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ITEM FOUR <br />Schedule Of Hired Or Borrowed Covered Auto Coverage And Premiums (Cont'd) <br />Cost Of Hire Rating Basis For Mobile Or Farm Equipment — Other <br />Than Physical Damage Coverages <br />Estimated Annual <br />Cost Of Hire For Each State <br />Premium <br />Coverage <br />State <br />Mobile Equipment <br />Farm Equipment <br />Mobile Equipment <br />Farm Equipment <br />Liability — <br />$ <br />$ <br />$ <br />$ <br />Primary <br />SEE <br />Coverage <br />SCHEDULE, IF <br />APPLICABLE <br />Liability — <br />$ <br />$ <br />$ <br />$ <br />Excess <br />Coverage <br />Personal Injury <br />$ <br />$ <br />$ <br />$ <br />Protection <br />Medical <br />$ <br />$ <br />$ <br />$ <br />Expense <br />Benefits <br />(Virginia Only) <br />Income Loss <br />$ <br />$ <br />$ <br />$ <br />Benefits <br />(Virginia Only) <br />Auto Medical <br />$ <br />$ <br />$ <br />$ <br />Payments <br />Total Premiums <br />$ <br />$ <br />Cost of hire means the total amount you incur for the hire of "autos" you don't own (not including "autos" you <br />borrow or rent from your partners or "employees" or their family members). Cost of hire does not include charges <br />for services performed by motor carriers of property or passengers. <br />Page 8 of 13 © Insurance Services Office, Inc., 2009 <br />oR,N F RiskMougementDMslcrn <br />a� REVIEWED & APPROVED BY. <br />`® tq {iceva�o <br />Risk Management Specialist <br />CA DS 03 03 10 0 <br />