Garage Policy Issuance Guidelines Ed 0313 - … · Garage Policy Issuance Guidelines Ed. 01/13 [1]$...

Colony Management Services Garage Policy Issuance Guidelines Ed. 01/13

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GARAGE POLICY ISSUANCE GUIDELINES

2013 Issuance Changes Update Effective

Date Pg. # Description

1/8/13 1/1/13 2 8, 9,10 16,17,18,26,29,38, 50,55,56

Scheduled Auto Clarification Admitted & Non-Admitted Optional Forms CA, CO, CT, KY, MD, NJ, TX, WV, WI

3/6/13 3/1/13 40, 41-58 Add NY Service, Re-number remaining pages 3/6/13 1/1/13 50 Correct TX Notice and CA2109 Edition Dates 3/6/13 5/7/13

5/1/13 1/1/13

11 7

Added property mandatory form U284 06/05 – Actual Cash Value Limitation – Roofs and Roof SurfacingUpdated G1525 Hail Exclusion, no longer Admitted only

Contacting us: Send Policies, Endorsements and Documentation by eMail All to [email protected]

TABLE OF CONTENTS

Policy Prefix & Libraries 2 Use of Symbols 2 Deductibles 2 Forms and Endorsements 2 Premium Placement Assistance 3 Approved Endorsement Wording 4-5 Optional Coverage Endorsements 6-7 Admitted Optional Garage Forms 8 Non-Admitted Optional Garage Forms 9-10 Property Forms 11 Detailed Forms Library by State 12-58


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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.


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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.


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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.


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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 G1524. - 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.


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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 Requiring title registration on an “auto” sold by the insured o 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.


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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)


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ADMITTED OPTIONAL GARAGE FORMS (alphabetical by Title)

Form # Edition Title CA2048 02/99 Additional Insured-Designated CA2049 07/97 Additional Insured-Franchisor CA2001 03/06 Additional Insured-Lessor of Auto (do not use in KS or TN) CA0430 06/07 Additional Insured-Lessor & Loss Payee (use in TN) CA2047 07/97 Additional Insured-Lessor of Equipment CA2509 12/93 Additional Insured-Owners of Premises (Landlord) CT3792 01/13 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) CA9903 03/06 Automobile Medical Payments (do not use in PA or WV) CA9968 03/06 Automobile Medical Payments (use in WV) CT3819 11/11 Auto Wrecker Bailees Coverage CA2514 03/10 Broadened Coverages-Garage IL0003 09/08 Calculation of Premium GT6002 03/13 Cancellation Endorsement GT3000 03/13 Changes Endorsement with Premium Distribution Worksheet GT3598 03/13 Continuation of Named Insured Endorsement CA9954 07/97 Covered Auto Designation (to defineSymbol 32) CA9910 03/10 Drive Other Car Coverage G1506 10/02 Driver Exclusion (do not use in CT, KS, ME, MD, MI, NH, NC, NJ, SC, WV) GT7002 01/13 Driver Limitation (do not use in IL, KS, MN, NH, or SC) GT7003MN 01/13 Driver Limitation (use in MN) G1551 07/09 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) CA2503 03/10 False Pretense Coverage CT3576 01/13 Firearms Exclusion (do not use in KS) CA2510 03/10 Fire Legal Liability G1526 05/12 Garagekeepers - On-Hook Endorsement (KS, KY, MD, ME, NH, WV) (for use with G1517 and G1518 only) G1569 02/11 Identity Recovery Coverage Endorsement (do not use in NC or NH) CA0301 03/10 Liability Deductible Endorsement (ME, MI, NV, NC, SC, TN) CA0302 03/10 Liability Deductible Endorsement (CT, IL, IA, KS, KY, MD, MN, NH, NJ, PA, WV) CA2507 12/93 Locations & Operations Not Covered CA9944 12/93 Loss Payee (do not use in TN) CA9987 10/05 Loss Payee (TN) CA2505 03/06 Premises Medical Payments CA2027 02/99 Registration Plates (other than Dealer Plates) GT100 03/13 Reinstatement Endorsement G1507 10/02 Related Operations G1511 10/02 Stated Amount Insurance G1509 06/05 Supplemental Schedule for Specifically Described Autos G1522 02/06 Supplemental Schedule for Valet Parking G1512 07/09 Waiver of Transfer of Rights G1524 05/12 Wind, Hail, Flood Deductible G1524A 05/12 Wind, Hail, Flood Deductible - $50,000 Aggregate G1524B 05/12 Wind, Hail, Flood Deductible - $25,000 Aggregate G1525 01/13 Wind, Hail, Flood Exclusion


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NON-ADMITTED OPTIONAL GARAGE FORMS (alphabetical by Title)

