**GREATAMERICAN INSURANCE GROUP**

Administrative Offices  
301 E 4th Street  
Cincinnati, Ohio 45202-4201  
Tel: 1-513-369-5000

**ORIGINAL POLICY**

**GAI 6013 (Ed. 06 97)**

**FORMS AND ENDORSEMENTS SCHEDULE**

It is hereby understood and agreed the following forms and endorsements are attached to and are a part of this policy:

| Date Added* or | Form and Edition | ST Date Deleted | Form Description |
|----------------|------------------|-----------------|------------------|
| 1.             | GA16600          | 06/97 NY        | Commercial Excess Liability Declarations |
| 2.             | GA16008          | 06/97 NY        | Schedule of U/L Insurance (Supplemental) |
| 3.             | GA16011          | 06/97 NY        | Catastrophe Management Coverage Exclusion |
| 4.             | GA16965          | 11/10 NY       | Following Form Coverage Endorsement |
| 5.             | GA16966          | 04/09 NY        | Pollution Liability Coverage-Follow Form |
| 6.             | GA16750          | 03/13 NY        | Cap On Losses From Certified Acts |
| 7.             | GA16753          | 03/13 NY        | Disclosure Pursuant To Terrorism |
| 8.             | GA16011          | 06/97 NY        | Amendment of Cancellation Condition - New |
| 9.             | GA16610          | 01/09 NY        | Excess Amendatory Endorsement (NY) |
| 10.            | GA16205          | 07/05 NY        | NY Changes - Cancellation and Nonrenewal |
| 11.            | GA16504          | 03/98 NY        | NY State Amendatory Endorsement |
| 12.            | GA16524          | 06/97 NY        | Excess Liability Coverage Form |

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*If not at inception

GAI 6013 (Ed. 06/97) PRO  
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