# CHUBB Commercial General Liability Declarations

**ACE American Insurance Company**
436 Walnut Street
Philadelphia PA 19106

**POLICY NUMBER:** HDO G27865355

| Endt. No. | Form No. | Description |
|-----------|----------|-------------|
| 3         | CG20260413 | Additional Insured – Designated Person Or Organization |
| 4         | CG24040509 | Waiver Of Transfer Of Rights Of Recovery Against Others To Us |
| 5         | LD202870606 | Non-Contributory Endorsement For Additional Insureds |
| 6         | ALL32677a0412 | Kentucky Local Government Premium Tax Schedule |
| 7         | ALL224211011 | Surcharge Schedule |
| 8         | CC24180c0314 | Signatures |
| 9         | LD200310206 | Combined Policy Aggregate |
| 10        | ALL18845c0612 | Difference In Conditions/Difference In Limits |
| 11        | ALL44289c1116 | Direct Action Expenses |
| 12        | ALL10617b0614 | Earlier Notice Of Cancellation And Non-Renewal Endorsement |
| 13        | LD3R160387 | Exclusion - Asbestos |
| 14        | LD5T92     | Fellow Employee Coverage |
| 15        | LD3T73     | Fire, Explosion, Smoke And Water Damage Legal Liability |
| 16        | LD34279a0116 | GPS Global Program Solutions Endorsement (Non-Admitted Eliminated) |
| 17        | LD202840606 | In Rem |
| 18        | LD200360206 | Incidental Medical Malpractice Liability Coverage |
| 19        | LD2X61     | Knowledge Of Occurrence |
| 20        | LD202850606 | Liberalization Clause |
| 21        | LD202870606 | Non-Contributory Endorsement For Additional Insureds |
| 22        | LD466861015 | Non-Owned Watercraft Exception |
| 23        | ALL326880111 | Notice To Others Endorsement - Specific Parties |
| 24        | ALL326880111 | Notice To Others Endorsement - Specific Parties |
| 25        | ALL326880111 | Notice To Others Endorsement - Specific Parties |
| 26        | ALL326880111 | Notice To Others Endorsement - Specific Parties |
| 27        | ALL180571211 | Notification Of Premium Adjustment |
| 28        | LD6260a1002 | Personal Injury And Advertising Injury Liability |
| 29        | LD195780106 | Protective Reimbursement Endorsement |
| 30        | LD195780106 | Protective Reimbursement Endorsement |
| 31        | ALL224220507 | Public Entity Additional Insured Endorsement |
| 32        | ALL224220507 | Public Entity Additional Insured Endorsement |
| 33        | LD4883788 | Pyramiding Of Limits Endorsement |
| 34        | LD19651e0909 | Reimbursement Of Deductible Endorsement Allocated Loss Adjustment Expense ("ALAE") Borne Entirely By The Insured |
| 35        | ALL211011106 | Trade Or Economic Sanctions Endorsement |
| 36        | LD2X62a0408 | Unintentional Failure To Disclose |
| 37        | MS394490517 | Access, Collection And Disclosure Of Information And Electronic Data Exclusion - Limited Bodily Injury And Redefined Property Damage |

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