Form # Edition Title G1521 07/09 Additional Coverage for Wreckers in OK CA2048 02/99 Additional Insured-Designated G1600 01/13 Additional Insured – Designated – Primary & Non-Contributory (do not use for Dealers) CA2049 07/97 Additional Insured-Franchisor CA2001 03/06 Additional Insured-Lessor of Auto (do not use in TN) CA0430 06/07 Additional Insured-Lessor & Loss Payee in TN CA2047 07/97 Additional Insured-Lessor of Equipment CA2509 12/93 Additional Insured-Owners of Premises (Landlord) CT3792 01/13 Animal Exclusion - Injury or Damage Caused by Animals (do not use in VA) CA9903 03/06 Automobile Medical Payments (do not use in CA, CO, WI or VA) CA0424 04/06 Automobile Medical Payments in CA CA0440 01/11 Automobile Medical Payments in CO CA9924 11/11 Automobile Medical Payments in WI CA2246 11/02 Auto Medical Expense and Income Loss (PIP) in VA CT3819 11/11 Auto Wrecker Bailees Coverage (do not use in MT) CT3819MT 01/13 Auto Wrecker Bailees Coverage (MT) G1514 10/02 Blank Endorsement G1514a 10/02 Blank - Restrictive Endorsement (select paragraphs) CA2514 03/10 Broadened Coverages-Garage CA2534 12/05 Broadened Coverages-Garage in VA IL0003 09/08 Calculation of Premium GT6002 03/13 Cancellation Endorsement GT3000 03/13 Changes Endorsement with Premium Distribution Worksheet GT3598 03/13 Continuation of Named Insured Endorsement CA9954 07/97 Covered Auto Designation (to define Symbol 32) CA9910 03/10 Drive Other Car Coverage CA0426 03/10 Drive Other Car Coverage in CA G1506 10/02 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) GT7002 01/13 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) G1551 07/09 Errors and Omissions Coverage for Automobile Dealers CA2503 03/10 False Pretense Coverage CT3576 01/13 Firearms Exclusion (do not use in VA) CA2510 03/10 Fire Legal Liability G1569 02/11 Identity Recovery Coverage Endorsement (do not use in NC) CA0301 03/10 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) CA0302 03/10 Liability Deductible Endorsement (CA, CT, GA, IN, KY, MD, MN, MT, NJ, OR, PA, WA, WV) CA0302 12/93 Liability Deductible Endorsement (VA) CA2507 12/93 Locations & Operations Not Covered CA9944 12/93 Loss Payee (do not use in TN) CA9987 10/05 Loss Payee in TN CA2505 03/06 Premises Medical Payments CA2027 02/99 Registration Plates (other than Dealer Plates) GT100 03/13 Reinstatement Endorsement G1507 10/02 Related Operations Endorsement G1511 10/02 Stated Amount Insurance G1509 06/05 Supplemental Schedule for Specifically Described Autos G1522 02/06 Supplemental Schedule for Valet Parking G1512 07/09 Waiver of Transfer of Rights G1524 05/12 Wind, Hail, Flood Deductible


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NON-ADMITTED OPTIONAL GARAGE FORMS CONTINUED (alphabetical by Title)

Form # Edition Title G1524A 05/12 Wind, Hail, Flood Deductible - $50,000 Aggregate G1524B 05/12 Wind, Hail, Flood Deductible - $25,000 Aggregate G1525 01/13 Wind, Hail, Flood Exclusion THE SLB DATA FORM (08/11) IS MANDATORY IF THE FOLLOWING TYPES OF NON-ADMITTED 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.


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PROPERTY MANDATORY FORMS (Non-Admitted Only)

Form # Edition Title I. Use on all Policies with Property:

G1515 09/11 Garages-Building & Personal Property Declarations CP0090 07/88 Commercial Property Conditions CP0010 06/07 Building & Personal Property Coverage Form CP1032 08/08 Water Exclusion

II. Causes of Loss – Use one of these:

• CP1010 06/07 Basic Form • CP1020 06/07 Broad Form • CP1030 06/07 Special Form

III. Terrorism – Use one of these and provide signed TRIA Selection/Rejection form:

• IL0953 01/08 Terrorism Exclusion • IL0952 03/08 Terrorism Limited Coverage

IV. Weather Restriction Mandatory Forms (See Weather Restrictions to Binding Authority):

CP1054 06/07 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:

• CP0155 07/07 Changes – Property • IL0107 07/02 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:

G1556 01/09 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) CP1211 10/00 Burglary, Robbery (Theft) Protective Systems CP0030 06/07 Business Income (with Extra Expense) CP1218 06/07 Loss Payable CP0320 10/92 Multiple Deductible CP1440 06/07 Outdoor Signs CP1033 06/95 Theft Exclusion CP1054 06/07 Windstorm and Hail Exclusion (Unless Mandatory in Weather Restrictions above) CP0402 09/09 Increased Cost of Loss and Related Expenses For Green Upgrades


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DETAILED FORMS LIBRARY BY STATE

ALABAMA (AL)

POLICY TYPE: Dealers (T02), Service (T03)

NON-ADMITTED

CLASSES: All

SIGCIC 03/12 Signature Page G1500 01/13 Common Policy Declarations

G1501 01/13 Garage Coverage Part Declarations G1502 04/03 Schedule of Forms & Endorsements G1504 01/13 Changes in Garage Coverage

G1505 01/13 Additional Garage Exclusions & Buy Back Schedules G1562 02/10 Garage Policyholder Notice CA0005 03/10 Garage Coverage Form

CA2384 01/06 Terrorism Exclusion CA2537 03/06 Fungi or Bacteria Exclusion U094 07/02 Service of Suit IL0017 11/98 Common Policy Conditions IL0021 09/08 Nuclear Energy Exclusion

STATE FORMS: Mandatory U173 07/02 Cancellation & Non Renewal Optional CA2159 03/06 UM


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ALASKA (AK)


NON-ADMITTED

CLASSES: All





STATE FORMS:

Mandatory AK Notice 08/08 Policyholder Notice-Surplus Lines AK Notice 04/07 Policyholder Notice-Attorney Fees CA0158 08/06 Changes-Garage IL0121 09/08 Changes-Attorneys Fees (Rule 82) IL0176 06/11 Changes-Appraisal IL0280 09/08 Cancellation & Non Renewal Optional CA2160 03/10 UM/UIM Property - Mandatory CP0155 07/07 Changes-Property IL0107 07/02 Changes-Loss Payment


