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POLICY NUMBER: BA-00646504-25-42-G <br />EFFECTIVE DATE: 11/01/2025 <br />ISSUE DATE: 10/30/2025 <br />LISTING OF FORMS, ENDORSEMENTS AND SCHEDULE NUMBERS <br />THIS LISTING SHOWS THE NUMBER OF FORMS, SCHEDULES AND ENDORSEMENTS <br />BY LINE OF BUSINESS <br />IL TO 02 11 89 COMMON POLICY DECLARATIONS <br />IL T8 01 01 01 FORMS ENDORSEMENTS AND SCHEDULE NUMBERS <br />IL TO O1 01 07 COMMON POLICY CONDITIONS <br />COMMERCIAL AUTO <br />CA <br />TO <br />76 <br />02 <br />15 <br />BA/AD/MC COV PART SUPP SCH ( ITEM 2) <br />CA <br />TO <br />O1 <br />02 <br />15 <br />BA- COVERAGE PART DECS (ITEMS 1 & 2) <br />CA <br />TO <br />02 <br />02 <br />15 <br />BUSINESS AUTO COVERAGE PART DECLARATIONS (ITEM 3) <br />CA <br />TO <br />03 <br />02 <br />15 <br />BUS AUTO COV PART DECLARATIONS-4&5 <br />CA <br />TO <br />30 <br />02 <br />16 <br />BUSINESS AUTO/MC COV PART -UM SUPPL SCHD <br />CA <br />TO <br />31 <br />02 <br />15 <br />TABLE OF CONTENTS -BUSINESS AUTO COV FORM <br />CA <br />00 <br />01 <br />10 <br />13 <br />BUSINESS AUTO COVERAGE FORM <br />CA <br />O1 <br />07 <br />10 <br />13 <br />CONNECTICUT CHANGES <br />CA <br />O1 <br />43 <br />05 <br />17 <br />CALIFORNIA CHANGES <br />CA <br />O1 <br />96 <br />10 <br />13 <br />TEXAS CHANGES <br />CA <br />02 <br />67 <br />01 <br />21 <br />FLORIDA CHANGES - CANCELLATION AND NONRENEWAL <br />CA <br />03 <br />05 <br />10 <br />13 <br />CALIFORNIA CHANGES - WAIVER OF COLLISION DEDUCTIBLE <br />CA <br />04 <br />24 <br />10 <br />13 <br />California Auto Medical Payments Coverage <br />CA <br />21 <br />09 <br />10 <br />13 <br />TEXAS UNINSURED/UNDERINSURED MOTORISTS COVERAGE <br />CA <br />21 <br />54 <br />11 <br />16 <br />CA UM MOTORISTS COVERAGE - BODILY INJURY <br />CA <br />21 <br />57 <br />03 <br />16 <br />CONNECTICUT UNINSURED AND UNDERINSURED MOTORISTS <br />COVERAGE <br />CA <br />22 <br />10 <br />08 <br />25 <br />FLORIDA PERSONAL INJURY PROTECTION <br />CA <br />22 <br />32 <br />11 <br />18 <br />NEW YORK MANDATORY PERSONAL INJURY PROTECTION <br />ENDORSEMENT <br />CA <br />22 <br />46 <br />11 <br />16 <br />VA MED EXP & INCOME LOSS BENEFITS END <br />CA <br />22 <br />64 <br />10 <br />13 <br />TEXAS PERSONAL INJURY PROTECTION ENDORSEMENT <br />CA <br />31 <br />07 <br />11 <br />18 <br />NEW YORK SUPPLEMENTARY UNINSURED/UNDERINSURED <br />MOTORISTS ENDORSEMENT <br />CA <br />99 <br />03 <br />10 <br />13 <br />AUTO MEDICAL PAYMENTS COVERAGE <br />CA <br />99 <br />23 <br />10 <br />13 <br />RENTAL REIMBURSEMENT COVERAGE <br />CA <br />99 <br />95 <br />10 <br />13 <br />TEXAS SUPPLEMENTARY DEATH BENEFIT <br />CA <br />T4 <br />20 <br />02 <br />15 <br />AUTO COVERAGE PLUS ENDORSEMENT <br />CA <br />T4 <br />52 <br />02 <br />16 <br />SHORT TERM HIRED AUTO - ADDITIONAL INSURED AND LOSS <br />PAYEE <br />CA <br />T4 <br />59 <br />02 <br />15 <br />AMENDMENT OF EMPLOYEE DEFINITION <br />CA <br />T4 <br />74 <br />02 <br />16 <br />BLANKET ADDITIONAL INSURED - PRIMARY AND <br />NON-CONTRIBUTORY WITH OTHER INSURANCE <br />CA <br />T4 <br />99 <br />02 <br />16 <br />BLNKT ADDL INSD-PNC W/OTHR INS-CNTRCTR <br />CA <br />T6 <br />25 <br />07 <br />18 <br />ROADSIDE ASSISTANCE COVERAGE <br />CA <br />T6 <br />44 <br />07 <br />24 <br />LONG TERM LEASED AUTOS COVERED AS OWNED AUTOS <br />CA <br />FO <br />51 <br />02 <br />15 <br />TEXAS CHANGES - CANCELLATION AND NONRENEWAL <br />IL T8 01 01 01 <br />PAGE: 1 OF 2 <br />