GARAGE POLICY ISSUANCE GUIDELINES

Transcription

1 GARAGE POLICY ISSUANCE GUIDELINES 2013 Issuance Changes Update 1/8/13 Effective Date 1/1/13 Pg. # Description 3/6/13 3/1/13 3/6/13 1/1/13 50 Correct TX Notice and CA2109 Edition Dates 3/6/13 5/1/ /7/13 1/1/13 7 Added property mandatory form U284 06/05 Actual Cash Value Limitation Roofs and Roof Surfacing Updated G1525 Hail Exclusion, no longer Admitted only 2 8, 9,10 16,17,18,26,29,38, 50,55,56 40, Contacting us: Send Policies, Endorsements and Documentation by Scheduled Auto Clarification Admitted & Non-Admitted Optional Forms CA, CO, CT, KY, MD, NJ, TX, WV, WI Add NY Service, Re-number remaining pages All to denverpolicies@colonyspecialty.com TABLE OF CONTENTS Policy Prefix & Libraries Use of Symbols Deductibles Forms and Endorsements Premium Placement Assistance Approved Endorsement Wording Optional Coverage Endorsements Admitted Optional Garage Forms Non-Admitted Optional Garage Forms Property Forms Detailed Forms Library by State Garage Policy Issuance Guidelines Ed. 01/13 [1]

2 POLICY ISSUANCE Policy Prefix and Libraries: There is 1 prefix - GP for Garage Policy. There are 2 libraries - Non-Admitted & Admitted. Scheduled Autos may only be written on a Garage policy in states where our Dealer, Service and Scheduled Auto Coverages are all written as 100% Admitted or as 100% Non-Admitted. For all other states, vehicles must be scheduled on a Commercial Auto policy with a BA or MC prefix. Follow the Commercial Auto guidelines based on the use of the vehicle. The Area of Operations Chart indicates where the Scheduled Autos need to be written for each state. The GA policy prefix is no longer available. Use of Numeric Symbols 22 For Liability of Car / Truck / Trailer Dealers 22 For Combined Med Pay (Premises & Auto) for Dealers (No Symbol applies for Premises only Medpay complete limit and premium fields and attach proper form) 25 For PIP 22 For UM / UIM if coverage can be rejected in your State 26 For UM / UIM if coverage cannot be rejected in your State 27 For any coverage on Specifically Described Autos 28 For Hired Auto Liability 29 For Non-Owned Auto Liability 30 For Garagekeepers 31 For Dealers Physical Damage 32 As defined by the company Deductibles Optional Liability deductibles of $500, $1,000 or more are available if approved by your Company Underwriter. See Exceptions to Binding Authority. Our minimum per auto deductible for Specified Causes of Loss, or Comprehensive is $500, with an aggregate equal to five (5) times the per auto deductible. Our minimum per auto deductible for Collision is $500. Higher deductibles are recommended for Mobile operations, for Truck Tractors and Semi-Trailers; and when we ve agreed to a higher maximum limit per vehicle. Forms and Endorsements The libraries displayed in these Guidelines and as they exist in DocuCorp are complete. You may not: Add or alter any forms; Delete mandatory forms; Alter the operation of our DocuCorp issuance system without the written permission of both Colony s DocuCorp Developer and a Colony Transportation Manager. [2]

3 PREMIUM PLACEMENT ASSISTANCE A. G1501 Garage Coverage Part Declarations: 1. Most Endorsement Premium is entered as a total at the bottom of the G1501 under Premium for Endorsements : Related Operations, Drive Other Car, Plates, Stop Gap, Waiver, On-Hook, Additional Coverage for Wreckers in Oklahoma, Drive-Away, Value Limitation, False Pretense. 2. Exceptions: Add Broadened Coverage to the Liability Premium. Add Michigan Property Damage Liability Buy-Back to the Liability Premium Add Michigan Broadened Coverage Collision to the Collision Premium B. G1500 COMMON POLICY DECLARATIONS: 1. Manually enter the Michigan MCCA Assessment below the Commercial Inland Marine Coverage Part. 2. Enter all Property premium, including the Automotive Service Tools & Equipment Floater premium, in the Commercial Property Coverage Part. [3]

4 APPROVED ENDORSEMENT WORDING The following wording is approved for use on manuscript endorsements. The wording of any other manuscript endorsement must be pre-approved by us. If you are adding an exclusion using our Blank Endorsement G1514 or our Restrictive Endorsement G1514a or CA2507 Locations and Operations Not Covered, during the policy term, add a line for the insured's signature. Boat Repair (Service risks - Garagekeepers) Use CA9954 and define Symbol 32 Insert: Any customer's watercraft left with you for repair, while ashore on premises where you conduct "Garage Operations". Boat Sales (Dealer risks - Physical Damage) Use CA9954 and define Symbol 32 Insert: Owned watercraft held for sale, while ashore on premises where you conduct "Garage Operations". Mobile Equipment (farming or construction) Sales and Service Use CA9954 and define Symbol 32 Physical Damage Insert: Owned land vehicles used in (farming or construction) including any attached machinery or equipment held for sale. Garagekeepers Insert: Any customer s land vehicles used in (farming or construction) including any attached machinery or equipment left in your care for service or repair. Products Exclusion (Non-Admitted Only) Use G1514a Restrictive Insert: We will not pay for "Bodily Injury" or "Property Damage" arising out of "Products" or "Work You Performed". Repossession Operations Exclusion Use CA2507 Insert for Dealers: Any operation to take back an "auto" from a buyer who has failed to make payments when due including wrongful repossession. Insert for Tow Truck Operators (Repo Storage Lot): Any act of repossession including wrongful repossession. Retreaded Tires Exclusion (Non-Admitted Only) Use G1514a Restrictive Insert: This insurance does not apply to "Bodily Injury, Property Damage, Personal Injury, or Advertising Injury caused by an accident, loss or offense and resulting from the manufacture, distribution, or sale of Retreaded Tires in your Garage Operations. This exclusion also applies to any negligent act, error or omission in providing or failure to provide warnings or instructions about Retreaded Tires. [4]