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ARIZONA (AZ)


NON-ADMITTED

CLASSES: All





STATE FORMS:

Mandatory NO AZ 07/06 Policyholder Notice U173 07/02 Cancellation & Non Renewal CA0175 07/04 Changes-Concealment, Misrepresentation, Fraud Optional CA2139 07/09 UM CA2140 07/09 UIM


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ARKANSAS (AR)


NON-ADMITTED

CLASSES: All




CA2384 01/06 Terrorism Exclusion CA2537 03/06 Fungi or Bacteria Exclusion U094 07/02 Service of Suit IL0017 11/98 Common Policy Conditions IL0021 09/08 Nuclear Energy Exclusion STATE FORMS: Mandatory NO AR 11/09 Policyholder Notice UIL0231 07/02 Cancellation & Non Renewal CA0162 10/07 Changes-Who is an Insured IL0909 03/98 AR Notice-Auto Parts Optional CA2108 03/06 UMBI CA2166 03/06 UMPD CA3128 03/06 UIM CA2202 03/06 PIP (use only for Scheduled Private Passenger Autos)


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CALIFORNIA (CA)


NON-ADMITTED

CLASSES: All




CA2384 01/06 Terrorism Exclusion CA2537 03/06 Fungi or Bacteria Exclusion U094 07/02 Service of Suit IL0017 11/98 Common Policy Conditions IL0021 09/08 Nuclear Energy Exclusion STATE FORMS: Mandatory U173 07/02 Cancellation & Non Renewal CAPRNOTICE 09/11 California Notice – Premium Refunds D2 07/11 California Surplus Line Policyholder Notice CA0143 05/07 California Changes ILN119 01/10 California Auto Body Repair Consumer Bill of Rights Optional CA2154 09/09 UMBI CA2155 06/10 UMPD CA0424 04/06 Auto Medical Payments – CA CA0426 03/10 Drive Other Car - CA


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COLORADO (CO)


NON-ADMITTED

CLASSES: All




CA2384 01/06 Terrorism Exclusion CA2537 03/06 Fungi or Bacteria Exclusion U094 07/02 Service of Suit IL0017 11/98 Common Policy Conditions IL0021 09/08 Nuclear Energy Exclusion STATE FORMS:

Mandatory U173 07/02 Cancellation & Non Renewal CA0113 01/11 Changes-Other Insurance IL0169 09/07 Changes-Concealment, Misrepresentation, Fraud Optional CA0440 01/11 Auto Medical Payments - CO CA2150 01/11 UMBI CA2126 01/11 UMPD


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CONNECTICUT (CT)

POLICY TYPE: Service (T03)

NON-ADMITTED





Mandatory UIL0260 07/02 Cancellation & Non Renewal IL0140 09/08 Connecticut Changes – Civil Union

POLICY TYPE: Dealers (T02)

ADMITTED

CLASSES: All

AG005 03/12 Signature Page G1500 01/13 Common Policy Declarations G1501 01/13 Garage Coverage Part Declarations G1502 04/03 Schedule of Forms & Endorsements G1504 01/13 Changes in Garage Coverage G1505 01/13 Additional Garage Exclusions & Buy Back Schedules G1562 02/10 Garage Policyholder Notice CA0005 03/10 Garage Coverage Form CA2537 03/06 Fungi or Bacteria Other Than Auto Exclusion CA2386 01/06 Terrorism Exclusion IL0017 11/98 Common Policy Conditions IL0021 09/08 Nuclear Energy Exclusion

STATE FORMS:

Mandatory CA0107 10/97 Connecticut Changes CA0190 10/97 Connecticut Changes – Liability of Municipalities IL0140 09/08 Connecticut Changes – Civil Union IL0260 02/10 Connecticut Changes – Cancellation & Nonrenewal Optional CA2022 10/97 Connecticut Transporter Plates Coverage CA2157 03/06 Connecticut UM & UIM Coverage CA9939 09/94 Glass Coverage – Connecticut


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FLORIDA (FL)


NON-ADMITTED

CLASSES: All

SIGCICFL 03/12 Signature Page - Florida G1500 01/13 Common Policy Declarations



CA2384 01/06 Terrorism Exclusion CA2537 03/06 Fungi or Bacteria Exclusion U094 07/02 Service of Suit IL0017 11/98 Common Policy Conditions IL0021 09/08 Nuclear Energy Exclusion STATE FORMS: Mandatory NO FL 07/06 Policyholder Notice CA0267 11/12 Cancellation & Non Renewal CA0128 03/09 Changes-Appraisal Optional GT7004FL 01/13 Driver Limitation CA2172 10/09 UM CA2210 01/08 PIP


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GEORGIA (GA)


NON-ADMITTED

CLASSES: All




CA2384 01/06 Terrorism Exclusion CA2537 03/06 Fungi or Bacteria Exclusion U094 07/02 Service of Suit IL0017 11/98 Common Policy Conditions IL0021 09/08 Nuclear Energy Exclusion STATE FORMS: Mandatory U173 07/02 Cancellation & Non Renewal CA0163 10/04 Changes-Garage Optional CA2111 01/09 UM-Fill-In Or CA3137 01/09 UM-Add-On And GT7000 10/08 UM Offset Endorsement


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IDAHO (ID)


NON-ADMITTED

CLASSES: All




CA2384 01/06 Terrorism Exclusion CA2537 03/06 Fungi or Bacteria Exclusion U094 07/02 Service of Suit IL0017 11/98 Common Policy Conditions IL0021 09/08 Nuclear Energy Exclusion STATE FORMS: Mandatory U173 07/02 Cancellation & Non Renewal CA0118 11/00 Changes-Other Insurance Optional CA3115 03/06 UM CA3118 11/11 UIM


