# CHUBB Commercial General Liability Declarations

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

**POLICY NUMBER:** HDO G72490587

## SCHEDULE OF NOTICES

| Form No. | Description |
|----------|-------------|
| ALL23445b0713 | Policyholder Notice Commercial Lines Deregulation New York |
| ALL2Y31b1109 | Arkansas Notice To Policyholders |
| ALL208871006 | Chubb Producer Compensation Practices & Policies |
| ALL223680607 | Colorado Fraud Statement |
| ALL8Z4172000 | Georgia Notice |
| ILN1751111 | Illinois Notice To Policyholders Regarding The Religious Freedom Protection And Civil Union Act |
| ALL301520710 | Important Information To Idaho Policyholders Regarding Your Insurance |
| ALL7X47a0206 | Important Information To Virginia Policyholders Regarding Your Insurance |
| ALL2Y810514 | Indiana Notice To Policyholders |
| ALL512200918 | Missouri Disclaimer Notice Commercial Lines Deregulation |
| ALL2U78b0206 | Notice To All Oklahoma Policyholders |
| ALL398220413 | Notice To Our Florida Property And Casualty Policyholders Guidelines For Loss Control Plans |
| IL09100702 | Pennsylvania Notice |
| ALL5W060795 | Policyholder Notice - Ohio |
| ALL18653d0714 | Questions About Your Insurance? |
| ALL5X451196 | Questions About Your Insurance? |
| ALL11559e0716 | Risk Control Services For Texas Policyholders |
| ALL4Y30g0520 | Texas Notice Information And Complaints |
| ILP0010104 | U.S. Treasury Department's Office Of Foreign Assets Control ("OFAC") Advisory Notice To Policyholders |
| ALL5X51a0206 | Wisconsin Notice To Policyholders |

## SCHEDULE OF COVERAGE FORMS

| Form No. | Description |
|----------|-------------|
| CG00010413 | Commercial General Liability Coverage Form |
| IL00171198 | Common Policy Conditions |

## SCHEDULE OF ENDORSEMENTS

| Endt. No. | Form No. | Description |
|-----------|----------|-------------|
| 1         | ALL32677a0412 | Kentucky Local Government Premium Tax Schedule |
| 2         | ALL224211011 | Surcharge Schedule |
| 3         | CC1K110218 | Signatures |
| 4         | LD200310206 | Combined Policy Aggregate |

**LD-25211 (10/08)**

Copyright, Insurance Services Office, Inc. 2000

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