5 ENDORSEMENT WORDING SUGGESTIONS continued Retreaded Tires Not Covered (Admitted Only) Use CA2507 Insert: Manufacture, distribution, or sale of Retreaded Tires including any negligent act, error or omission in providing or failure to provide warnings or instructions about Retreaded Tires. Theft Exclusion for Garagekeepers and/or Physical Damage (Non-Admitted Only) Use G1514a Restrictive Insert: We will not pay for "loss" to a covered "auto" or to its equipment caused by Theft. Truck Rental Operations Exclusion Use CA2507 Insert: U-Haul Dealership; Ryder Truck Rental Agency; etc. Valet Special Event Endorsement Use GT3000 Insert: In consideration of the Fully Earned Additional Premium of $, coverage has been extended to include a special event on (xx/xx/xxxx date) (or from xx/xx/xxxx through xx/xx/xxxx), located at (complete address). The Liability limit for this event is $. The Garagekeepers limit for this event is $. The deductibles for this event are the same as listed in Item Six of the G1501. Windstorm, Hail, or Flood Deductibles and Exclusion We have removed this option from the G1514a Restrictive Endorsement. - For Wind/Hail/Flood Deductible with $1000 per vehicle, no maximum use form G For Wind/Hail/Flood with $50,000 Aggregate, use form G1524A. - For Wind/Hail/Flood with $25,000 Aggregate, use form G1524B. - For Wind/Hail/Flood Exclusion use form G1525. [5]

6 OPTIONAL GARAGE COVERAGE ENDORSEMENTS Additional Coverage for Related Operations (G1507) The purposes of this endorsement are: 1] to provide coverage for and 2] to get more premium for exposures that are not generally part of garage operations. Available classes are listed in your Binding Authority. Additional Insured No Charge (CA2509) Landlord, (CA2048) Designated, (CA2047) Leased Equipment, (CA2001) Leased Autos, (CA2049) Franchisor (G1600) Designated - Primary and Non-Contributory: Available only for Non-Admitted Garage Service Risks Broadened Coverage-Garages (CA2514) Charge is 5% of Garage Liability Premium Buy-Back Schedules On-Hook for Garagekeepers (G1505 and various versions or G1526 in KS, KY, MD, ME, NH, WV). Available limits $50,000 or $100,000 per vehicle. The limit for each truck cannot be more than the Garagekeepers limit or less than the maximum limit per vehicle (MLPV). Drive-Away Road Miles for Dealers Physical Damage-Collision (G1505, G1517 and various versions of each) Charge is $50 for each additional 100 miles 1] in excess of 50 road miles in KS, KY, MD, ME, NH & WV where G1517 is used for Dealers; and 2] in excess of 300 road miles in all other States where G1505 is used for Dealers. Maximum additional premium is $500. Value Limitation for Dealers Physical Damage (G1505A and various versions) - This only applies to Car Dealers, Auctions, Dealers with Salvage and Wholesalers. - The maximum vehicle limit available is $750,000. Drive Other Car Coverage-Broadened for Named Individuals (CA9910) Charge is $50 per individual. Available when Named Insured is a Corporation, you may use this endorsement to provide coverage for officers for Liability only at Financial Responsibility Single Limit. Errors and Omissions for Auto Dealers (G1551, G1551NH): Charge is $300 per policy $25,000 Liability Limit with a $100,000 Aggregate and a $1000 Deductible Extends Liability coverage to include damages arising out of error or omission in compliance with Federal, State or local statutory provisions: o Requiring disclosure of credit terms to consumers obtaining credit to purchase an auto o Requiring disclosure of the odometer reading to consumers who purchase an auto o o Requiring title registration on an auto sold by the insured Requiring disclosure of terms and conditions applying to credit life insurance, credit disability insurance, auto liability insurance, auto physical damage insurance or an extended warranty plan sold by the insured to cover an auto sold by the insured False Pretense (CA2503) Refer to Company if test drives are not accompanied. Maximum Limit is $25,000. Charge is $0.18 per hundred of the total physical damage limit. Fire Legal Liability (CA2510) Charge is $0.20 per hundred of limit. Garagekeepers-Additional Coverage for Wreckers in Oklahoma (G1521) o Legal Liability for Personal Property in a Customer s Auto. o Charge is $200 for the endorsement. [6]

