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1 Policy Forms and Endorsements IT IS WOLTERS KLUWER FINANCIAL SERVICES' POLICY TO LIMIT THE SALE OF BUREAU FORMS TO THE MEMBERS AND SUBSCRIBERS OF THOSE RESPECTIVE BUREAUS. PURCHASE AND USE OF BUREAU FORMS BY ENTITIES THAT ARE NOT MEMBERS OR SUBSCRIBERS TO THAT RESPECTIVE BUREAU COULD BE A VIOLATION OF THEIR COPYRIGHT. Forms are listed alphabetically by form title. PAGE 1 of 6 WOLTERS KLUWER FINANCIAL SERVICES Customer Care:
2 CL0347 AAIS SAMPLE DECLARATIONS (C) CR0350 AAIS COMMERCIAL CRIME COVERAGES DECLARATIONS, AL, AR, AZ, CA, CO, CT, DC, DE, FL, GA, HI, IA, ID, IL, IN, KS, KY, LA, MA, MD, ME, MI, MN, MO, MS, MT, NC, ND, NE, NH, NJ, NM, NV, NY, OH, OK, OR, PA, RI, SC, SD, TN, TX, UT, VA, VT,, WI, WV, WY COVERAGE FORMS (B) CR0303 AAIS BURGLARY AND ROBBERY COVERAGES-SAFE BURGLARY, CA, MT, PR, SD, TN, UT AND MESSENGER ROBBERY (C) CR0100 AAIS COMMERCIAL CRIME PROGRAM, CA, MT, PR, SD, TN, UT CR0311 AAIS COMPUTER FRAUD COVERAGE, CA, MT, PR, SD, TN, UT CR0313 AAIS COUNTERFEIT MONEY, MONEY ORDERS, AND TRAVELERS, CA, MT, PR, SD, TN, UT CHECKS CR0310 AAIS CRIME COVERAGES CR0310 AAIS CRIME COVERAGES, CA, MT, PR, SD, TN, UT (E) CR0308 AAIS EMPLOYEE DISHONESTY COVERAGE, CA, MT, PR, SD, TN, UT (F) CR0314 AAIS FORGERY COVERAGE, CA, MT, TN, UT (M) CR0304 AAIS MONEY AND SECURITIES COVERAGE - INSIDE AND OUTSIDE OF PREMISES, CA, MT, PR, SD, TN, UT (P) CR0302 AAIS PREMISES BURGLARY AND ROBBERY COVERAGE, CA, MT, PR, SD, TN, UT CR0312 AAIS PREMISES LIABILITY FOR GUESTS' PROPERTY, CA, MT, PR, SD, TN, UT (T) CR0307 AAIS THEFT COVERAGE - CHURCHES, CA, MT, PR, SD, TN, UT CR0306 AAIS THEFT COVERAGE - PROPERTY OTHER THAN MONEY AND SECURITIES GENERAL USE/STATE SPECIFIC (A) CL0172 AAIS AMENDATORY ENDORSEMENT - DISTRICT OF COLUMBIA DC CR0406 AAIS AMENDATORY ENDORSEMENT - ALASKA CR0406 AAIS AMENDATORY ENDORSEMENT - ALASKA CR0406 AAIS AMENDATORY ENDORSEMENT - ALASKA, CA, MT, PR, SD, TN, UT CL0192 AAIS AMENDATORY ENDORSEMENT - ALASKA (BUSINESS OR COMMERCIAL CL0148 AAIS AMENDATORY ENDORSEMENT - ARIZONA AZ CR0408 AAIS AMENDATORY ENDORSEMENT - ARIZONA AZ CR0408 AAIS AMENDATORY ENDORSEMENT - ARIZONA CL297 AAIS 1.0 AMENDATORY ENDORSEMENT - ARIZONA AZ CR0407 AAIS AMENDATORY ENDORSEMENT - ARKANSAS AR CL0178 AAIS AMENDATORY ENDORSEMENT - ARKANSAS AR CL0162 AAIS AMENDATORY ENDORSEMENT - CALIFORNIA CA CL0182 AAIS AMENDATORY ENDORSEMENT - COLORADO CO CR0443 AAIS AMENDATORY ENDORSEMENT - CONNECTICUT CT CL0180 AAIS AMENDATORY ENDORSEMENT - CONNECTICUT CT PAGE 2 of 6 WOLTERS KLUWER FINANCIAL SERVICES Customer Care:
3 CL0180 AAIS AMENDATORY ENDORSEMENT - CONNECTICUT CT CL0160 AAIS AMENDATORY ENDORSEMENT - FLORIDA FL CR0410 AAIS AMENDATORY ENDORSEMENT - FLORIDA FL CR0434 AAIS AMENDATORY ENDORSEMENT - HAII HI CL0195 AAIS AMENDATORY ENDORSEMENT - IDAHO ID CL0120 AAIS AMENDATORY ENDORSEMENT - ILLINOIS IL CR0429 AAIS AMENDATORY ENDORSEMENT - ILLINOIS IL CL0188 AAIS AMENDATORY ENDORSEMENT - INDIANA IN CR0416 AAIS AMENDATORY ENDORSEMENT - INDIANA IN CL0190 AAIS AMENDATORY ENDORSEMENT - IO IA CR0400 AAIS AMENDATORY ENDORSEMENT - KANSAS KS CL0122 AAIS AMENDATORY ENDORSEMENT - KANSAS KS CR0433 AAIS AMENDATORY ENDORSEMENT - LOUISIANA CR0433 AAIS AMENDATORY ENDORSEMENT - LOUISIANA LA CL0196 AAIS AMENDATORY ENDORSEMENT - LOUISIANA LA CR0433 AAIS AMENDATORY ENDORSEMENT - LOUISIANA CL0116 AAIS AMENDATORY ENDORSEMENT - MAINE ME CL0168 AAIS AMENDATORY ENDORSEMENT - MARYLAND MD CR0412 AAIS AMENDATORY ENDORSEMENT - MARYLAND MD CR0430 AAIS AMENDATORY ENDORSEMENT - MASSACHUESETTS MA CL0233 AAIS AMENDATORY ENDORSEMENT - MASSACHUSETTS MA CR0422 AAIS AMENDATORY ENDORSEMENT - MICHIGAN MI CL0200 AAIS AMENDATORY ENDORSEMENT - MICHIGAN MI CL0142 AAIS AMENDATORY ENDORSEMENT - MINNESOTA MN CR0428 AAIS AMENDATORY ENDORSEMENT - MINNESOTA MN CL0206 AAIS AMENDATORY ENDORSEMENT - MISSISSIPPI MS CR0315 AAIS AMENDATORY ENDORSEMENT - MISSISSIPPI MS CR0417 AAIS AMENDATORY ENDORSEMENT - MISSOURI MO CL0171 AAIS AMENDATORY ENDORSEMENT - MISSOURI MO CL0171 AAIS AMENDATORY ENDORSEMENT - MISSOURI MO CL0171 AAIS AMENDATORY ENDORSEMENT - MISSOURI MO CL0144 AAIS AMENDATORY ENDORSEMENT - MONTANA MT CR0418 AAIS AMENDATORY ENDORSEMENT - MONTANA MT CR0415 AAIS AMENDATORY ENDORSEMENT - NEBRASKA NE CR0415 AAIS AMENDATORY ENDORSEMENT - NEBRASKA CL0176 AAIS AMENDATORY ENDORSEMENT - NEVADA NV CR0442 AAIS AMENDATORY ENDORSEMENT - NEVADA NV CL0138 AAIS AMENDATORY ENDORSEMENT - NEW HAMPSHIRE NH CL0138 AAIS AMENDATORY ENDORSEMENT - NEW HAMPSHIRE NH CR0437 AAIS AMENDATORY ENDORSEMENT - NEW MEXICO NM CL0140 AAIS AMENDATORY ENDORSEMENT - NEW YORK NY CR0426 AAIS AMENDATORY ENDORSEMENT - NEW YORK CR0426 AAIS AMENDATORY ENDORSEMENT - NEW YORK NY CL0158 AAIS AMENDATORY ENDORSEMENT - NORTH CAROLINA NC CR0401 AAIS AMENDATORY ENDORSEMENT - NORTH CAROLINA NC CR0413 AAIS AMENDATORY ENDORSEMENT - NORTH DOTA