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®Allstate <br />AMENDED DECLARATIONS <br />CUSTOMIZER POLICY NO. 050 828050 <br />SPECIAL FORM <br />6. OPTIONAL COVERAGES <br />The following optional coverages, if any, are provided under this policy. <br />Coverage <br />Location(s) <br />Limits of Liability <br />ADDITIONAL INSURED <br />ALL <br />SEE COVERAGE B - PART 1 <br />EMPLOYER NON -OWNER AUTO LIABILITY <br />ALL <br />SAME AS COVERAGE B - PART 3 <br />HIRED AUTO <br />ALL <br />SEE COVERAGE B - PART 4 <br />LOSS OF INCOME - RENTS <br />ALL <br />SEE COVERAGE A - PART 3 <br />TERRORISM COVERAGE <br />ALL <br />7. Annual Premium for the Policy and Optional Coverages $714.00 <br />—SEE THE IMPORTANT PAYMENT INFORMATION FORM BU5857 <br />FOR DETAILS ABOUT PAYMENT OPTIONS AND INSTALLMENT FEES— <br />The portion of the annual premium shown above that is attributable to coverage for losses caused by "acts <br />of terrorism" to which the Program established by the "Terrorism Risk Insurance Act" as extended on December 22, <br />2005 applies is $1.00 . SEE DISCLOSURE NOTICE ON PAGE 4 OF 4. <br />BUS570-6 <br />(ED. 06.06) <br />3UI14R 3 <br />Page 2 of 4 <br />