7 OPTIONAL GARAGE COVERAGE ENDORSEMENTS continued Identity Recovery Coverage Endorsement (G1569 not available in NC or NH) Charge is $9 per policy o Additional Coverage under Physical Damage section: Case Management Service for up to 12 months for any one identity theft Expense Reimbursement with a $15,000 limit Plate Coverage (other than Dealer Plates): Plates are scheduled on CA2027. Property (Non-Admitted only: Building, Contents, and Business Income forms - Signs and Fences may be covered for Basic Form only. - Automotive Service Tools & Equipment (Tool Floater) (G1556) - Terrorism Limited Coverage (UIL0959) TRIA Notice Required Stop Gap Employers Liability in OH, WA, and WY (Non-Admitted only: (G1519) Waiver of Transfer of Rights of Recovery (G1512) Charge is $150 each - $750 maximum Wind/Hail/Flood Deductible for Dealers Physical Damage (Admitted G1524) Wind, Hail, Flood Deductible - $50,000 Aggregate (G1524A) Refer to company Wind, Hail, Flood Deductible - $25,000 Aggregate (G1525B) Refer to company Wind/Hail/Flood Exclusion for Dealers Physical Damage (G1525) [7]

8 Form # Edition Title ADMITTED OPTIONAL GARAGE FORMS (alphabetical by Title) CA /99 Additional Insured-Designated CA /97 Additional Insured-Franchisor CA /06 Additional Insured-Lessor of Auto (do not use in KS or TN) CA /07 Additional Insured-Lessor & Loss Payee (use in TN) CA /97 Additional Insured-Lessor of Equipment CA /93 Additional Insured-Owners of Premises (Landlord) CT /13 Animal Exclusion - Injury or Damage Caused by Animals (do not use in IL, KS, ME, or NJ) CT3792IL 01/13 Animal Exclusion - Injury or Damage Caused by Animals (IL) CA /06 Automobile Medical Payments (do not use in PA or WV) CA /06 Automobile Medical Payments (use in WV) CT /11 Auto Wrecker Bailees Coverage CA /10 Broadened Coverages-Garage IL /08 Calculation of Premium GT /13 Cancellation Endorsement GT /13 Changes Endorsement with Premium Distribution Worksheet GT /13 Continuation of Named Insured Endorsement CA /97 Covered Auto Designation (to definesymbol 32) CA /10 Drive Other Car Coverage G /02 Driver Exclusion (do not use in CT, KS, ME, MD, MI, NH, NC, NJ, SC, WV) GT /13 Driver Limitation (do not use in IL, KS, MN, NH, or SC) GT7003MN 01/13 Driver Limitation (use in MN) G /09 Errors and Omissions Coverage for Automobile Dealers (do not use in NH) G1551NH 07/09 Errors and Omissions Coverage for Automobile Dealers (use in NH) CA /10 False Pretense Coverage CT /13 Firearms Exclusion (do not use in KS) CA /10 Fire Legal Liability G /12 Garagekeepers - On-Hook Endorsement (KS, KY, MD, ME, NH, WV) (for use with G1517 and G1518 only) G /11 Identity Recovery Coverage Endorsement (do not use in NC or NH) CA /10 Liability Deductible Endorsement (ME, MI, NV, NC, SC, TN) CA /10 Liability Deductible Endorsement (CT, IL, IA, KS, KY, MD, MN, NH, NJ, PA, WV) CA /93 Locations & Operations Not Covered CA /93 Loss Payee (do not use in TN) CA /05 Loss Payee (TN) CA /06 Premises Medical Payments CA /99 Registration Plates (other than Dealer Plates) GT100 03/13 Reinstatement Endorsement G /02 Related Operations G /02 Stated Amount Insurance G /05 Supplemental Schedule for Specifically Described Autos G /06 Supplemental Schedule for Valet Parking G /09 Waiver of Transfer of Rights G /12 Wind, Hail, Flood Deductible G1524A 05/12 Wind, Hail, Flood Deductible - $50,000 Aggregate G1524B 05/12 Wind, Hail, Flood Deductible - $25,000 Aggregate G /13 Wind, Hail, Flood Exclusion [8]