CL0186 AAIS AMENDATORY ENDORSEMENT - NORTH DOTA ND CR0413 AAIS AMENDATORY ENDORSEMENT - NORTH DOTA ND CL248 AAIS 1.0 AMENDATORY ENDORSEMENT - NORTH DOTA ND CR0163 AAIS AMENDATORY ENDORSEMENT - OHIO OH CL0126 AAIS AMENDATORY ENDORSEMENT - OHIO OH CR0419 AAIS AMENDATORY ENDORSEMENT - OKLAHOMA OK CL0150 AAIS AMENDATORY ENDORSEMENT - OKLAHOMA OK CR0419 AAIS AMENDATORY ENDORSEMENT - OKLAHOMA CR0420 AAIS AMENDATORY ENDORSEMENT - PENNSYLVANIA CR0420 AAIS AMENDATORY ENDORSEMENT - PENNSYLVANIA PA CL0124 AAIS AMENDATORY ENDORSEMENT - PENNSYLVANIA PA CL0277 AAIS AMENDATORY ENDORSEMENT - PUERTO RICO PR CR0435 AAIS AMENDATORY ENDORSEMENT - PUERTO RICO PR PAGE 3 of 6 WOLTERS KLUWER FINANCIAL SERVICES Customer Care:
4 CL0166 AAIS AMENDATORY ENDORSEMENT - RHODE ISLAND RI CL0114 AAIS AMENDATORY ENDORSEMENT - SOUTH CAROLINA SC CR0414 AAIS AMENDATORY ENDORSEMENT - SOUTH CAROLINA SC CL0291 AAIS AMENDATORY ENDORSEMENT - SOUTH DOTA SD CR0421 AAIS AMENDATORY ENDORSEMENT - SOUTH DOTA SD CR0421 AAIS AMENDATORY ENDORSEMENT - SOUTH DOTA CL0273 AAIS AMENDATORY ENDORSEMENT - TEXAS TX CR0438 AAIS AMENDATORY ENDORSEMENT - TEXAS TX CL0164 AAIS AMENDATORY ENDORSEMENT - UTAH UT CR0423 AAIS AMENDATORY ENDORSEMENT - UTAH CR0423 AAIS AMENDATORY ENDORSEMENT - UTAH UT CL0132 AAIS AMENDATORY ENDORSEMENT - VERMONT VT CR0427 AAIS AMENDATORY ENDORSEMENT - VERMONT VT CR0330 AAIS AMENDATORY ENDORSEMENT VIRGINIA VA CR0424 AAIS AMENDATORY ENDORSEMENT - WEST VIRGINIA CR0424 AAIS AMENDATORY ENDORSEMENT - WEST VIRGINIA WV CL0197 AAIS AMENDATORY ENDORSEMENT - WISCONSIN WI CR402 AAIS 2.0 AMENDATORY ENDORSEMENT - WISCONSIN WI CR0404 AAIS AMENDATORY ENDORSEMENT - WYOMING CR0404 AAIS AMENDATORY ENDORSEMENT - WYOMING WY CL0130 AAIS AMENDATORY ENDORSEMENT - WYOMING WY CR0439 AAIS AMENDATORY ENDORSEMENT ALABAMA AL CR0439 AAIS AMENDATORY ENDORSEMENT ALABAMA AL CR0425 AAIS AMENDATORY ENDORSEMENT -NEW HAMPSHIRE NH CR0425 AAIS AMENDATORY ENDORSEMENT -NEW HAMPSHIRE CR0405 AAIS AMENDATORY ENDORSEMENT -SHINGTON CR0402 AAIS AMENDATORY ENDORSEMENT -WISCONSIN CR0402 AAIS AMENDATORY ENDORSEMENT -WISCONSIN WI CL0128 AAIS AMENDATORY ENDORSEMENT-GEORGIA GA CR0440 AAIS AMENDATORY ENDORSEMENT-GEORGIA GA CL0156 AAIS AMENDATORY ENDORSEMENT-KENTUCKY KY CR0441 AAIS AMENDATORY ENDORSEMENT-KENTUCKY KY CR0411 AAIS AMENDATORY ENDORSEMENT-MAINE ME CR0411 AAIS AMENDATORY ENDORSEMENT-MAINE CL0154 AAIS AMENDATORY ENDORSEMENT-NEBRASKA NE CL0146 AAIS AMENDATORY