# DECLARATIONS - GENERAL LIABILITY POLICY Page 4

**POLICY IDENTIFICATION**
- HDO
- G24931407

## FORMS AND ENDORSEMENTS (Page 1 of 4)

### FORMS AND ENDORSEMENTS ATTACHED TO THIS POLICY AT INCEPTION

#### SCHEDULE OF COVERAGE FORMS
- ALL20887: ACE Producer Compensation Practices & Policies
- ILP0010104: U.S. Treasury Department's Office of Foreign Assets Control ("OFAC") Advisory Notice to Policyholders
- IL00171198: Common Policy Conditions
- CG00011207: Commercial General Liability Coverage Form
- ALL2Y31a: Arkansas Notice to Policyholders
- ALL22368: Colorado Fraud Statement
- ALL5X45: Questions About Your Insurance?
- ALL18653b: Questions About Your Insurance? (IL)
- ALL2Y81: Indiana Notice To Policyholders
- ALL5W06: Policyholder Notice - Ohio
- ALL2U78b: Notice To All Oklahoma Policyholders
- A115S54: Notice To Pennsylvania Property and Casualty Insurance Policyholders
- ALL4Y30c: Information and Complaints (TX)
- ALL11559d: Risk Control Services for Texas Policyholders
- ALL7X47a: Important Information to Virginia Policyholders Regarding Your Insurance
- ALL5XS1a: Wisconsin Notice to Policyholders

#### SCHEDULE OF FORMS AND ENDORSEMENTS

| Endt. No. | Form No. | Description |
|-----------|----------|-------------|
| 1.        | LD19651d | Reimbursement of Deductible Endorsement |
| 2.        | CC1E15   | Waiver of Government Immunity |
| 3.        | CC1E15   | Bodily Injury Definition Extension |
| 4.        | CC1E15   | Architect Endorsement |
| 5.        | LD3R16   | Exclusion - Asbestos |
| 6.        | LD4S35   | Exclusion - Lead |
| 7.        | LD9863A  | Employee Benefits Liability Endorsement |
| 8.        | LD19578  | Protective Reimbursement Endorsement |
| 9.        | LD20031  | Combined Policy Aggregate |
| 10.       | ALL18057-0 | Notification of Premium Adjustment |
| 11.       | CG00680509 | Recording and Distribution of Material or Information in Violation of Law Exclusion |

This declaration and the coverage form(s) and endorsements, if any, listed above and attached, completes this policy.

**COUNTERSIGNED AT:** _______________________
**AUTHORIZED AGENT:** _______________________
**DATE:** _______________________

LD-2A48a (Ed. 3/87) Printed in U.S.A.
AA 067266a