9 Form # Edition Title OPTIONAL GARAGE FORMS (alphabetical by Title) G /09 Additional Coverage for Wreckers in OK CA /99 Additional Insured-Designated G /13 Additional Insured Designated Primary & Non-Contributory (do not use for Dealers) CA /97 Additional Insured-Franchisor CA /06 Additional Insured-Lessor of Auto (do not use in TN) CA /07 Additional Insured-Lessor & Loss Payee in TN CA /97 Additional Insured-Lessor of Equipment CA /93 Additional Insured-Owners of Premises (Landlord) CT /13 Animal Exclusion - Injury or Damage Caused by Animals (do not use in VA) CA /06 Automobile Medical Payments (do not use in CA, CO, WI or VA) CA /06 Automobile Medical Payments in CA CA /11 Automobile Medical Payments in CO CA /11 Automobile Medical Payments in WI CA /02 Auto Medical Expense and Income Loss (PIP) in VA CT /11 Auto Wrecker Bailees Coverage (do not use in MT) CT3819MT 01/13 Auto Wrecker Bailees Coverage (MT) G /02 Blank Endorsement G1514a 10/02 Blank - Restrictive Endorsement (select paragraphs) CA /10 Broadened Coverages-Garage CA /05 Broadened Coverages-Garage in VA IL /08 Calculation of Premium GT /13 Cancellation Endorsement GT /13 Changes Endorsement with Premium Distribution Worksheet GT /13 Continuation of Named Insured Endorsement CA /97 Covered Auto Designation (to define Symbol 32) CA /10 Drive Other Car Coverage CA /10 Drive Other Car Coverage in CA G /02 Driver Exclusion (do not use in OR, SD, VA) G1506OR 07/09 Driver Exclusion in OR (duplicate for Signatures) G1506A 07/09 Driver Exclusion in SD (duplicate for Signatures) GT /13 Driver Limitation (do not use in FL, MN, SC or WA) GT7003MN 01/13 Driver Limitation (use in MN) GT7004FL 01/13 Driver Limitation (use in FL) G /09 Errors and Omissions Coverage for Automobile Dealers CA /10 False Pretense Coverage CT /13 Firearms Exclusion (do not use in VA) CA /10 Fire Legal Liability G /11 Identity Recovery Coverage Endorsement (do not use in NC) CA /10 Liability Deductible Endorsement Endorsement (AL, AZ, AR, CO, ID, LA, ME, MI, MS, MO, NE, NV, NM, NC, ND, OH, OK, RI, SC, SD, TN, TX, UT, VT, WI, WY) CA /10 Liability Deductible Endorsement (CA, CT, GA, IN, KY, MD, MN, MT, NJ, OR, PA, WA, WV) CA /93 Liability Deductible Endorsement (VA) CA /93 Locations & Operations Not Covered CA /93 Loss Payee (do not use in TN) CA /05 Loss Payee in TN CA /06 Premises Medical Payments CA /99 Registration Plates (other than Dealer Plates) GT100 03/13 Reinstatement Endorsement G /02 Related Operations Endorsement G /02 Stated Amount Insurance G /05 Supplemental Schedule for Specifically Described Autos G /06 Supplemental Schedule for Valet Parking G /09 Waiver of Transfer of Rights G /12 Wind, Hail, Flood Deductible [9]

10 Form # Edition Title OPTIONAL GARAGE FORMS CONTINUED (alphabetical by Title) G1524A 05/12 Wind, Hail, Flood Deductible - $50,000 Aggregate G1524B 05/12 Wind, Hail, Flood Deductible - $25,000 Aggregate G /13 Wind, Hail, Flood Exclusion THE SLB DATA FORM (08/11) IS MANDATORY IF THE FOLLOWING TYPES OF POLICIES ARE WRITTEN: o The risk state differs from the agents home state (domicile state). o The risk is multi-state (involving locations in different states). o The SL Broker used in the policy transaction is a broker other than the agency, or principle of the agency. The form has become mandatory if the above types of policies are written. [10]

11 PROPERTY MANDATORY FORMS (Non-Admitted Only) Form # Edition Title I. Use on all Policies with Property: G /11 Garages-Building & Personal Property Declarations CP /88 Commercial Property Conditions CP /07 Building & Personal Property Coverage Form CP /08 Water Exclusion II. Causes of Loss Use one of these: CP /07 Basic Form CP /07 Broad Form CP /07 Special Form III. Terrorism Use one of these and provide signed TRIA Selection/Rejection form: IL /08 Terrorism Exclusion IL /08 Terrorism Limited Coverage IV. Weather Restriction Mandatory Forms (See Weather Restrictions to Binding Authority): CP /07 Windstorm and Hail Exclusion A. For Building, Contents and Income, the CP1054 Wind/Hail/Flood Exclusion is required for risks located anywhere in Florida, and as follows for risks located in AL, GA, LA, MS, NC, SC, TX or VA: Within 50 miles of the Eastern U.S. Coast On any off shore or barrier island located off the Eastern U.S. Coast Within 50 miles from the Gulf, any bay or inter-coastal water On any off shore or barrier Island located off the Gulf Coast B. For risks located in CT, MD, ME, NH, NJ, PA or RI, the restriction in A above applies, except that any reference to a mileage radius is changed to within 25 miles. NOTE: For Building, Contents and Income, the Wind/Hail/Flood Deductible should increase from $500 to $2,500 when there is substantial weather risk (applies to areas where the exclusion is not required). V. Additional State Mandatory Property Forms A. In AK use: CP /07 Changes Property IL /02 Changes Loss Payment B. In LA one of these: LA Notice WD 01/10 Windstorm or Hail Deductible LA Notice WE 01/10 Windstorm or Hail Exclusion VI. OPTIONAL PROPERTY FORMS: G /09 Automotive Service Tools & Equipment (For mobile operations and employee tools) U284 06/05 Actual Cash Value Limitation Roofs and Roof Surfacing (Mandatory If the building is to be insured on a replacement cost basis and the construction is Frame, JM, or NC) CP /00 Burglary, Robbery (Theft) Protective Systems CP /07 Business Income (with Extra Expense) CP /07 Loss Payable CP /92 Multiple Deductible CP /07 Outdoor Signs CP /95 Theft Exclusion CP /07 Windstorm and Hail Exclusion (Unless Mandatory in Weather Restrictions above) CP /09 Increased Cost of Loss and Related Expenses For Green Upgrades [11]