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ILLINOIS (IL)


ADMITTED

CLASSES: All

AG005 03/12 Signature Page G1500 01/13 Common Policy Declarations G1501 01/13 Garage Coverage Part Declarations G1502 04/03 Schedule of Forms & Endorsements G1504IL 01/13 Changes in Garage Coverage - Illinois G1505IL 01/13 Additional Garage Exclusions & Buy Back Schedules - Illinois G1562 02/10 Garage Policyholder Notice CA0005 03/10 Garage Coverage Form CA2537 03/06 Fungi or Bacteria Other Than Auto Exclusion CA2384 01/06 Terrorism Exclusion IL0017 11/98 Common Policy Conditions IL0021 09/08 Nuclear Energy Exclusion

STATE FORMS:

Mandatory CA0270 08/94 Cancellation & Non Renewal CA0120 06/03 Changes CA0104 03/06 Changes in Garage Coverage Form IL0147 09/11 IL Changes – Civil Union IL0162 09/08 Changes-Defense Costs IL NOTICE 02/11 IL Policyholder Notice Optional CA2130 11/08 UMBI CA2153 03/06 UMPD CA2138 11/08 UIM CA0302 03/10 Liability Deductible - IL


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INDIANA (IN)

POLICY TYPE: Dealers (T02), Service (T03) NON-ADMITTED CLASSES: All




CA2384 01/06 Terrorism Exclusion CA2537 03/06 Fungi or Bacteria Exclusion U094 07/02 Service of Suit IL0017 11/98 Common Policy Conditions IL0021 09/08 Nuclear Energy Exclusion STATE FORMS: Mandatory NO IN 07/06 Policyholder Notice IL0156 09/07 Indiana Changes – Concealment, Misrepresentation or Fraud UIL0272 07/02 Cancellation & Non Renewal Optional CA2144 12/11 UM CA3116 12/11 UIM CA0433 02/08 Indiana Changes – Pollution Exclusion CA0434 02/08 Indiana Changes – Amendment of Definition of Pollutants IL0117 12/10 Indiana Changes – Workers’ Compensation Exclusion


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IOWA (IA)

POLICY TYPE: Dealers (T02), Service (T03) ADMITTED

CLASSES: All

AG005 03/12 Signature Page G1500 01/13 Common Policy Declarations G1501 01/13 Garage Coverage Part Declarations G1502 04/03 Schedule of Forms & Endorsements G1504 01/13 Changes in Garage Coverage G1505 01/13 Additional Garage Exclusions & Buy Back Schedules G1562 02/10 Garage Policyholder Notice CA0005 03/10 Garage Coverage Form CA2537 03/06 Fungi or Bacteria Other Than Auto Exclusion CA2384 01/06 Terrorism Exclusion IL0017 11/98 Common Policy Conditions IL0021 09/08 Nuclear Energy Exclusion

STATE FORMS:

Mandatory NO IA 07/06 Policyholder Notice (only if UM/UIM provided) IL0276 09/08 Cancellation & Non Renewal CA0160 02/03 Changes CA0182 03/06 Changes in Garage Coverage Form Optional CA2112 03/06 UM/UIM


[25]

KANSAS (KS)


CLASSES: All

AG005KS 03/12 Signature Page - Kansas G1500 01/13 Common Policy Declarations G1501A 01/13 Garage Coverage Part Declarations G1502 04/03 Schedule of Forms & Endorsements G1517KS 01/13 Changes in Garage Coverage - Kansas G1562 02/10 Garage Policyholder Notice CA0005 03/10 Garage Coverage Form CA2537 03/06 Fungi or Bacteria Other Than Auto Exclusion CA2386 01/06 Terrorism Exclusion IL0017 11/98 Common Policy Conditions IL0021 09/08 Nuclear Energy Exclusion

STATE FORMS:

Mandatory CA0265 02/96 Cancellation & Non Renewal CA0122 05/06 Changes CA0448 12/10 Kansas Commercial Auto Coverage Changes Optional CA2137 01/05 UM CA2214 10/97 PIP


[26]

KENTUCKY (KY)


NON-ADMITTED





Mandatory UIL0263 03/09 Cancellation & Non Renewal KYPolNot 11/08 Kentucky Policyholder Notice


ADMITTED

CLASSES: All

AG005 03/12 Signature Page G1500 01/13 Common Policy Declarations G1501A 01/13 Garage Coverage Part Declarations G1502 04/03 Schedule of Forms & Endorsements G1517 01/13 Changes in Garage Coverage G1518 07/09 Additional Garage Limitations G1562 02/10 Garage Policyholder Notice CA0005 03/10 Garage Coverage Form CA2537 03/06 Fungi or Bacteria Other Than Auto Exclusion (not for Auto only policies) CA2386 01/06 Terrorism Exclusion IL0017 11/98 Common Policy Conditions

IL0021 09/08 Nuclear Energy Exclusion

STATE FORMS:

Mandatory IL0263 09/08 Cancellation & Non-Renewal CA0125 12/02 Changes CA0164 03/06 Changes-Garage KYPolNot 11/08 Kentucky Policyholder Notice Optional CA2176 09/06 UMBI CA2179 03/06 UIM CA2216 03/11 PIP


[27]

LOUISIANA (LA)


NON-ADMITTED

CLASSES: All





STATE FORMS:

Garage Mandatory U173 07/02 Cancellation & Non Renewal CA0103 02/08 Changes-Garage Liability Optional CA0413 08/07 Lessor - Additional Insured & Loss Payee CA2148 11/08 UMBI CA2181 01/10 UMPD Property – Mandatory LA Notice WD 01/10 Windstorm or Hail Deductible Or LA Notice WE 01/10 Windstorm or Hail Exclusion


[28]

MAINE (ME)


NON-ADMITTED




CA2384 01/06 Terrorism Exclusion CA2537 03/06 Fungi or Bacteria Exclusion U094 07/02 Service of Suit IL0017 11/98 Common Policy Conditions IL0021 09/08 Nuclear Energy Exclusion STATE FORMS: Mandatory UIL0247 06/05 Cancellation & Non Renewal

POLICY TYPE: Dealers (T02) ADMITTED CLASSES: All

AG005 03/12 Signature Page G1500 01/13 Common Policy Declarations G1501A 01/13 Garage Coverage Part Declarations G1502 04/03 Schedule of Forms & Endorsements G1517 01/13 Changes in Garage Coverage G1518 07/09 Additional Garage Limitations G1562 02/10 Garage Policyholder Notice CA0005 03/10 Garage Coverage Form CA2537 03/06 Fungi or Bacteria Other Than Auto Exclusion (not for Auto only policies) CA2384 01/06 Terrorism Exclusion IL0017 11/98 Common Policy Conditions

IL0021 09/08 Nuclear Energy Exclusion

STATE FORMS:

Mandatory IL0247 02/11 Cancellation & Non Renewal CA0134 06/09 Changes IL0189 09/07 Concealment, Misrepresentation or Fraud CA0176 06/09 Changes in Garage Coverage Form Optional CA2174 06/08 UM


[29]

MARYLAND (MD)

POLICY TYPE: Service (T03) NON-ADMITTED





Mandatory U173 07/02 Cancellation & Non Renewal


ADMITTED

CLASSES: All

AG005 03/12 Signature Page G1500 01/13 Common Policy Declarations G1501A 01/13 Garage Coverage Part Declarations G1502 04/03 Schedule of Forms & Endorsements G1517 01/13 Changes in Garage Coverage G1518 07/09 Additional Garage Limitations G1562 02/10 Garage Policyholder Notice CA0005 03/10 Garage Coverage Form CA2537 03/06 Fungi or Bacteria Other Than Auto Exclusion (not for Auto only policies) CA2384 01/06 Terrorism Exclusion IL0017 11/98 Common Policy Conditions IL0021 09/08 Nuclear Energy Exclusion

STATE FORMS:

Mandatory CA0215 10/09 Cancellation CA0101 10/01 Changes in Garage Coverage Form CA0170 03/10 Changes Optional CA2113 03/06 UM CA2219 01/02 PIP MD PIP NO 11/11 Maryland PIP Policyholder Notice


[30]

MICHIGAN (MI)


NON-ADMITTED







AG005 03/12 Signature Page G1500 01/13 Common Policy Declarations G1501 01/13 Garage Coverage Part Declarations G1502 04/03 Schedule of Forms & Endorsements G1504 01/13 Changes in Garage Coverage G1505 01/13 Additional Garage Exclusions & Buy Back Schedules G1562 02/10 Garage Policyholder Notice CA0005 03/10 Garage Coverage Form CA2537 03/06 Fungi or Bacteria Other Than Auto Exclusion CA2384 01/06 Terrorism Exclusion IL0017 11/98 Common Policy Conditions IL0021 09/08 Nuclear Energy Exclusion STATE FORMS:

Mandatory IL0286 09/08 Cancellation & Non Renewal CA0110 03/11 Changes Optional CA9941 01/13 MI Property Damage Liability Buy-Back CA2222 03/11 Broadened coverage Collision CA2131 03/06 UM CA2220 03/11 PIP CA2224 03/06 Property Protection Endorsement (PPI) CA2221 03/94 Michigan Coordination of PIP CA0217 03/94 Michigan Changes – Cancellation and Non Renewal


[31]

MINNESOTA (MN)


NON-ADMITTED




CA2384 01/06 Terrorism Exclusion CA2537 03/06 Fungi or Bacteria Exclusion U094 07/02 Service of Suit IL0017 11/98 Common Policy Conditions IL0021 09/08 Nuclear Energy Exclusion STATE FORMS: Mandatory NO MN 07/06 Policyholder Notice U173 07/02 Cancellation & Non Renewal Optional GT7003 MN 01/13 Driver Limitation – MN



Mandatory NO MN 07/06 Policyholder Notice CA0218 06/00 Cancellation CA0138 02/07 Changes CA0133 02/07 Changes in Garage Coverage Form Optional GT7003 01/13 Driver Limitation - MN CA2124 09/08 UM/UIM CA2225 01/07 PIP


[32]

MISSISSIPPI (MS)





CA2384 01/06 Terrorism Exclusion CA2537 03/06 Fungi or Bacteria Exclusion U094 07/02 Service of Suit IL0017 11/98 Common Policy Conditions IL0021 09/08 Nuclear Energy Exclusion STATE FORMS: Mandatory U173 07/02 Cancellation & Non Renewal Optional CA2180 07/09 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.