ENDORSEMENT-NEW JERSEY NJ CL0136 AAIS AMENDATORY ENDORSEMENT-OREGON OR CL0118 AAIS AMENDATORY ENDORSEMENT-TENNESSEE TN CP390 AAIS 2.0 AMENDMENT OF POLICY TERMS - OREGON OR (B) CL0650 AAIS BIOLOGICAL AND CHEMICAL NON-CERTIFIED ACT OF TERRORISM AND R AND MILITARY ACTION CL0650 AAIS BIOLOGICAL AND CHEMICAL NON-CERTIFIED ACT OF TERRORISM AND R AND MILITARY ACTION CL0650 AAIS BIOLOGICAL AND CHEMICAL NON-CERTIFIED ACT OF TERRORISM AND R AND MILITARY ACTION, AL, AR, AZ, CA, CO, CT, DC, UT, VA, VI, VT,, WI, WV, WY (C) CL0610 AAIS CERTIFIED ACT OF TERRORISM CL0610 AAIS CERTIFIED ACT OF TERRORISM AL, AR, AZ, CO, CT, DC, DE, FL, GA, HI, IA, ID, IL, IN, KS, KY, LA, MA, MD, ME, MI, MN, MS, MT, NC, ND, NE, NH, NJ, NM, PAGE 4 of 6 WOLTERS KLUWER FINANCIAL SERVICES Customer Care:
5 NV, NY, OH, OK, PA, PR, RI, SC, SD, TN, TX, UT, VA, VT, WV, WY CL0610 AAIS CERTIFIED ACT OF TERRORISM, AZ CL0600 AAIS CERTIFIED TERRORISM LOSS, AL, AR, AZ, CA, CO, CT, DC, DE, FL, GA, HI, IA, ID, IL, IN, KS, KY, LA, MA, MD, ME, MI, UT, VA, VT,, WI, WV, WY CL1605 AAIS CERTIFIED TERRORISM LOSS DISCLOSURE OF PREMIUM AND FEDERAL SHARE OF INSURED LOSSES, AL, AR, AZ, CA, CO, CT, DC, DE, GA, HI, IA, ID, IL, IN, KS, KY, LA, MA, MD, ME, MI, MN, MO, MS, MT, NC, ND, NE, NH, NJ, NM, NV, OH, OK, OR, PA, PR, RI, SC, SD, TN, TX, UT, VA, VT,, WI, WV, WY CL0101 AAIS COMMON POLICY CONDITIONS - VIRGINIA VA CL0103 AAIS COMMON POLICY CONDITIONS - SHINGTON CL1650 AAIS CONDITIONAL NUCLEAR, BIOLOGICAL, AND CHEMICAL TERRORISM AL, AR, AZ, CO, CT, DC, DE, HI, IA, ID, IL, IN, KS, KY, LA, MA, MD, MI, MN, MS, MT, NC, ND, NE, NH, NJ, NM, NV, OH, OK, PA, PR, RI, SC, SD, TN, TX, UT, VA, VT, WV, WY CL1650 AAIS CONDITIONAL NUCLEAR, BIOLOGICAL, AND CHEMICAL TERRORISM CL1650 AAIS CONDITIONAL NUCLEAR, BIOLOGICAL, AND CHEMICAL TERRORISM CL2660 AAIS CONDITIONAL NUCLEAR, BIOLOGICAL, AND CHEMICAL CA, MA, ME, MO, OR, WI TERRORISM (WITH LIMITED EXCEPTION) CL1660 AAIS CONDITIONAL NUCLEAR, BIOLOGICAL, AND CHEMICAL TERRORISM (WITH LIMITED EXCEPTION) CA, CT, HI, IA, ID, IL, MA, MD, ME, MO, NC, NJ, OR, PA, RI, VA, WI, WV CL2660 AAIS CONDITIONAL NUCLEAR, BIOLOGICAL, AND CHEMICAL TERRORISM (WITH LIMITED EXCEPTION) CL1630 AAIS CONDITIONAL TERRORISM AL, AR, AZ, CO, CT, DC, DE, HI, IA, ID, IL, IN, KS, KY, LA, MA, MD, MI, MN, MO, MS, MT, NC, ND, NE, NH, NJ, NM, NV, OH, OK, OR, PA, PR, RI, SC, SD, TN, TX, UT, VA, VT,, WV, WY CL1630 AAIS CONDITIONAL TERRORISM CL1630 AAIS