12 DETAILED FORMS LIBRARY BY STATE ALABAMA (AL) Mandatory U173 07/02 Cancellation & Non Renewal Optional CA /06 UM [12]

13 ALASKA (AK) CA /06 Terrorism Exclusion Mandatory AK Notice 08/08 Policyholder Notice-Surplus Lines AK Notice 04/07 Policyholder Notice-Attorney Fees CA /06 Changes-Garage IL /08 Changes-Attorneys Fees (Rule 82) IL /11 Changes-Appraisal IL /08 Cancellation & Non Renewal Optional CA /10 UM/UIM Property - Mandatory CP /07 Changes-Property IL /02 Changes-Loss Payment [13]

14 ARIZONA (AZ) Mandatory NO AZ 07/06 Policyholder Notice U173 07/02 Cancellation & Non Renewal CA /04 Changes-Concealment, Misrepresentation, Fraud Optional CA /09 UM CA /09 UIM [14]

15 ARKANSAS (AR) Mandatory NO AR 11/09 Policyholder Notice UIL /02 Cancellation & Non Renewal CA /07 Changes-Who is an Insured IL /98 AR Notice-Auto Parts Optional CA /06 UMBI CA /06 UMPD CA /06 UIM CA /06 PIP (use only for Scheduled Private Passenger Autos) [15]

16 CALIFORNIA (CA) Mandatory U173 07/02 Cancellation & Non Renewal CAPRNOTICE 09/11 California Notice Premium Refunds D2 07/11 California Surplus Line Policyholder Notice CA /07 California Changes ILN119 01/10 California Auto Body Repair Consumer Bill of Rights Optional CA /09 UMBI CA /10 UMPD CA /06 Auto Medical Payments CA CA /10 Drive Other Car - CA [16]

17 COLORADO (CO) Mandatory U173 07/02 Cancellation & Non Renewal CA /11 Changes-Other Insurance IL /07 Changes-Concealment, Misrepresentation, Fraud Optional CA /11 Auto Medical Payments - CO CA /11 UMBI CA /11 UMPD [17]

18 CONNECTICUT (CT) POLICY TYPE: Service (T03) CA /06 Terrorism Exclusion Mandatory UIL /02 Cancellation & Non Renewal IL /08 Connecticut Changes Civil Union POLICY TYPE: Dealers (T02) ADMITTED AG005 03/12 Signature Page CA /06 Fungi or Bacteria Other Than Auto Exclusion CA /06 Terrorism Exclusion Mandatory CA /97 Connecticut Changes CA /97 Connecticut Changes Liability of Municipalities IL /08 Connecticut Changes Civil Union IL /10 Connecticut Changes Cancellation & Nonrenewal Optional CA /97 Connecticut Transporter Plates Coverage CA /06 Connecticut UM & UIM Coverage CA /94 Glass Coverage Connecticut [18]

19 FLORIDA (FL) SIGCICFL 03/12 Signature Page - Florida Mandatory NO FL 07/06 Policyholder Notice CA /12 Cancellation & Non Renewal CA /09 Changes-Appraisal Optional GT7004FL 01/13 Driver Limitation CA /09 UM CA /08 PIP [19]

20 GEORGIA (GA) Mandatory U173 07/02 Cancellation & Non Renewal CA /04 Changes-Garage Optional CA /09 UM-Fill-In Or CA /09 UM-Add-On And GT /08 UM Offset Endorsement [20]

21 IDAHO (ID) Mandatory U173 07/02 Cancellation & Non Renewal CA /00 Changes-Other Insurance Optional CA /06 UM CA /11 UIM [21]

22 ILLINOIS (IL) ADMITTED AG005 03/12 Signature Page G1504IL 01/13 Changes in Garage Coverage - Illinois G1505IL 01/13 Additional Garage Exclusions & Buy Back Schedules - Illinois CA /06 Fungi or Bacteria Other Than Auto Exclusion Mandatory CA /94 Cancellation & Non Renewal CA /03 Changes CA /06 Changes in Garage Coverage Form IL /11 IL Changes Civil Union IL /08 Changes-Defense Costs IL NOTICE 02/11 IL Policyholder Notice Optional CA /08 UMBI CA /06 UMPD CA /08 UIM CA /10 Liability Deductible - IL [22]

23 INDIANA (IN) Mandatory NO IN 07/06 Policyholder Notice IL /07 Indiana Changes Concealment, Misrepresentation or Fraud UIL /02 Cancellation & Non Renewal Optional CA /11 UM CA /11 UIM CA /08 Indiana Changes Pollution Exclusion CA /08 Indiana Changes Amendment of Definition of Pollutants IL /10 Indiana Changes Workers Compensation Exclusion [23]

24 IOWA (IA) ADMITTED AG005 03/12 Signature Page CA /06 Fungi or Bacteria Other Than Auto Exclusion Mandatory NO IA 07/06 Policyholder Notice (only if UM/UIM provided) IL /08 Cancellation & Non Renewal CA /03 Changes CA /06 Changes in Garage Coverage Form Optional CA /06 UM/UIM [24]

