| Yes | No | Remarks |
| --- | --- | --- |
| - Notice of Non-renewal? | ✗ | Days: ( ) |
| b. Rating Program and Premium Payment Plan? | ✗ |  |
| - Endorsed to Policy? |  |  |
| - Documented in File? | ✗ |  |
| c. If Loss Prevention and/or claim services are to be provided by J&H, have appropriate persons been notified? | ✗ |  |
| d. Amended legal action against us (J&H Form) included? |  |  |
| e. Amended Transfer of Right of Recovery (J&H Form) included? |  |  |
| f. Amended Notice of Occurrence? |  |  |
| g. If composite rated, is rating base clearly defined? | ✗ |  |
| h. Waiver of subrogation: |  |  |
| - Blanket, where required by contract. | ✗ |  |
| - Specified. |  |  |
| i. Punitive Damages: |  |  |
| - Excluded? |  |  |
| - Specifically covered? |  |  |
| - Covered, where permitted? | ✗ |  |
| - Silent? |  |  |
| V. PERSONS INSURED |  |  |
| a. Are all entities, including joint ventures and partnerships (past and present) included as Named Insureds? | ✗ |  |
| b. Broad Form Named Insured? | ✗ |  |
| c. Automatic coverage for newly formed/acquired entities? | ✗ |  |
| JOHNSON & HIGGINS |  | M4 9/87 |
| MM 009797 |  |  |