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POLICY NUMBER: 2LP-15P6297A-15-.15 <br />EFFECTIVE DATE: 08/01/15 <br />ISSUE DATE: 08/10/15 <br />LISTING OF FORMS, ENDORSEMENTS AND SCHEDULE NUMBERS <br />This listing shows the number of forms, schedules and endorsements by line of business. <br />IL <br />TO <br />02 <br />11 <br />89 <br />COMMON POLICY DECLARATIONS <br />IL <br />T3 <br />18 <br />05 <br />11 <br />COMMON POLICY CONDITIONS - DELUXE <br />IL <br />TO <br />03 <br />04 <br />96 <br />LOCATION SCHEDULE <br />IL <br />T8 <br />01 <br />10 <br />93 <br />FORMS, ENDORSEMENTS AND SCHEDULE NUMBERS <br />IL <br />T3 <br />68 <br />01 <br />15 <br />FEDERAL TERRORISM RISK INSURANCE ACT DISCLOSURE <br />IL <br />00 <br />21 <br />09 <br />08 <br />NUCLEAR ENERGY LIABILITY EXCLUSION ENDORSEMENT <br />IL <br />T4 <br />05 <br />03 <br />11 <br />DESIGNATED ENTITY - NOTICE OF CANCELLATION PROVIDED BY US <br />IL <br />T4 <br />14 <br />01 <br />15 <br />CAP ON LOSSES FROM CERTIFIED ACTS OF TERRORISM <br />IL <br />T9 <br />16 <br />09 <br />07 <br />GEORGIA CHANGES - CANCELLATION AND NONRENEWAL <br />PROPERTY <br />DX TO 00 11 12 DELUXE PROPERTY COVERAGE PARC DECLARATIONS <br />DX <br />00 <br />04 <br />11 <br />12 <br />TABLE OF CONTENTS <br />DX <br />Tl <br />00 <br />11 <br />12 <br />DELUXE PROPERTY COVERAGE FORM <br />DX <br />T1 <br />01 <br />11 <br />12 <br />DELUXE BUSINESS INCOME (AND EXTRA EXPENSE) COVERAGE FORM <br />DX <br />T4 <br />15 <br />11 <br />12 <br />CRIME ADDITIONAL COVERAGES <br />DX <br />T4 <br />16 <br />11 <br />12 <br />TECHNOLOGY INDUSTRY DIRECT DAMAGE AND CAUSE OF LOSS <br />CG <br />TO <br />09 <br />09 <br />93 <br />EXTENSIONS <br />DX <br />T4 <br />17 <br />11 <br />12 <br />TECHNOLOGY INDUSTRY BUSINESS INCOME AND EXTRA EXPENSE <br />CG <br />00 <br />01 <br />10 <br />01 <br />EXTENSIONS <br />DX <br />T3 <br />79 <br />11 <br />12 <br />LOSS PAYABLE PROVISIONS <br />DX <br />T4 <br />02 <br />01 <br />15 <br />FEDERAL TERRORISM RISK INSURANCE ACT DISCLOSURE <br />DX <br />01 <br />94 <br />11 <br />12 <br />GEORGIA CHANGES <br />DX <br />T3 <br />98 <br />04 <br />02 <br />ELECTRONIC VANDALISM LIMITATION ENDORSEMENT <br />COMMERCIAL GENERAL LIABILITY <br />CG <br />TO <br />01 <br />11 <br />03 <br />COMMERCIAL GENERAL LIABILITY COVERAGE PART DECLARATIONS <br />CG <br />TO <br />34 <br />11 <br />03 <br />TABLE OF CONTENTS COMMERCIAL GENERAL LIABILITY COVERAGE FORM <br />CG 00 01 10 01 <br />CG <br />TO <br />07 <br />09 <br />87 <br />DECLARATIONS PREMIUM SCHEDULE <br />CC <br />TO <br />08 <br />11 <br />03 <br />KEY TO DECLARATIONS PREMIUM SCHEDULE <br />CG <br />TO <br />09 <br />09 <br />93 <br />EMPLOYEE BENEFITS LIABILITY COVERAGE PART DECLARATIONS <br />CG <br />Tl <br />01 <br />07 <br />86 <br />EMPLOYEE BENEFIT LIABILITY COVERAGE FORM <br />CG <br />00 <br />01 <br />10 <br />01 <br />COMMERCIAL GENERAL LIABILITY COVERAGE FORM <br />CG <br />D2 <br />55 <br />11 <br />03 <br />AMENDMENT OF COVERAGE - POLLUTION <br />CG <br />D4 <br />19 <br />07 <br />08 <br />AMENDMENT OF PROPERTY DAMAGE DEFINITION <br />CG <br />D4 <br />20 <br />07 <br />08 <br />AMENDMENT - OTHER INSURANCE CONDITION & MEANING 4F OTHER <br />INSURANCE, OTHER INSURER AND INSURER <br />CG <br />D4 <br />22 <br />07 <br />08 <br />AMENDMENT OF SUPPLEMENTARY PAYMENTS - TAXED COSTS AND <br />APPEAL BONDS <br />CG <br />D4 <br />25 <br />07 <br />08 <br />OTHER INSURANCE - ADDITIONAL INSUREDS - PRIMARY AND <br />NON-CONTRIBUTORY WITH RESPECT TO CERTAIN OTHER INSURANCE <br />CG <br />D4 <br />36 <br />01 <br />15 <br />AMENDMENT OF COVERAGE B - PERSONAL AND ADVERTISING INJURY <br />LIABILITY - TECHNOLOGY <br />IL T8 01 10 93 Page 1 of 2 <br />