25 KANSAS (KS) ADMITTED AG005KS 03/12 Signature Page - Kansas G1501A 01/13 Garage Coverage Part Declarations G1517KS 01/13 Changes in Garage Coverage - Kansas CA /06 Fungi or Bacteria Other Than Auto Exclusion CA /06 Terrorism Exclusion Mandatory CA /96 Cancellation & Non Renewal CA /06 Changes CA /10 Kansas Commercial Auto Coverage Changes Optional CA /05 UM CA /97 PIP [25]

26 KENTUCKY (KY) POLICY TYPE: Service (T03) CA /06 Terrorism Exclusion Mandatory UIL /09 Cancellation & Non Renewal KYPolNot 11/08 Kentucky Policyholder Notice POLICY TYPE: Dealers (T02) ADMITTED AG005 03/12 Signature Page G1501A 01/13 Garage Coverage Part Declarations G /13 Changes in Garage Coverage G /09 Additional Garage Limitations CA /06 Fungi or Bacteria Other Than Auto Exclusion (not for Auto only policies) CA /06 Terrorism Exclusion Mandatory IL /08 Cancellation & Non-Renewal CA /02 Changes CA /06 Changes-Garage KYPolNot 11/08 Kentucky Policyholder Notice Optional CA /06 UMBI CA /06 UIM CA /11 PIP [26]

27 LOUISIANA (LA) CA /06 Fungi or Bacteria Exclusion Garage Mandatory U173 07/02 Cancellation & Non Renewal CA /08 Changes-Garage Liability Optional CA /07 Lessor - Additional Insured & Loss Payee CA /08 UMBI CA /10 UMPD Property Mandatory LA Notice WD 01/10 Windstorm or Hail Deductible Or LA Notice WE 01/10 Windstorm or Hail Exclusion [27]

28 MAINE (ME) POLICY TYPE: Service (T03) Mandatory UIL /05 Cancellation & Non Renewal POLICY TYPE: Dealers (T02) ADMITTED AG005 03/12 Signature Page G1501A 01/13 Garage Coverage Part Declarations G /13 Changes in Garage Coverage G /09 Additional Garage Limitations CA /06 Fungi or Bacteria Other Than Auto Exclusion (not for Auto only policies) Mandatory IL /11 Cancellation & Non Renewal CA /09 Changes IL /07 Concealment, Misrepresentation or Fraud CA /09 Changes in Garage Coverage Form Optional CA /08 UM [28]

29 MARYLAND (MD) POLICY TYPE: Service (T03) Mandatory U173 07/02 Cancellation & Non Renewal POLICY TYPE: Dealers (T02) ADMITTED AG005 03/12 Signature Page G1501A 01/13 Garage Coverage Part Declarations G /13 Changes in Garage Coverage G /09 Additional Garage Limitations CA /06 Fungi or Bacteria Other Than Auto Exclusion (not for Auto only policies) Mandatory CA /09 Cancellation CA /01 Changes in Garage Coverage Form CA /10 Changes Optional CA /06 UM CA /02 PIP MD PIP NO 11/11 Maryland PIP Policyholder Notice [29]

30 MICHIGAN (MI) POLICY TYPE: Service (T03) Mandatory U173 07/02 Cancellation & Non Renewal POLICY TYPE: Dealers (T02) ADMITTED AG005 03/12 Signature Page CA /06 Fungi or Bacteria Other Than Auto Exclusion Mandatory IL /08 Cancellation & Non Renewal CA /11 Changes Optional CA /13 MI Property Damage Liability Buy-Back CA /11 Broadened coverage Collision CA /06 UM CA /11 PIP CA /06 Property Protection Endorsement (PPI) CA /94 Michigan Coordination of PIP CA /94 Michigan Changes Cancellation and Non Renewal [30]

31 MINNESOTA (MN) POLICY TYPE: Service (T03) Mandatory NO MN 07/06 Policyholder Notice U173 07/02 Cancellation & Non Renewal Optional GT7003 MN 01/13 Driver Limitation MN POLICY TYPE: Dealers (T02) ADMITTED AG005 03/12 Signature Page CA /06 Fungi or Bacteria Other Than Auto Exclusion Mandatory NO MN 07/06 Policyholder Notice CA /00 Cancellation CA /07 Changes CA /07 Changes in Garage Coverage Form Optional GT /13 Driver Limitation - MN CA /08 UM/UIM CA /07 PIP [31]

32 MISSISSIPPI (MS) Mandatory U173 07/02 Cancellation & Non Renewal Optional CA /09 UMBI/PD (non-stacked) NOTE: A SIGNED AND DATED UM SELECTION FORM IS REQUIRED FOR ANY POLICY WITH A DEALER OR SCHEDULED AUTO EXPOSURE IN THIS STATE. [32]

33 MISSOURI (MO) Mandatory U173 07/02 Cancellation & Non Renewal CA /06 Changes-Who is an Insured CA /06 Changes-Pollution Optional CA /12 UM CA /10 UIM [33]

