTON - LIMITED COVERAGEFOR BODILY INJURY, PROPERTYDAMAGE OR PERSONAL ANDADVERTISING INJURY GENERALLIABILITY COVERAGES INVOLVINGEFFICIENT PROXIMATE CAUSE(DEFENSE WITHIN LIMITS)

WA

CA9936 02/14 CA99360214 WASHINGTON BUSINESSINTERRUPTION COVERAGE

WA

CA0135 10/13 CA01351013 1, 2, 3, 4, 5, F WASHINGTON CHANGES WAIL0123 11/13 IL01231113 WASHINGTON CHANGES - DEFENSE

COSTSWA

CA0431 10/13 CA04311013 1, 3, 5, F WASHINGTON CHANGES - TRUCKERS -NAMED LESSEE AS INSURED

WA

CA2392 10/13 CA23921013 1, 2, 3, 4, 5 WASHINGTON EXCLUSION OFTERRORISM

WA

CA2393 10/13 CA23931013 1, 2, 3, 4, 5 WASHINGTON EXCLUSION OFTERRORISM INVOLVING NUCLEAR,BIOLOGICAL OR CHEMICALTERRORISM

WA

CA2543 10/13 CA25431013 1, F WASHINGTON FUNGI OR BACTERIAEXCLUSION - GENERAL LIABILITYCOVERAGES

WA

CA2544 10/13 CA25441013 1, F WASHINGTON LIMITED FUNGI ORBACTERIA COVERAGE FOR GENERALLIABILITY COVERAGES

WA

CA9989 05/01 CA99890501 2 WASHINGTON LOSS PAYABLE FORMREG-335

WA

CA2257 10/13 CA22571013 1, 2, 3, 5, F WASHINGTON PERSONAL INJURYPROTECTION - NAMED INDIVIDUALS

WA

CA2326 10/13 CA23261013 1, 3, 5, F WASHINGTON TRUCKERS -INTERMODAL INTERCHANGE UNIFORMENDORSEMENT FORM UIIE - 1

WA

CA2134 10/13 CA21341013 1, 2, 3, 5, F WASHINGTON UNDERINSUREDMOTORISTS COVERAGE

WA

CA9968 11/13 CA99681113 1, 2, 3, 5, F WEST VIRGINIA AUTO MEDICALPAYMENTS COVERAGE

WV

CA0252 09/17 CA02520917 WEST VIRGINIA CHANGES -CANCELLATION

WV

CA0189 10/13 CA01891013 WEST VIRGINIA CHANGES - COVERAGEEXTENSION FOR TEMPORARYSUBSTITUTE AUTOS

WV

CA405 C 03/94 CA02520394 1, 2, 3, 5 WEST VIRGINIA CHANGES-CANCELLATION

WV

CA0181 01/16 CA01810116 1, 2, 3, 4, 5 WEST VIRGINIA GARAGE LIABILITYCOVERAGE CHANGES

WV




CA0512 09/17 CA05120917 WEST VIRGINIA PUBLIC OR LIVERYPASSENGER CONVEYANCE ANDTRANSPORTATION NETWORKSERVICES EXCLUSION

WV

CA0513 09/17 CA05130917 WEST VIRGINIA PUBLIC OR LIVERYPASSENGER CONVEYANCE,TRANSPORTATION NETWORK ANDON-DEMAND DELIVERY SERVICESEXCLUSION