[33]

MISSOURI (MO)





CA2384 01/06 Terrorism Exclusion CA2537 03/06 Fungi or Bacteria Exclusion U094 07/02 Service of Suit IL0017 11/98 Common Policy Conditions IL0021 09/08 Nuclear Energy Exclusion STATE FORMS: Mandatory U173 07/02 Cancellation & Non Renewal CA0165 10/06 Changes-Who is an Insured CA0166 03/06 Changes-Pollution Optional CA2104 12/12 UM CA3104 09/10 UIM


[34]

MONTANA (MT)





CA2384 01/06 Terrorism Exclusion CA2537 03/06 Fungi or Bacteria Exclusion U094 07/02 Service of Suit IL0017 11/98 Common Policy Conditions IL0021 09/08 Nuclear Energy Exclusion STATE FORMS: Mandatory CA0220 10/03 Cancellation & Non Renewal Optional CA3135 12/07 UM (Non-Stacked) CA3133 12/07 UIM (Non-Stacked)


[35]

NEBRASKA (NE)





CA2384 01/06 Terrorism Exclusion CA2537 03/06 Fungi or Bacteria Exclusion U094 07/02 Service of Suit IL0017 11/98 Common Policy Conditions IL0021 09/08 Nuclear Energy Exclusion STATE FORMS: Mandatory U173 07/02 Cancellation & Non Renewal Optional CA2170 03/06 UM/UIM


[36]

NEVADA (NV)


NON-ADMITTED




CA2384 01/06 Terrorism Exclusion CA2537 03/06 Fungi or Bacteria Exclusion U094 07/02 Service of Suit IL0017 11/98 Common Policy Conditions IL0021 09/08 Nuclear Energy Exclusion STATE FORMS: Mandatory UIL0251 07/02 Cancellation & Non Renewal



Mandatory IL0251 09/07 Cancellation & Non Renewal CA0136 03/10 Changes IL0110 09/07 Concealment, Misrepresentation & Fraud IL0115 01/10 NV Changes – Domestic Partnership Optional CA2127 06/08 UM/UIM


[37]

NEW HAMPSHIRE (NH)


CLASSES: All

AG005 03/12 Signature Page G1500 01/13 Common Policy Declarations G1501NH 01/13 Garage Coverage Part Declarations G1502 04/03 Schedule of Forms & Endorsements G1517NH 01/13 Changes in Garage Coverage – New Hampshire G1562 02/10 Garage Policyholder Notice CA0005 03/10 Garage Coverage Form CA2384 01/06 Terrorism Exclusion CA2537 03/06 Fungi or Bacteria Other Than Auto Exclusion IL0017 11/98 Common Policy Conditions IL0021 09/08 Nuclear Energy Exclusion

STATE FORMS:

Mandatory CA0262 01/10 Cancellation & Non Renewal CA0111 01/10 Changes IL0187 09/07 Concealment, Misrepresentation & Fraud IL0145 09/08 Changes-Civil Union Optional CA3126 11/08 UM


[38]

NEW JERSEY (NJ)


NON-ADMITTED







ADMITTED

CLASSES: All

AG005 03/12 Signature Page G1500 01/13 Common Policy Declarations G1501 01/13 Garage Coverage Part Declarations G1502 04/03 Schedule of Forms & Endorsements G1504NJ 01/13 Changes in Garage Coverage – New Jersey G1505 01/13 Additional Garage Exclusions & Buy Back Schedules G1562 02/10 Garage Policyholder Notice CA0005 03/10 Garage Coverage Form CA2386 01/06 Terrorism Exclusion IL0017 11/98 Common Policy Conditions IL0021 09/08 Nuclear Energy Exclusion STATE FORMS: Mandatory CA0108 03/99 NJ Changes-Garage Liability CA0184 09/95 NJ Changes-Physical Damage Inspection CA0187 09/95 NJ Changes-Loss Information IL0141 09/08 NJ Changes-Civil Union IL0208 09/07 Cancellation & Non Renewal Optional CA0204 04/11 NJ Changes – Cancellation for Oversized Vehicles CA2114 02/08 UM/UIM CA2230 03/06 PIP CA2231 03/06 NJ Added PIP


[39]

NEW MEXICO (NM)





CA2384 01/06 Terrorism Exclusion CA2537 03/06 Fungi or Bacteria Exclusion U094 07/02 Service of Suit IL0017 11/98 Common Policy Conditions IL0021 09/08 Nuclear Energy Exclusion STATE FORMS: Mandatory CA0250 02/99 Cancellation & Non Renewal Optional CA3129 08/11 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.


[40]

NEW YORK (NY)


NON-ADMITTED





STATE FORMS:

Mandatory CA0152 11/11 NEW New York Changes in Garage Coverage Form CA0225 01/11 NEW New York Changes – Cancellation IL0183 08/08 NEW New York Changes – Fraud Optional IL0185 08/08 NEW New York Changes – Calculation of Premium


[41]

NORTH CAROLINA (NC)

POLICY TYPE: Service (T03) NON-ADMITTED







AG005 03/12 Signature Page G1500 01/13 Common Policy Declarations G1501 01/13 Garage Coverage Part Declarations G1502 04/03 Schedule of Forms & Endorsements G1504 01/13 Changes in Garage Coverage G1505NC 01/13 Additional Garage Exclusions & Buy Back Schedules – North Carolina G1562 02/10 Garage Policyholder Notice CA0005 03/10 Garage Coverage Form CA2537 03/06 Fungi or Bacteria Other Than Auto Exclusion CA2384 01/06 Terrorism Exclusion IL0017 11/98 Common Policy Conditions IL0021 09/08 Nuclear Energy Exclusion STATE FORMS:

Mandatory CA0126 07/10 Changes CAN002 02/10 NC UM/UIM Notice (required for owned autos) Optional CA2116 04/10 UM/UIM


[42]

NORTH DAKOTA (ND)


