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Coverage Is Provided In: Policy Number: <br />Liberty Ohio Security Insurance Company - a stock company BKS (16) 55 96 34 27 <br />Mutual ® 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 SVS 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 <br />TITLE <br />CP 88 04 03 10 <br />Removal Permit <br />CP 90 55 12 12 <br />Business Income And Extra Expense Changes - Actual Loss Sustained In A <br />Twelve -Month Period <br />CP 90 59 12 12 <br />Identity Theft Incident Administrative Services and Expense Coverage <br />CP 99 93 10 90 <br />Tentative Rate <br />IL 00 17 11 98 <br />Common Policy Conditions <br />IL 00 21 09 08 <br />Nuclear Energy Liability Exclusion Endorsement (Broad Form) <br />IL 01 02 05 05 <br />California Changes - Actual Cash Value <br />IL 01 04 09 07 <br />California Changes <br />IL 02 70 09 12 <br />California Changes - Cancellation and NonRenewal <br />IL 04 15 04 98 <br />Protective Safeguards <br />IL 09 35 07 02 <br />Exclusion of Certain Computer -Related Losses <br />IL 09 52 03 08 <br />Cap on Losses From Certified Acts of Terrorism <br />IL 09 96 01 07 Conditional Exclusion of Terrorism Involving Nuclear, Biological or Chemical <br />Terrorism (Relating to Dispostion of Federal Terrorism Risk Insurance Act) <br />IM 20 09 12 04 Amendatory Endorsement - California <br />IM 75 00 04 04 Scheduled Property Floater <br />LC 87 10 05 00 Punitive or Exemplary Damages Exclusion <br />To report a claim, calf your Agent or 1-800-362-0000 <br />DS 70 2101 08 <br />05/01/15 55963427 N0197371 275 GCXOPPNO INSURED COPY 000496 PAGE 30 OF 212 <br />