**GREAT AMERICAN INSURANCE GROUP**

**Administrative Offices**
301 E 4th Street
Cincinnati, Ohio 45202-4201
Tel: 1-513-389-5000

**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 ST Date Deleted | Form and Edition | 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. GA16011                      | 06/97 NY         | Amendment Of Insuring Agreement - Limits O |
| 7. GA16750                      | 03/13 NY         | Cap On Losses From Certified Acts |
| 8. GA16753                      | 03/13 NY         | Disclosure Pursuant To Terrorism |
| 9. GA16011                      | 06/97 NY         | Amendment of Cancellation Condition - New |
| 10. GA16610                     | 02/14 NY         | Excess Amendatory Endorsement - NY |
| 11. GA16504                     | 03/98 NY         | NY State Amendatory Endorsement |
| 12. GA16768                     | 02/14 NY         | NY Changes - Cancellation And Nonrenewal |
| 13. GA16524                     | 06/97 NY         | Excess Liability Coverage Form |
| 14. IL7268DL                    | 09/09 NY         | In Witness Signature Form |

*If not at inception

GAI 6013 (Ed. 06/97) PRO
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