NON-ADMITTED

CLASSES: All




CA2384 01/06 Terrorism Exclusion CA2537 03/06 Fungi or Bacteria Exclusion U094 07/02 Service of Suit IL0017 11/98 Common Policy Conditions IL0021 09/08 Nuclear Energy Exclusion STATE FORMS: Mandatory U173 07/02 Cancellation & Non Renewal NDNotice 10/11 ND Policyholder Notice Optional CA2183 11/11 UM CA2186 11/11 UIM CA2234 03/06 PIP


[43]

OHIO (OH)






STATE FORMS:

Mandatory U173 07/02 Cancellation & Non Renewal CA0145 03/06 Changes-Garage Liability Optional CA2133 06/10 UMBI CA3117 03/06 UMPD G1519 08/05 Stop-Gap Employers Liability


[44]

OKLAHOMA (OK)


NON-ADMITTED

CLASSES: All





STATE FORMS:

Mandatory IL0179 10/02 Policyholder Notice IL0177 10/10 OK Changes – Concealment, Misrepresentation, or Fraud CA0132 03/94 Changes-Other Liability UIL0236 07/02 Cancellation & Non Renewal Optional CA2118 02/12 UM


[45]

OREGON (OR)


NON-ADMITTED

CLASSES: All



G1505OR 01/13 Additional Garage Exclusions & Buy Back Schedules G1562 02/10 Garage Policyholder Notice CA0005 03/10 Garage Coverage Form


STATE FORMS:

Mandatory NO OR 07/06 Policyholder Notice CA0149 01/10 Oregon Changes IL0142 09/08 Oregon Changes – Domestic Partnership U173 07/02 Cancellation & Non Renewal Optional CA2105 01/10 UMBI/UIM CA2187 01/10 UMPD CA2236 01/10 PIP G1506OR 07/09 Driver Exclusion – OR


[46]

PENNSYLVANIA (PA)

POLICY TYPE: Service Only (T03) NON-ADMITTED




CA2384 01/06 Terrorism Exclusion CA2537 03/06 Fungi or Bacteria Exclusion U094 07/02 Service of Suit IL0017 11/98 Common Policy Conditions IL0021 09/08 Nuclear Energy Exclusion STATE FORMS: Mandatory IL0910 07/02 Policyholder Notice UIL0246 07/02 Cancellation & Non Renewal


AG005 03/12 Signature Page G1500 01/13 Common Policy Declarations G1501 01/13 Garage Coverage Part Declarations G1502 04/03 Schedule of Forms & Endorsements G1504 01/13 Changes in Garage Coverage G1505 01/13 Additional Garage Exclusions & Buy Back Schedules G1562 02/10 Garage Policyholder Notice CA0005 03/10 Garage Coverage Form CA2537 03/06 Fungi or Bacteria Other Than Auto Exclusion CA2384 01/06 Terrorism Exclusion IL0017 11/98 Common Policy Conditions IL0021 09/08 Nuclear Energy Exclusion STATE FORMS: Mandatory IL0910 07/02 Policyholder Notice IL0246 09/07 Cancellation & Non Renewal IL0120 05/11 Pennsylvania Changes – Defense Costs CA0157 03/06 Changes in Garage Coverage Form CA0180 09/97 Changes Optional CA2192 06/12 UM (Non-Stacked) CA2193 06/12 UIM (Non-Stacked) CA2237 03/06 First Party Benefits (PIP) CA2238 03/95 PA Added & Combination First Party Benefit Endorsement CA2256 03/95 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.


[47]

RHODE ISLAND (RI)





CA2384 01/06 Terrorism Exclusion CA2537 03/06 Fungi or Bacteria Exclusion U094 07/02 Service of Suit IL0017 11/98 Common Policy Conditions IL0021 09/08 Nuclear Energy Exclusion STATE FORMS: Mandatory CA0148 12/06 Rhode Island Changes CA0273 01/10 Cancellation & Non Renewal IL0161 03/12 Rhode Island Changes – Civil Union Optional CA2143 03/06 UMBI/UMPD/UIM


[48]

SOUTH CAROLINA (SC)





CA2384 01/06 Terrorism Exclusion CA2537 03/06 Fungi or Bacteria Exclusion U094 07/02 Service of Suit IL0017 11/98 Common Policy Conditions IL0021 09/08 Nuclear Energy Exclusion STATE FORMS: Mandatory CA0230 04/10 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 G1500 01/13 Common Policy Declarations G1501 01/13 Garage Coverage Part Declarations G1502 04/03 Schedule of Forms & Endorsements G1504 01/13 Changes in Garage Coverage G1505 01/13 Additional Garage Exclusions & Buy Back Schedules G1562 02/10 Garage Policyholder Notice CA0005 03/10 Garage Coverage Form CA2537 03/06 Fungi or Bacteria Other Than Auto Exclusion CA2384 01/06 Terrorism Exclusion IL0017 11/98 Common Policy Conditions IL0021 09/08 Nuclear Energy Exclusion STATE FORMS: Mandatory CA0230 04/10 Cancellation & Non Renewal CA0150 03/06 Changes NOSCB 07/06 SC Notice of Right to Cancel (Must be attached to Insured’s copy of the G1501) Optional CA2119 03/06 UM CA2188 03/06 UIM Required for NO SCA 07/06 Policyholder Notice-UM Owned autos


[49]

SOUTH DAKOTA (SD)


NON-ADMITTED CLASSES: All




CA2384 01/06 Terrorism Exclusion CA2537 03/06 Fungi or Bacteria Exclusion U094 07/02 Service of Suit IL0017 11/98 Common Policy Conditions IL0021 09/08 Nuclear Energy Exclusion STATE FORMS: Mandatory U173 07/02 Cancellation & Non Renewal Optional CA2141 03/06 UM/UIM G1506A 07/09 Driver Exclusion - SD


