# Commercial General Liability Declarations

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

**POLICY NUMBER:** HDO G27865355

| Endt. No. | Form No. | Description |
|-----------|----------|-------------|
| 98        | CG26080490 | Arkansas Changes - Multi-Year Policies |
| 99        | CG32340105 | California Changes |
| 100       | IL02700912 | California Changes – Cancellation And Nonrenewal |
| 101       | IL01251113 | Colorado Changes – Civil Union |
| 102       | CG02200312 | Florida Changes - Cancellation And Nonrenewal |
| 103       | IL02620215 | Georgia Changes – Cancellation And Nonrenewal |
| 104       | IL02650702 | Hawaii Changes - Cancellation And Nonrenewal |
| 105       | CG02001207 | Illinois Changes - Cancellation And Nonrenewal |
| 106       | IL01621013 | Illinois Changes – Defense Costs |
| 107       | CG01230397 | Indiana Changes - Pollution Exclusion |
| 108       | CG01091185 | Kansas And Oklahoma Changes - Transfer Of Rights |
| 109       | IL02610907 | Kansas Changes - Cancellation And Nonrenewal |
| 110       | CG01250303 | Louisiana Changes - Insuring Agreement |
| 111       | CG01181204 | Louisiana Changes - Legal Action Against Us |
| 112       | CG26841204 | Louisiana Changes - Transfer Of Rights Of Recovery Against Others To Us Condition |
| 113       | CG02010115 | Maryland Changes |
| 114       | CG26731204 | Maryland Changes - Premium Audit Condition |
| 115       | CG01681009 | Michigan Changes |
| 116       | CG26050207 | Minnesota Changes |
| 117       | CG01221207 | Minnesota Changes - Contractual Liability Exclusion And Supplementary Payments |
| 118       | CG26811204 | Minnesota Changes - Duties Condition |
| 119       | IL02740908 | Missouri Changes - Cancellation And Nonrenewal |
| 120       | CG26250405 | Missouri Changes - Guaranty Association |
| 121       | CG26500413 | Missouri Changes – Medical Payments |
| 122       | CG01340803 | Missouri Changes - Pollution Exclusion |
| 123       | IL01671013 | Montana Changes – Conformity With Statutes |
| 124       | CG26611001 | Montana Changes - Medical Payments |
| 125       | IL02590907 | Nebraska Changes - Cancellation And Nonrenewal |
| 126       | CG01120615 | New Hampshire Changes |
| 127       | CG26551108 | New Hampshire Changes - Amendment Of Representations Condition |
| 128       | CG26201093 | New Jersey Changes - Loss Information |
| 129       | IL02980515 | New Mexico Changes – Cancellation And Nonrenewal |
| 130       | IL02680114 | New York Changes - Cancellation And Nonrenewal |
| 131       | CG01630711 | New York Changes - Commercial General Liability Coverage Form |
| 132       | CG01041204 | New York Changes - Premium Audit |

**LD-25211 (10/08)**
Copyright, Insurance Services Office, Inc. 2000
Page 7 of 9