# Commercial General Liability Declarations

**ACE American Insurance Company**
436 Walnut Street
Philadelphia PA

**POLICY NUMBER:** HDO G48898919

| Endt. No. | Form No. | Description |
|-----------|----------|-------------|
| 125       | CG02000118 | Illinois Changes – Cancellation And Nonrenewal |
| 126       | IL01621013 | Illinois Changes – Defense Costs |
| 127       | CG01230397 | Indiana Changes - Pollution Exclusion |
| 128       | CG01091185 | Kansas And Oklahoma Changes - Transfer Of Rights |
| 129       | IL02610907 | Kansas Changes - Cancellation And Nonrenewal |
| 130       | CG01250303 | Louisiana Changes - Insuring Agreement |
| 131       | CG01181204 | Louisiana Changes - Legal Action Against Us |
| 132       | CG26841204 | Louisiana Changes - Transfer Of Rights Of Recovery Against Others To Us Condition |
| 133       | CG02011217 | Maryland Changes |
| 134       | CG26731204 | Maryland Changes - Premium Audit Condition |
| 135       | CG01681120 | Michigan Changes |
| 136       | CG26050207 | Minnesota Changes |
| 137       | CG01221207 | Minnesota Changes - Contractual Liability Exclusion And Supplementary Payments |
| 138       | CG26811204 | Minnesota Changes - Duties Condition |
| 139       | IL02740908 | Missouri Changes - Cancellation And Nonrenewal |
| 140       | CG26250405 | Missouri Changes - Guaranty Association |
| 141       | CG26500413 | Missouri Changes – Medical Payments |
| 142       | CG01340803 | Missouri Changes - Pollution Exclusion |
| 143       | IL01671013 | Montana Changes – Conformity With Statutes |
| 144       | CG26611001 | Montana Changes - Medical Payments |
| 145       | CG26201093 | New Jersey Changes - Loss Information |
| 146       | IL02980515 | New Mexico Changes – Cancellation And Nonrenewal |
| 147       | IL02680114 | New York Changes – Cancellation And Nonrenewal |
| 148       | CG01630417 | New York Changes – Commercial General Liability Coverage Form |
| 149       | CG01041204 | New York Changes - Premium Audit |
| 150       | CG26211091 | New York Changes - Transfer Of Duties When A Limit Of Insurance Is Used Up |
| 151       | IL02690908 | North Carolina Changes - Cancellation And Nonrenewal |
| 152       | CG01030606 | Texas Changes |
| 153       | IL02751113 | Texas Changes – Cancellation And Nonrenewal Provisions For Casualty Lines And Commercial Package Policies |
| 154       | CG01861204 | Utah Changes |
| 155       | CG01790710 | Virginia Changes |
| 156       | IL01381015 | Virginia Changes – Cancellation And Nonrenewal |
| 157       | CG01810508 | Washington Changes |
| 158       | IL01231113 | Washington Changes – Defense Costs |

**LD-25211 (10/08)**
Copyright, Insurance Services Office, Inc. 2000
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