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40 <br />HISCOX <br />HISCOX INSURANCE COMPANY INC. (A Stock Company) <br />104 South Michigan Avenue, Suite 600, Chicago, Illinois 60603 <br />Forms and Endorsements Schedule <br />Forms and Endorsements made part of this policy at time of issue: <br />CGL D001 01 10 - Commercial General Liability Declarations <br />CG 00 01 12 07 - General Liability Coverage Form <br />CGL E5421 CW (02/14) - Additional Insured - Automatic Status <br />CGL E5409 CW (03/10) - Right and Duty to Select Defense Counsel <br />CGL E5404 CW (03/10) - Exclusion - Personal Information <br />CGL E5408 CW (03/10) - Cancellation Provision (14 Day Full Refund) <br />CGL E5403 CW (03/10) - Notice Information <br />CGL E5401 CW (03/10) - Definition of Employee <br />CGL E5407 CW (03/10) - Exclusion - Professional Services <br />IL 00 21 09 08 - Nuclear Energy Liability Exclusion Endorsement (Broad Form) <br />IL 02 70 09 08 - California Changes - Cancellation and Nonrenewal <br />CG 32 34 01 05 - California Changes <br />IL 00 17 1198 - Common Policy Conditions <br />CG 04 37 12 04 - Electronic Data Liability <br />CG 21 41 11 85 - Exclusion - Intercompany Products Suits <br />CG 00 68 05 09 - Recording and Distribution of Material or Information in Violation of Law Exclusion <br />CG 21 70 01 15 - Cap On Losses From Certified Acts Of Terrorism <br />IL 09 85 01 15 - Disclosure Pursuant To Terrorism Risk Insurance Act <br />INT N001 CW (01/09) - Economic And Trade Sanctions Policyholder Notice <br />INT D001 01 10 Page 1 of 1 <br />