# Comprehensive Automobile Liability Insurance Coverage Schedule

## Policy No.
86-68-700

## Effective Date
[Not specified]

## Agency No.
[Not specified]

## Description of Hazards

### 1. Owned Automobiles - Premium Basis - Per Automobile
- **Town or City and State:** [Not specified]
- **Year of Model:** [Not specified]
- **Trade Name:** [Not specified]
- **Body Type and Model:** [Not specified]
- **Truck, Van, Carriage Capacity:** [Not specified]
- **Bus Seating Capacity:** [Not specified]
- **Identification Number:** [Not specified]
- **Serial Number:** [Not specified]
- **Motor Number:** [Not specified]
- **Purposes of Use:** [Not specified]

**As per schedules in company files**

### 2. Hired Automobiles - Premium Basis - Cost of Hire
- **Types Hired:** [Not specified]
- **Location Where Automobiles Will Be Principally Used:** [Not specified]
- **Purposes of Use:** [Not specified]
- **Estimated Cost of Hire:** [Not specified]
- **Rates Per $100 Cost of Hire:** [Not specified]

**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:** [Not specified]
- **Location of Headquarters of Persons Named Herein:** [Not specified]

**As per schedules in company files**

- **Class 2 Employees - Estimated Average Number:** [Not specified]
- **Location of Headquarters of Class 2 Employees:** [Not specified]

**As per schedules in company files**

## Minimum Premiums - Sections 2 and 3 - B1: $ [Not specified] - P.D.: $ [Not specified]

## Total Advance Premium: $ [Not specified]

---

**When used as a premium basis:**
A. "Cost of hire" means the amount incurred for (a) the hire of automobiles, including the entire remuneration of each employee of the named insured engaged in the operation of such automobiles subject to an average weekly maximum remuneration of $100, and for (b) pickup, transportation or delivery service of property or passengers by hired such automobiles conforming to motor carriers which are subject to the security requirements of any motor carrier law or ordinance. The rates for any $100 of cost of hire shall be 5% of the applicable hired automobile rates, provided the owner of such hired automobile has purchased automobile liability and property damage liability insurance covering the interest of the named insured on a direct primary basis as respects such automobile and submits evidence of such insurance to the named insured.

B. "Class 1 persons" means the named insureds, provided their usual duties in the business of the named insured include the use of non-owned automobiles: (a) all employees, including officers, of the named insured compensated for the use of such automobiles by salary, commission, terms of employment, or specific operating allowance of any sort; (b) all direct agents and representatives of the named insured.

C. "Class 2 employees" means all employees, including officers, of the named insured, not included in Class 1 persons.

Form No. S76
IBM 062358