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Coverage Is Provided In: Policy Number: <br />L berty Ohio Security Insurance Company - a stag company BKS (16) 55 96 34 27 <br />I'.L1tLic�IG Policy Period: <br />INSURANCE From 05/31/2015 To 05/31/2016 <br />Common Policy Declarations 12:01 am Standard Time <br />at Insured Mailing Location <br />Named Insured Agent <br />AVT INC (626) 300-9000 <br />NEW CENTURY INSURANCE SV'S INC <br />POLICY FORMS AND ENDORSEMENTS CONTINUED <br />This section lists all of the Forms and Endorsements for your policy. Refer to these documents as needed for <br />detailed information concerning your coverage. <br />FORM NUMBER TITTLE <br />CG 21 88 01 07 <br />Conditional. Exclusion of Terrorism Involving Nuclear, Biological or Chemical <br />Terrorism (Relating to Disposition of Federal Terrorism Risk Insurance Act) <br />CG 24 04 05 09 <br />Waiver of Transfer of Rights of Recovery Against Others to Us <br />CG 24 26 04 13 <br />Amendment of Insured Contract Definition <br />CG 32 34 01 05 <br />California Changes <br />CG 84 9901 12 <br />Non -Cumulation Of Liability Limits Same Occurrence <br />CG 88 10 04 13 <br />Commercial General Liability Extension <br />CG 88 60 1208 <br />Each Location General Aggregate Limit <br />CG 88 62 04 13 <br />Additional Insured - Blanket Venders <br />CG 88 77 12 08 <br />Medical Expense At Your Request Endorsement <br />CG 88 83 04 12 <br />Amendment of Other Insurance Condition - Designated Persons or Organizations <br />CG 88 86 12 08 <br />Exclusion - Asbestos Liability <br />CG 89 98 04 1.2 <br />Amendment of Other Insurance Condition <br />CG 90 41 01 13 <br />Amendment Of Coverage B Personal And Advertising Injury <br />CL 01 00 03 99 <br />Common Policy Conditions <br />CL 01 62 1.0 1.3 <br />Amendatory Endorsement - California <br />CL 06 00 01 08 <br />Certified Terrorism Loss <br />CL 07 00 10 06 <br />Virus or Bacteria Exclusion <br />CL 16 60 06 06 <br />Conditional Nuclear, Biological, And Chemical Terrorism Exclusion - (With <br />Limited Exception) <br />CP 00 10 0402 <br />Building and Personal Property Coverage Form <br />CP 00 30 04 02 <br />may' <br />Business Income (and Extra Expense) Coverage FormwQ 9 <br />CP 00 90 07 88 <br />Commercial Property Conditions 'tie <br />CP 01 40 07 06 <br />Exclusion of Loss Due to Virus or Bacteria �+ a <br />Changes Replacement Cost <br />CP 04 49 12 05 <br />California - <br />CP 10 30 0402 <br />Causes of Loss - Special Form <br />CP 10 32 08 08 <br />Water Exclusion Endorsement <br />CP 12 18 0695 <br />Loss Payable Provisions ,Q - <br />CP 70 02 01 01 <br />General Endorsement <br />CP 72 97 0402 <br />Equipment Breakdown Enhancement Endorsement - Special Form <br />To report a claim, call your Agent or 1-800-362-0000 <br />©S 70 21 01 08 <br />05/01/15 55963427 N0197371 275 GCXOPPNO INSURED COPY 000496 PAGE 29 OF 212 <br />