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MMMMUM <br />AMERICAN SPECIALTY' <br />FORMS SCHEDULE <br />Form <br />Edition <br />Description <br />OOM L006500 <br />06/07 <br />U.S. Treasury Department's Office of Foreign Assets Control ("OFAC") <br />IL N018 <br />09/03 <br />California Fraud Statement <br />05M L000205A <br />12/14 <br />California Signature Page <br />FAI CSKLBUSFE <br />06/01 <br />Schedule of Forms and Endorsements <br />IL 0017 <br />11/98 <br />Common Policy Conditions <br />IL 0021 <br />09/08 <br />Nuclear Energy Liability Exclusion Endorsement (Broad Form) <br />IL 0270 <br />09/12 <br />California Changes - Cancellation and Nonrenewal <br />IL 0985 <br />01/15 <br />Disclosure Pursuant to Terrorism Risk Insurance Act <br />05S GL000100 <br />10/16 <br />Commercial General Liability Insurance Certificate Declarations <br />CG 0001 <br />04/13 <br />Commercial General Liability Coverage Form <br />CG 2101 <br />11 /85 <br />Exclusion - Athletic or Sports Participants <br />CG 2107 <br />05114 <br />Exclusion - Access or Disclosure of Confidential or Personal <br />Information and Data -Related Liability - Limited bodily Injury Exception <br />Not Included <br />CG 2135 <br />10/01 <br />Exclusion - Coverage C - Medical Payments <br />CG 2144 <br />04/17 <br />Limitation of Coverage to Designated Premises or Project <br />CG 2147 <br />12/07 <br />Employment -Related Practices Exclusion <br />CG 2167 <br />12/04 <br />Fungi or Bacteria Exclusion <br />CG 2170 <br />01/15 <br />Cap on Losses From Certified Acts of Terrorism <br />CG 2404 <br />05/09 <br />Waiver of Transfer of Rights of Recovery Against Others to Us <br />CG 2407 <br />01/96 <br />Products/Completed Operations Hazard Redefined <br />CG 3234 <br />01/05 <br />California Changes <br />OOG L004500 <br />12/03 <br />Asbestos Exclusion <br />00G LO17300 <br />04/04 <br />Lead Contamination Exclusion <br />OOS GLOO1400 <br />10/16 <br />Changes in Other Insurance Condition <br />OOS GL002100 <br />10/16 <br />Aggregate Limit Per Event <br />OOS GL002900 <br />10/16 <br />Additional Insured - Designated Person or Organization Written <br />Contract or Written Agreement <br />OOS GL003100 <br />10/16 <br />Commercial General Liability Extension Endorsement <br />OOS GL005200 <br />10/16 <br />Minimum Earned Premium <br />OOS GL006000 <br />10/16 <br />Schedule of Event(s) <br />OOS GL006800 <br />10/16 <br />Purchasing Group Conversion Endorsement <br />OOS GLO10800 <br />10/16 <br />Fireworks Exclusion <br />OOS GLO12100 <br />10/16 <br />Contingent Coverage - Designated Activity Service or Work <br />OOS GLO13100 <br />10/16 <br />Amendatory Exclusion Endorsement - Miscellaneous Liability <br />©2019. American Specialty Insurance & Risk Services, Inc. dba A.S.I.R.S.I. Insurance Agency, American Specialty <br />Insurance & Risk Services Agency, and A S Insurance & Risk Services Agency. All rights reserved. Last modified <br />September 11, 2019. <br />