34 MONTANA (MT) Mandatory CA /03 Cancellation & Non Renewal Optional CA /07 UM (Non-Stacked) CA /07 UIM (Non-Stacked) [34]

35 NEBRASKA (NE) Mandatory U173 07/02 Cancellation & Non Renewal Optional CA /06 UM/UIM [35]

36 NEVADA (NV) POLICY TYPE: Service (T03) Mandatory UIL /02 Cancellation & Non Renewal POLICY TYPE: Dealers (T02) ADMITTED AG005 03/12 Signature Page CA /06 Fungi or Bacteria Other Than Auto Exclusion Mandatory IL /07 Cancellation & Non Renewal CA /10 Changes IL /07 Concealment, Misrepresentation & Fraud IL /10 NV Changes Domestic Partnership Optional CA /08 UM/UIM [36]

37 NEW HAMPSHIRE (NH) ADMITTED AG005 03/12 Signature Page G1501NH 01/13 Garage Coverage Part Declarations G1517NH 01/13 Changes in Garage Coverage New Hampshire CA /06 Fungi or Bacteria Other Than Auto Exclusion Mandatory CA /10 Cancellation & Non Renewal CA /10 Changes IL /07 Concealment, Misrepresentation & Fraud IL /08 Changes-Civil Union Optional CA /08 UM [37]

38 NEW JERSEY (NJ) POLICY TYPE: Service (T03) CA /06 Terrorism Exclusion Mandatory U173 07/02 Cancellation & Non Renewal POLICY TYPE: Dealers (T02) ADMITTED CLASSES: All AG005 03/12 Signature Page G1504NJ 01/13 Changes in Garage Coverage New Jersey CA /06 Terrorism Exclusion Mandatory CA /99 NJ Changes-Garage Liability CA /95 NJ Changes-Physical Damage Inspection CA /95 NJ Changes-Loss Information IL /08 NJ Changes-Civil Union IL /07 Cancellation & Non Renewal Optional CA /11 NJ Changes Cancellation for Oversized Vehicles CA /08 UM/UIM CA /06 PIP CA /06 NJ Added PIP [38]

39 NEW MEXICO (NM) Mandatory CA /99 Cancellation & Non Renewal Optional CA /11 UMBI/PD-(Non-Stacked) NOTE: A SIGNED AND DATED UM SELECTION FORM IS REQUIRED FOR ANY POLICY WITH A DEALER OR SCHEDULED AUTO EXPOSURE IN THIS STATE. [39]

40 NEW YORK (NY) POLICY TYPE: Service (T03) Mandatory CA /11 NEW New York Changes in Garage Coverage Form CA /11 NEW New York Changes Cancellation IL /08 NEW New York Changes Fraud Optional IL /08 NEW New York Changes Calculation of Premium [40]

41 NORTH CAROLINA (NC) POLICY TYPE: Service (T03) Mandatory U173 07/02 Cancellation & Non Renewal POLICY TYPE: Dealers (T02) ADMITTED AG005 03/12 Signature Page G1505NC 01/13 Additional Garage Exclusions & Buy Back Schedules North Carolina CA /06 Fungi or Bacteria Other Than Auto Exclusion Mandatory CA /10 Changes CAN002 02/10 NC UM/UIM Notice (required for owned autos) Optional CA /10 UM/UIM [41]

42 NORTH DAKOTA (ND) Mandatory U173 07/02 Cancellation & Non Renewal NDNotice 10/11 ND Policyholder Notice Optional CA /11 UM CA /11 UIM CA /06 PIP [42]

43 OHIO (OH) Mandatory U173 07/02 Cancellation & Non Renewal CA /06 Changes-Garage Liability Optional CA /10 UMBI CA /06 UMPD G /05 Stop-Gap Employers Liability [43]

44 OKLAHOMA (OK) CA /06 Terrorism Exclusion Mandatory IL /02 Policyholder Notice IL /10 OK Changes Concealment, Misrepresentation, or Fraud CA /94 Changes-Other Liability UIL /02 Cancellation & Non Renewal Optional CA /12 UM [44]

45 OREGON (OR) G1505OR 01/13 Additional Garage Exclusions & Buy Back Schedules CA /06 Terrorism Exclusion Mandatory NO OR 07/06 Policyholder Notice CA /10 Oregon Changes IL /08 Oregon Changes Domestic Partnership U173 07/02 Cancellation & Non Renewal Optional CA /10 UMBI/UIM CA /10 UMPD CA /10 PIP G1506OR 07/09 Driver Exclusion OR [45]

46 PENNSYLVANIA (PA) POLICY TYPE: Service Only (T03) Mandatory IL /02 Policyholder Notice UIL /02 Cancellation & Non Renewal POLICY TYPE: Dealers (T02) ADMITTED AG005 03/12 Signature Page CA /06 Fungi or Bacteria Other Than Auto Exclusion Mandatory IL /02 Policyholder Notice IL /07 Cancellation & Non Renewal IL /11 Pennsylvania Changes Defense Costs CA /06 Changes in Garage Coverage Form CA /97 Changes Optional CA /12 UM (Non-Stacked) CA /12 UIM (Non-Stacked) CA /06 First Party Benefits (PIP) CA /95 PA Added & Combination First Party Benefit Endorsement CA /95 PA Extraordinary Medical Benefits Coverage Endorsement NOTE: A SIGNED AND DATED UM SELECTION FORM IS REQUIRED FOR ANY POLICY WITH A DEALER OR SCHEDULED AUTO EXPOSURE IN THIS STATE. [46]

