# Commercial General Liability Declarations

**CHUBB**

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

**POLICY NUMBER:** HDO G72490587

| Endt. No. | Form No. | Description |
|-----------|----------|-------------|
| 95        | CG20101219 | Additional Insured – Owners, Lessees Or Contractors – Scheduled Person Or Organization |
| 96        | CG20101219 | Additional Insured – Owners, Lessees Or Contractors – Scheduled Person Or Organization |
| 97        | CG20101219 | Additional Insured – Owners, Lessees Or Contractors – Scheduled Person Or Organization |
| 98        | CG20101219 | Additional Insured – Owners, Lessees Or Contractors – Scheduled Person Or Organization |
| 99        | CG20101219 | Additional Insured – Owners, Lessees Or Contractors – Scheduled Person Or Organization |
| 100       | CG20101219 | Additional Insured – Owners, Lessees Or Contractors – Scheduled Person Or Organization |
| 101       | CG20101219 | Additional Insured – Owners, Lessees Or Contractors – Scheduled Person Or Organization |
| 102       | CG20101219 | Additional Insured – Owners, Lessees Or Contractors – Scheduled Person Or Organization |
| 103       | CG20101219 | Additional Insured – Owners, Lessees Or Contractors – Scheduled Person Or Organization |
| 104       | CG20151219 | Additional Insured – Vendors |
| 105       | CG24220413 | Amendment Of Coverage Territory – Worldwide Coverage |
| 106       | CG24121185 | Boats |
| 107       | CG21700115 | Cap On Losses From Certified Acts Of Terrorism |
| 108       | CG24171001 | Contractual Liability – Railroads |
| 109       | CG21471207 | Employment-Related Practices Exclusion |
| 110       | CG21110615 | Exclusion – Unmanned Aircraft (Coverage B Only) |
| 111       | CG24510615 | Limited Coverage For Designated Unmanned Aircraft (Coverage A Only) |
| 112       | CG22750413 | Professional Liability Exclusion – Computer Software |
| 113       | CG22880413 | Professional Liability Exclusion – Electronic Data Processing Services And Computer Consulting Or Programming Services |
| 114       | CG24041219 | Waiver Of Transfer Of Rights Of Recovery Against Others To Us (Waiver Of Subrogation) |
| 115       | CG24041219 | Waiver Of Transfer Of Rights Of Recovery Against Others To Us (Waiver Of Subrogation) |
| 116       | LD380420712 | Stop Gap – Employers Liability Coverage Endorsement – Puerto Rico Supplementary Payments 100% Borne By Insured |
| 117       | LD316620811 | Vermont Changes - Pollution |
| 118       | IL02580120 | Arizona Changes – Cancellation And Nonrenewal |
| 119       | CG01420711 | Arkansas Changes |
| 120       | CG26080490 | Arkansas Changes - Multi-Year Policies |
| 121       | CG32340105 | California Changes |

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