# Commercial General Liability Declarations

**CHUBB**
ACE American Insurance Company
436 Walnut Street
Philadelphia PA 19106

**POLICY NUMBER:** HDO G27865355

| Endt. No. | Form No. | Description |
|-----------|----------|-------------|
| 133       | CG26211091 | New York Changes - Transfer Of Duties When A Limit Of Insurance Is Used Up |
| 134       | IL02690908 | North Carolina Changes - Cancellation And Nonrenewal |
| 135       | IL01201013 | Pennsylvania Changes – Defense Costs |
| 136       | CG01071093 | Puerto Rico Changes |
| 137       | IL02730110 | Rhode Island Changes - Cancellation And Nonrenewal |
| 138       | CG01441011 | South Dakota Changes |
| 139       | CG01030606 | Texas Changes |
| 140       | IL02751113 | Texas Changes – Cancellation And Nonrenewal Provisions For Casualty Lines And Commercial Package Policies |
| 141       | CG01861204 | Utah Changes |
| 142       | CG01790710 | Virginia Changes |
| 143       | IL01381015 | Virginia Changes – Cancellation And Nonrenewal |
| 144       | CG01810508 | Washington Changes |
| 145       | IL01231113 | Washington Changes – Defense Costs |
| 146       | CG01240193 | Wisconsin Changes - Amendment Of Policy Conditions |
| 147       | CG01600798 | Wyoming Changes |
| 148       | IL01141013 | Wyoming Changes – Defense Costs |
| 149       | IL02310908 | Arkansas Changes - Cancellation And Nonrenewal |
| 150       | IL01990908 | Arkansas Changes - Transfer Of Rights Of Recovery Against Others To Us |
| 151       | IL02280907 | Colorado Changes - Cancellation And Nonrenewal |
| 152       | IL02600210 | Connecticut Changes - Cancellation And Nonrenewal |
| 153       | IL01400908 | Connecticut Changes - Civil Union |
| 154       | IL01510112 | Delaware Changes - Civil Union |
| 155       | IL02370412 | Delaware Changes - Termination Provisions |
| 156       | IL01490112 | Hawaii Changes - Civil Union |
| 157       | IL02040908 | Idaho Changes - Cancellation And Nonrenewal |
| 158       | IL01470911 | Illinois Changes - Civil Union |
| 159       | IL01580908 | Indiana Changes |
| 160       | IL02720907 | Indiana Changes - Cancellation And Nonrenewal |
| 161       | IL01171210 | Indiana Changes - Workers' Compensation Exclusion |
| 162       | IL09130498 | Insurance Inspection Services Exemption From Liability |
| 163       | IL02760908 | Iowa Changes - Cancellation And Nonrenewal |
| 164       | IL02630908 | Kentucky Changes - Cancellation And Nonrenewal |
| 165       | IL02770312 | Louisiana Changes - Cancellation And Nonrenewal |
| 166       | IL02470211 | Maine Changes - Cancellation And Nonrenewal |

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