CONDITIONAL TERRORISM CL1640 AAIS CONDITIONAL TERRORISM (WITH LIMITED EXCEPTION) CA, CT, HI, IA, ID, IL, MA, MD, ME, MO, NC, NJ, OR, PA, RI, VA, WI, WV (E) CR0432 AAIS EMPLOYEE DISHONESTY COVERAGE - DELETED EMPLOYEES, CA, MT, NM, PR, SD, TN, UT CR0436 AAIS EMPLOYEE DISHONESTY COVERAGE - JEWELRY, TCHES,, CA, MT, PR, SD, TN, UT JEWELS, PEARLS, PRECIOUS STONES, AND METALS (G) CL0167 AAIS GUARANTY ASSOCIATION COVERAGE LIMITATIONS - MISSOURI MO (I) ML0120 AAIS INSURANCE CONSULTATION SERVICES EXEMPTION ACT - NOTICE (N) CL0630 AAIS NON-CERTIFIED ACT OF TERRORISM AND R AND MILITARY ACTION CL0630 AAIS NON-CERTIFIED ACT OF TERRORISM AND R AND MILITARY ACTION CL0630 AAIS PA PAGE 5 of 6 WOLTERS KLUWER FINANCIAL SERVICES Customer Care:
6 NON-CERTIFIED ACT OF TERRORISM AND R AND MILITARY ACTION CL2650 AAIS NUCLEAR, BIOLOGICAL, AND CHEMICAL TERRORISM, AL, AR, AZ, CA, CO, CT, DC, UT, VA, VI, VT,, WI, WV, WY AL, AR, AZ, CO, CT, DC, DE, HI, IA, ID, IL, IN, KS, KY, LA, MA, MD, MI, MN, MS, MT, NC, ND, NE, NH, NJ, NM, NV, OH, OK, PA, PR, RI, SC, SD, TN, TX, UT, VA, VT, WV, WY CL2650 AAIS NUCLEAR, BIOLOGICAL, AND CHEMICAL TERRORISM CL2650 AAIS NUCLEAR, BIOLOGICAL, AND CHEMICAL TERRORISM (O) CL0276 AAIS OKLAHOMA NOTICE OK (P) CL1045 AAIS POLICYHOLDER DISCLOSURE NOTICE OF TERRORISM INSURANCE COVERAGE CL1035 AAIS POLICYHOLDER DISCLOSURE NOTICE OF TERRORISM INSURANCE COVERAGE, AL, AR, AZ, CA, CO, CT, DC, DE, FL, GA, HI, IA, ID, IL, IN, KS, KY, LA, MA, MD, ME, MI, MN, MO, MS, MT, NC, ND, NE, NH, NJ, NM, NV, OH, OK, UT, VA, VT,, WI, WV, WY, AL, AR, AZ, CA, CO, CT, DC, UT, VA, VI, VT,, WI, WV, WY CR0155 AAIS PREMIUM PAYMENTS, CA, MT, PR, SD, TN, UT (R) CR0162 AAIS RESIDENT AGENT COUNTERSIGNATURE CA, MT, PR, SD, TN, UT (T) CL2630 AAIS TERRORISM AL, AR, AZ, CA, CO, CT, DC, DE, HI, IA, ID, IL, IN, KS, KY, LA, MA, MD, ME, MI, MN, MO, MS, MT, NC, ND, NE, NH, NJ, NM, NV, OH, OK, OR, PA, PR, RI, SC, SD, TN, TX, UT, VA, VT, WI, WV, WY CL2630 AAIS TERRORISM CL2630 AAIS TERRORISM CL2640 AAIS TERRORISM (WITH LIMITED EXCEPTION) AZ, CA, CT, HI, IA, ID, IL, MA, ME, MO, NC, ND, NJ, OR, PA, RI, VA, WI, WV (W) CL0468 AAIS R, MILITARY ACTION, AND TERRORISM S, AL, AR, AZ, CA, CO, CT, DC, UT, VA, VI, VT,, WI, WV, WY CL0468 AAIS R, MILITARY ACTION, AND TERRORISM S CL0468 AAIS R, MILITARY ACTION, AND TERRORISM S PAGE 6 of 6 WOLTERS KLUWER FINANCIAL SERVICES Customer Care:
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