# Commercial General Liability Declarations

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

**POLICY NUMBER:** HDO G71445653

| Endt. No. | Form No. | Description |
|-----------|----------|-------------|
| 192       | IL02510907 | Nevada Changes - Cancellation And Nonrenewal |
| 193       | IL01150110 | Nevada Changes - Domestic Partnership |
| 194       | IL01350119 | New Hampshire Changes – Cancellation And Nonrenewal |
| 195       | IL01450908 | New Hampshire Changes - Civil Union |
| 196       | IL02080907 | New Jersey Changes - Cancellation And Nonrenewal |
| 197       | IL01410908 | New Jersey Changes - Civil Union |
| 198       | IL00230702 | Nuclear Energy Liability Exclusion Endorsement (Broad Form) |
| 199       | IL02440907 | Ohio Changes - Cancellation And Nonrenewal |
| 200       | IL02360907 | Oklahoma Changes - Cancellation And Nonrenewal |
| 201       | IL02790908 | Oregon Changes - Cancellation And Nonrenewal |
| 202       | IL01420908 | Oregon Changes - Domestic Partnership |
| 203       | IL02460907 | Pennsylvania Changes - Cancellation And Nonrenewal |
| 204       | IL01970908 | Rhode Island Changes |
| 205       | IL01610312 | Rhode Island Changes - Civil Union |
| 206       | IL01280908 | Rhode Island Changes - Prejudgment Interest |
| 207       | IL02490719 | South Carolina Changes – Cancellation And Nonrenewal |
| 208       | IL02320908 | South Dakota Changes - Cancellation And Nonrenewal |
| 209       | IL02500908 | Tennessee Changes - Cancellation And Nonrenewal |
| 210       | IL01680908 | Texas Changes - Duties |
| 211       | IL02660908 | Utah Changes - Cancellation And Nonrenewal |
| 212       | IL02190615 | Vermont Changes – Cancellation And Nonrenewal |
| 213       | IL01090908 | Vermont Changes - Civil Union |
| 214       | IL01260908 | Vermont Changes - Statutory Liability |
| 215       | IL02810489 | West Virginia Changes - Cancellation |
| 216       | IL02830907 | Wisconsin Changes - Cancellation And Nonrenewal |
| 217       | IL02520907 | Wyoming Changes - Cancellation And Nonrenewal |

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