# SCHEDULE A.

| Item 4. Description of Hazards | Classification Code No. | Territory Code No. | Premium Bases | Rates | Premiums |
|---|---|---|---|---|---|
| (a) Premises—Operations |  |  | (a) Area (sq. ft.) (b) Frontage (c) Remuneration | (a) Per 100 sq. ft. (b) Per Linear Foot (c) Per $100 of Remuneration | Coverage A | Coverage C |
| AS PER SCHEDULES IN COMPANY FILES |  |  |  |  | Coverage A | Coverage C |
| (b) Elevators |  |  |  | No Insured | Per Elevator |  |
| AS PER SCHEDULES IN COMPANY FILES |  |  |  |  |  |  |
| (c) Independent Contractors |  |  | Cost | Per $100 of Cost |  |  |
| AS PER SCHEDULES IN COMPANY FILES |  |  |  |  |  |  |
| (d) Products (including completed operations) |  |  | Sales | Per $1,000 of Sales |  |  |
| AS PER SCHEDULES IN COMPANY FILES |  |  |  |  |  |  |
| (e) Contracts as defined in Condition 3 |  |  | (a) No. Insured (b) Cost | (a) Per Contract (b) Per $100 |  |  |
| AS PER SCHEDULES IN COMPANY FILES |  |  |  |  |  |  |
| Special Coverage Premiums | $ | $ | Total Advance Premiums | $ | $ |

## SCHEDULE B.

### Item 4. Description of Hazards

#### 1. Owned Automobiles
- **Premium Basis—Per Automobile**
  - Town and State in which the Automobiles Will Be Principally Garaged
  - Year of Model
  - Trade Name
  - Body Type & Model: Truck Size; Tank Capacity; Passenger Capacity; or Bus Seating Capacity
  - 1. Serial Number
  - 2. Vehicle Identification No.
  - Purpose of Use
  - AS PER SCHEDULES IN COMPANY FILES

#### 2. Hired Automobiles
- **Premium Basis—Cost of Hire**
  - Locations Where Automobiles will be Principally Used
  - Type Hired
  - Purposes of Use
  - Estimated Cost of Hire
  - Rates Per $100 Cost of Hire
  - Coverage A | Coverage B
  - AS PER SCHEDULES IN COMPANY FILES

#### 3. Non-owned Automobiles
- **Premium Basis—Class 1 Persons and Class 2 Employees**
  - Class 1 Persons—Name of Each
  - Location of Headquarters of Persons Named Herein
  - AS PER SCHEDULES IN COMPANY FILES
  - Class 2 Employees—Estimated Average Number
  - Location of Headquarters of Class 2 Employees
  - Rates Per Employee
  - Coverage A | Coverage B
  - AS PER SCHEDULES IN COMPANY FILES
  - Special Coverage Premiums | $ | $ | Total Advance Premiums | $ | $

Form S-919-C. 6M. 724C (For use with Comprehensive General and Automobile Liability Policy.) 100 CPN Z 006847