47 RHODE ISLAND (RI) Mandatory CA /06 Rhode Island Changes CA /10 Cancellation & Non Renewal IL /12 Rhode Island Changes Civil Union Optional CA /06 UMBI/UMPD/UIM [47]

48 SOUTH CAROLINA (SC) POLICY TYPE: Service Only (T03) Mandatory CA /10 Cancellation & Non Renewal NOSCB 07/06 SC Notice of Right to Cancel (Must be attached to Insured s copy of the G1501) POLICY TYPE: Dealers (T02) ADMITTED AG005 03/12 Signature Page CA /06 Fungi or Bacteria Other Than Auto Exclusion Mandatory CA /10 Cancellation & Non Renewal CA /06 Changes NOSCB 07/06 SC Notice of Right to Cancel (Must be attached to Insured s copy of the G1501) Optional CA /06 UM CA /06 UIM Required for NO SCA 07/06 Policyholder Notice-UM Owned autos [48]

49 SOUTH DAKOTA (SD) Mandatory U173 07/02 Cancellation & Non Renewal Optional CA /06 UM/UIM G1506A 07/09 Driver Exclusion - SD [49]

50 TENNESSEE (TN) POLICY TYPE: Service Only (T03) Mandatory NO TN 07/06 Policyholder Notice U173 07/02 Cancellation & Non Renewal Optional CA /07 Additional Insured Lessor and Loss Payee TN CA /05 Loss Payee POLICY TYPE: Dealers (T02) ADMITTED AG005 03/12 Signature Page CA /06 Fungi or Bacteria Other Than Auto Exclusion Mandatory NO TN 07/06 Policyholder Notice IL /08 Cancellation & Non Renewal CA /01 Changes Optional CA /06 UM/UIM CA /07 Additional Insured Lessor & Loss Payee TN CA /05 Loss Payee - TN [50]

51 TEXAS (TX) POLICY TYPE: Dealers (T02), Service T03) G1504TX 01/13 Changes in Garage Coverage Mandatory TX Notice 06/12 Policyholder Notice U173 07/02 Cancellation & Non Renewal Optional CA /13 UMBI/UMPD/UIM CA /08 PIP [51]

52 UTAH (UT) Mandatory U173 07/02 Cancellation & Non Renewal Optional CA /10 UMBI CA /09 UMPD CA /10 UIM CA /06 PIP CA /94 Utah PIP Exclusion of Loss of Income Benefits [52]

53 VERMONT (VT) POLICY TYPE: Service Only (T03) Mandatory IL /08 Cancellation & Non Renewal [53]

54 VIRGINIA (VA) SIGCSIC 03/12 Signature Page Mandatory NO VA A 07/06 Policyholder Notice NO VA B 07/06 Policyholder Notice-Optional Benefits CA /08 Changes in Garage Coverage Form CA /05 Cancellation & Non Renewal Optional CA /02 Auto Medical Expense and Income Loss (PIP) UCA /02 UM (Includes Limits Schedule) CA /05 Broadened Coverage Garage VA CA /02 Virginia Limited Subrogation Rights [54]

55 WASHINGTON (WA) G1504WA 01/13 Changes in Garage Coverage G1505WA 01/13 Additional Garage Exclusions & Buy Back Schedules CA /06 Terrorism Exclusion CA /06 Fungi or Bacteria Exclusion Mandatory UIL /10 Cancellation & Non Renewal Optional CA /08 Underinsured Motorists CA /06 PIP (use only for Individual Named Insured) G /05 Stop-Gap Employers Liability [55]

56 WEST VIRGINIA (WV) POLICY TYPE: Service Only (T03) Mandatory U173 07/02 Cancellation & Non Renewal POLICY TYPE: Dealers (T02) ADMITTED AG005 03/12 Signature Page G1501A 01/13 Garage Coverage Part Declarations G /13 Changes in Garage Coverage G /09 Additional Garage Limitations CA /06 Fungi or Bacteria Other Than Auto Exclusion Mandatory CA /94 WV Changes - Cancellation CA /02 Changes CA /06 Changes in Garage Coverage Form Optional CA /12 UM/UIM CA /06 Auto Medical Payments - WV PA /04 West Virginia Changes Cancellation and Non Renewal (attach when named insured is an individual and there is a covered auto of the private passenger type) [56]

57 WISCONSIN (WI) Mandatory NO WIA 07/06 Policyholder Notice U173 07/02 Cancellation & Non Renewal CA /11 Changes NOWIIRC 08/09 WI Notice To Policyholders Insured Requested Cancellations Optional CA /11 UM CA /11 UIM CA /11 Automobile Medical Payments WI [57]

58 WYOMING (WY) Mandatory UIL /02 Cancellation & Non Renewal IL /08 Changes-Defense Costs CA /94 Wyoming Changes Duty to Defend Optional CA /06 UMBI G /05 Stop-Gap Employers Liability [58]