[50]

TENNESSEE (TN)






Mandatory NO TN 07/06 Policyholder Notice U173 07/02 Cancellation & Non Renewal Optional CA0430 06/07 Additional Insured – Lessor and Loss Payee – TN CA9987 10/05 Loss Payee


ADMITTED

CLASSES: All


Mandatory NO TN 07/06 Policyholder Notice IL0250 09/08 Cancellation & Non Renewal CA0146 07/01 Changes Optional CA2120 03/06 UM/UIM CA0430 06/07 Additional Insured – Lessor & Loss Payee – TN CA9987 10/05 Loss Payee - TN


[51]

TEXAS (TX)

POLICY TYPE: Dealers (T02), Service T03) NON-ADMITTED CLASSES: All


G1501 01/13 Garage Coverage Part Declarations G1502 04/03 Schedule of Forms & Endorsements G1504TX 01/13 Changes in Garage Coverage



STATE FORMS:

Mandatory TX Notice 06/12 Policyholder Notice U173 07/02 Cancellation & Non Renewal Optional CA2109 05/13 UMBI/UMPD/UIM CA2264 07/08 PIP


[52]

UTAH (UT)


NON-ADMITTED

CLASSES: All




CA2384 01/06 Terrorism Exclusion CA2537 03/06 Fungi or Bacteria Exclusion U094 07/02 Service of Suit IL0017 11/98 Common Policy Conditions IL0021 09/08 Nuclear Energy Exclusion STATE FORMS: Mandatory U173 07/02 Cancellation & Non Renewal Optional CA2162 10/10 UMBI CA2136 01/09 UMPD CA3106 10/10 UIM CA2244 03/06 PIP CA2263 09/94 Utah PIP – Exclusion of Loss of Income Benefits


[53]

VERMONT (VT)





CA2384 01/06 Terrorism Exclusion CA2537 03/06 Fungi or Bacteria Exclusion U094 07/02 Service of Suit IL0017 11/98 Common Policy Conditions IL0021 09/08 Nuclear Energy Exclusion STATE FORMS: Mandatory IL0219 09/08 Cancellation & Non Renewal


[54]

VIRGINIA (VA)


SIGCSIC 03/12 Signature Page G1500 01/13 Common Policy Declarations




STATE FORMS:

Mandatory NO VA A 07/06 Policyholder Notice NO VA B 07/06 Policyholder Notice-Optional Benefits CA0195 08/08 Changes in Garage Coverage Form CA0268 12/05 Cancellation & Non Renewal Optional CA2246 11/02 Auto Medical Expense and Income Loss (PIP) UCA2121 11/02 UM (Includes Limits Schedule) CA2534 12/05 Broadened Coverage – Garage – VA CA9952 11/02 Virginia Limited Subrogation Rights


[55]

WASHINGTON (WA)



G1501 01/13 Garage Coverage Part Declarations G1502 04/03 Schedule of Forms & Endorsements G1504WA 01/13 Changes in Garage Coverage

G1505WA 01/13 Additional Garage Exclusions & Buy Back Schedules G1562 02/10 Garage Policyholder Notice CA0005 03/10 Garage Coverage Form


STATE FORMS:

Mandatory UIL0146 08/10 Cancellation & Non Renewal Optional CA2134 01/08 Underinsured Motorists CA2257 03/06 PIP (use only for Individual Named Insured) G1519 08/05 Stop-Gap Employers Liability


[56]

WEST VIRGINIA (WV)





CA2384 01/06 Terrorism Exclusion CA2537 03/06 Fungi or Bacteria Exclusion U094 07/02 Service of Suit IL0017 11/98 Common Policy Conditions IL0021 09/08 Nuclear Energy Exclusion STATE FORMS: Mandatory U173 07/02 Cancellation & Non Renewal POLICY TYPE: Dealers (T02)

ADMITTED

CLASSES: All

AG005 03/12 Signature Page G1500 01/13 Common Policy Declarations G1501A 01/13 Garage Coverage Part Declarations G1502 04/03 Schedule of Forms & Endorsements G1517 01/13 Changes in Garage Coverage G1518 07/09 Additional Garage Limitations G1562 02/10 Garage Policyholder Notice CA0005 03/10 Garage Coverage Form CA2537 03/06 Fungi or Bacteria Other Than Auto Exclusion CA2384 01/06 Terrorism Exclusion IL0017 11/98 Common Policy Conditions IL0021 09/08 Nuclear Energy Exclusion STATE FORMS:

Mandatory CA0252 03/94 WV Changes - Cancellation CA0183 09/02 Changes CA0181 03/06 Changes in Garage Coverage Form Optional CA2122 02/12 UM/UIM CA9968 03/06 Auto Medical Payments - WV PA0235 11/04 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)


[57]

WISCONSIN (WI)






STATE FORMS:

Mandatory NO WIA 07/06 Policyholder Notice U173 07/02 Cancellation & Non Renewal CA0117 11/11 Changes NOWIIRC 08/09 WI – Notice To Policyholders Insured Requested Cancellations Optional CA2103 11/11 UM CA2145 11/11 UIM CA9924 11/11 Automobile Medical Payments – WI


[58]

WYOMING (WY)






STATE FORMS:

Mandatory UIL0252 07/02 Cancellation & Non Renewal IL0114 09/08 Changes-Defense Costs CA0144 03/94 Wyoming Changes – Duty to Defend Optional CA2123 03/06 UMBI G1519 08/05 Stop-Gap Employers Liability

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