# C.G.L. [5]

- **Notice of Non-renewal?** Yes No Remarks Days: 60
- **Rating Program and Premium Payment Plan?** Yes No Remarks
- **Endorsed to Policy?** Yes No Remarks
- **Documented in File?** Yes No Remarks

c. If Loss Prevention and/or claim services are to be provided by J&H, have appropriate persons been notified?
- **Amended legal action against us (J&H Form) included?** Yes No Remarks
- **Amended Transfer of Right of Recovery (J&H Form) included?** Yes No Remarks
- **Amended Notice of Occurrence?** Yes No Remarks
- **If composite rated, is rating base clearly defined?** Yes No Remarks
- **Waiver of subrogation:** - Blanket, where required by contract. Yes No Remarks - Specified. Yes No Remarks
- **Punitive Damages:** - Excluded? Yes No Remarks - Specifically covered? Yes No Remarks - Covered, where permitted? Yes No Remarks - Silent? Yes No Remarks

V. **PERSONS INSURED**
a. Are all entities, including joint ventures and partnerships (past and present) included as Named Insureds? Yes No Remarks
b. Broad Form Named Insured? Yes No Remarks
c. Automatic coverage for newly formed/acquired entities? Yes No Remarks

MM 009863