WV

CA3102 01/07 CA31020107 1, 2, 3, 5, F WEST VIRGINIA SPLIT UNINSURED& UNDERINSURED MOTORISTSCOVERAGE LIMITS

WV

CA2122 11/13 CA21221113 1, 2, 3, 5, F WEST VIRGINIA UNINSURED ANDUNDERINSURED MOTORISTSCOVERAGE

WV

CA9924 10/13 CA99241013 1, 2, 3, 5, F WISCONSIN AUTO MEDICALPAYMENTS COVERAGE

WI

CA0117 10/13 CA01171013 1, 2, 3, 5, F WISCONSIN CHANGES WIIL0283 11/18 IL02831118 WISCONSIN CHANGES -

CANCELLATION AND NONRENEWALWI

CA2145 10/13 CA21451013 1, 2, 3, 5, F WISCONSIN UNDERINSUREDMOTORISTS COVERAGE

WI

CA2103 10/13 CA21031013 1, 2, 3, 5, F WISCONSIN UNINSURED MOTORISTSCOVERAGE

WI

CA2560 10/13 CA25601013 WORLDWIDE GENERAL LIABILITYCOVERAGES




CA712 03/92 TE23050392 1, 3 WRONG DELIVERY OF LIQUIDPRODUCTS

TX

CA824 12/93 CA23051293 1, 3, 5 WRONG DELIVERY OF LIQUIDPRODUCTS

AK , AL , AR , AZ , CA , CO , CT ,DC , DE , FL , GA , GU , HI , IA , ID ,

IL , IN , KS , KY , LA , MD , ME ,MI , MN , MO , MS , MT , NC , ND ,NE , NH , NJ , NM , NV , OH , OK ,OR , PA , RI , SC , SD , TN , TX ,

UT , VA , VT , WA , WI , WV , WYCA1048 12/93 CA23051293(HI) 1, 3, 5, F WRONG DELIVERY OF LIQUID

PRODUCTSHI

CA629 B 03/94 CA01890394 1, 2, 3, 4, 5 WV CHANGES-COV.EXTENSION FORTEMPORARY SUB. AUTOS

WV

CA284 B 10/97 CA99121097 1, 2, 3, 5, F WY CHGS - FED EMP USING AUTOS INGOV'T BUSINESS

WY

IL0114 10/13 IL01141013 WYOMING CHANGES - DEFENSE COSTS WYCA0144 10/13 CA01441013 + WYOMING CHANGES - DUTY TO

DEFENDWY

CA282 A 03/94 CA01440394 1, 2, 3, 5 WYOMING CHANGES - DUTY TODEFEND

WY

CA2571 10/13 CA25711013 + WYOMING EMPLOYEE BENEFITSLIABILITY COVERAGE

WY

CA528 A 03/94 CA20320394 1, 2, 3, 4, 5 WYOMING SNOWMOBILES WYCA466 A 03/94 CA21680394 F WYOMING SPLIT UNINSURED

MOTORISTS COVERAGE LIMITSWY

CA2123 10/13 CA21231013 1, 2, 3, 5, F WYOMING UNINSURED MOTORISTSCOVERAGE

WY

(Y)UG168 03/99 Y2K ENDORSEMENT NOTICE LACA2525 10/13 CA25251013 2, F YEAR 2000 COMPUTER - RELATED

AND OTHER ELECTRONIC PROBLEMS -AL , AR , AZ , CA , CO , CT , DC , DE ,

FL , GA , HI , IA , ID , IL , IN , KS ,




EXCLUSION OF SPECIFIED COVERAGESFOR DESIGNATED LOCATIONS,PRODUCTS, SERVICES OR WORK YOUPERFORMED

KY , LA , ME , MI , MN , MO , MS ,MT , NC , ND , NE , NH , NJ , NM ,

NV , NY , OH , OK , OR , PA , RI , SC ,SD , TN , UT , VT , WA , WI , WV , WY

CA1076 09/98 CA25250998(HI) 2, F YEAR 2000 COMPUTER-RELATED ANDOTHER ELECTRONIC PROBLEMS—EXCLUSION OF SPECIFIED COVERAGESFOR DESIGNATED LOCATIONS,PRODUCTS, SERVICES OR WORK YOUPERFORMED

HI

CA967 09/98 CA25200998 2, F YEAR 2000 LIMITED COV OPT-COMP-REL & OTHER ELEC PB

AL , AR , AZ , CO , DC , DE , GA , IA ,ID , IL , IN , KS , KY , LA , MD , ME , MI ,MN , MO , MS , MT , NC , ND , NH , NJ ,NM , NV , OH , OK , OR , PA , RI , SC ,SD , TN , UT , VT , WA , WI , WV , WY

CA1074 09/98 CA25200998(HI) 2, F YEAR 2000 LIMITED COVERAGEOPTIONS—COMPUTER-RELATED ANDOTHER ELECTRONIC PROBLEMS

HI

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Commercial Automobile - Wolters KluwerCommercial Automobile (New)Denotes change. PAGE CA 2 of 76 WOLTERS KLUWER Customer Support: 800-382-2424 UNIFORM EDITION BUREAU NUMBER DATE NUMBER