This Policy As of Its Effective Date Consists of These Coverage Declarations, Endorsements

NAMED INSURED:
POLICY NUMBER:
EFFECTIVE DATE:
DECLARATION EFFECTIVE:

This policy as of its effective date consists of these Coverage Declarations, endorsements, the applicable General Declarations page and the following printed forms:

Attached to all Policies
Policy Cover / Stock #105416
Welcome Letter / Form G-3294-0
ACE Cover Page / Form UW-8H24A
Common Policy Conditions / Form UW-2L52
General Declarations / Form IT-1X80
Attached Forms / Form IT-1X72
How to Obtain Claims Help / Form G-3314-0
Optional Endorsements
Broad Named Insured / Form IT-608075
Broker Amendment / Form IT-610210
Income Tax Equalization / Form IT-612313
Named Insured / Form IT-10192
Policy Term Change Endorsement / Form IT-612516
Contingent Auto Liability and Hired Auto Physical Damage
Liability Coverage Declarations / Form IT-1X83
Contingent Auto Liability Coverage Form / Form UW 1608D
Hired Auto Physical Damage Coverage Endorsement / Form IT-610372
Automobile Medical Payments Endorsement / Form IT-612310
Optional Endorsements
Exclusion – German Pollution / Form IT-100016
Fellow Employee Exclusion / Form IT-612314
Injury to Participants Exclusion / Form IT-610400
Commercial General Liability
Liability Coverage Declarations / Form IT-1X83
Commercial General Liability Coverage / Form UW-4J50H
Employee Benefits Liability Endorsement / Form UW-6L68
Optional Endorsements
Additional Insured – Designated Person or Organization / Form IT-10151
Additional Insured – Lessor of Leased Equipment / Form IT-10152
Broad Form Vendors / Form IT-612304
Contractual Liability Limitation / Form IT-10160
Cross Liability Endorsement / Form IT-10269
Engineers, Architects or Surveyors Professional Liability Exclusion / Form IT-1X73
Exclusion – Aircraft Products – Completed Operations / Form IT-1X63
Exclusion – Airports, Aviation Activities / Form IT-10167
Exclusion – Alarm or Signal Installation / Form IT-10168
Exclusion – All Hazards in Connection with Designated Premises / Form IT-11589
Exclusion -- Asbestos / Form IT-1X64
Exclusion – Athletic or Sports Participants / Form IT-10003
Exclusion – Broadcasters, Telecasters, Publishers and Printers Errors and Omissions / Form IT-10006
Exclusion – Clinical Trials / Form IT-10169

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Exclusion – Construction Management Errors and Omissions / Form IT-10008
Exclusion – Contractors – Professional Liability / Form IT-10271
Exclusion – Corporal Punishment / Form-IT-10170
Exclusion – Designated Ongoing Operations / Form IT-10171
Exclusion – Designated Products/Completed Operations / Form IT-10004
Exclusion – Designated Professional Services / Form IT-1X87
Exclusion – Detective, Patrol or Security Companies Errors and Omissions / Form IT-10272
Exclusion – Electronic Data Processing Professional Liability / Form IT-1X86
Exclusion – Failure to Supply / Form IT-100012
Exclusion – Field of Entertainment / Form IT-1X74
Exclusion – Financial Institutions / Form IT-100013
Exclusion – German Pollution / Form IT-100016
Exclusion – Health, Medical or Cosmetic Malpractice and Professional Liability / Form IT-10016
Exclusion – Inspection, Appraisal and Survey Companies Professional Liability / Form IT-10274
Exclusion – Manufacturers of Protective Devices and Sprinkler Installers / Form IT-10174
Exclusion – Personal and Advertising Injury / Form IT-13188
Exclusion – Products/Completed Operations Hazard / Form IT-610202
Exclusion – Real Estate Errors and Omissions / Form IT-10278
Exclusion – Testing or Consultants Errors and Omissions / Form IT-10179
Exclusion – Tobacco / Form IT-10180
Exclusion – U. S. Suits / Form IT-10279
Injury to Participants Exclusion / Form IT-610400
Professional Liability Exclusion – Computer Software / Form IT-1X88
Waiver of Transfer of Rights of Recovery Against Others to Us / Form IT-10938
Commercial Property
Commercial Property/Business Income Coverage Declarations / Form IT-1X69
Extensions of Property Coverage / Form IT-1X75
Commercial Property Coverage Form / Form UW-2254B
Commercial Property and Business Income Conditions / Form UW-1102B
Causes of Loss – Special Form / Form UW-9K26A
Coinsurance Deficiency Endorsement / Form IT-612315
Electronic Data Amendment Endorsement / Form IT-12932
Additional Causes of Loss – Flood and Earthquake / Form IT-1X78
Inflation Guard Endorsement / Form IT-612312
Terrorism-War Exclusion / Form IT-10183
Business Income Forms – use only when this coverage is provided
Extensions of Business Income and Extra Expense Coverage / Form It-1X66
Business Income and Extra Expense Coverage / Form UW-2455C
Optional Endorsements
Cargo Coverage Endorsement / Form IT-1X67
Mortgage Holders / Form IT-1X84
Kidnap & Extortion
Kidnap & Extortion Declarations / Form IT 607685b
Corporate Kidnap & Extortion Coverage / Form IT-607668b
Kidnap & Extortion Declarations – including Church Members / Form IT-607685x
Kidnap & Extortion Declarations – including Students / Form IT-607685w
Accidental Death & Dismemberment
Accidental Death & Dismemberment and Medical Coverage / Form IT-607737C
Accidental Death & Dismemberment and Medical Coverage for Educational Services / Form IT-607738C
Accidental Death & Dismemberment and Medical Coverage including Occupational Injury / Form IT-8Z30
Employee Dishonesty
Employee Dishonesty Coverage Declarations / Form IT-1X76
Employee Dishonesty Coverage / Form UW-2403

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Employers Responsibility
Employers Responsibility Coverage Declarations / Form IT-1X70
Employers Responsibility Coverages with Executive Assistance / Form UW-601658D
Medical, Personal and Travel Assistance Services / Form EA-0002
Security Assistance Services / Form EA-0001
Policy Inserts affixed to front of policy when Employers Responsibility coverage is provided
CityBrief website access information / Stocked locally
Worldwide Assistance Identification Cards (10) / Item #616002
Medical Assistance Telephone Numbers / Item #616003
Optional Endorsements
Exclusion – Argentina Employers Liability / Form IT-11591
Maritime Employers Liability Endorsement / Form IT-10191
Sole Proprietor Endorsement / Form IT-10199

Liberalization

During the policy year, and any subsequent renewal, we may replace any of the above forms with a revised form of the same form number as shown above. You will have the benefit of any changes in coverage in the revised form as though the changes had been part of this policy at the beginning of the policy year in which we first used such form to replace the form of the same number listed above.

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