Policy Forms and Endorsements IT IS WOLTERS KLUWER 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 5 WOLTERS KLUWER Customer Support: 800-382-2424
-------------------------------------------------------- GENERAL USE/STATE SPECIFIC -------------------------------------------------------- (A) BT6001 AAIS 05.08 ADDITIONAL INSURED AL, AR, AZ, CA, CO, CT, DC, DE, BT6000 AAIS 05.08 ADDITIONAL INTERESTS AL, AR, AZ, CA, CO, CT, DC, DE, TN, TX, UT, VT, WA, WI, WV, WY BT1608 AAIS 05.08 AGREED VALUE LOSS PAYEE PROVISION NH BT1602 AAIS 05.08 AGREED VALUE LOSS PAYEE PROVISION MS BT1612 AAIS 05.08 AGREED VALUE LOSS PAYEE PROVISION MN BT1606 AAIS 05.08 AGREED VALUE LOSS PROVISION NJ BT4800 AAIS 05.08 AGREED VALUE SETTLEMENT PROVISION AL, AR, AZ, CA, CO, CT, DC, DE, TN, TX, UT, VA, VT, WI, WV, WY BT1604 AAIS 05.08 AGREED VALUE SETTLEMENT PROVISION WA BT0837 AAIS 05.13 AMENDATORY ENDORSEMENT - PENNSYLVANIA PA BT0801 AAIS 05.13 AMENDATORY ENDORSEMENT - ALABAMA AL BT0854 AAIS 05.13 AMENDATORY ENDORSEMENT - ALASKA AK BT0802 AAIS 05.13 AMENDATORY ENDORSEMENT - ARIZONA AZ BT0803 AAIS 05.08 AMENDATORY ENDORSEMENT - ARKANSAS AR BT0803 AAIS 05.13 AMENDATORY ENDORSEMENT - ARKANSAS AR BT0804 AAIS 05.13 AMENDATORY ENDORSEMENT - CALIFORNIA CA BT0859 AAIS 05.13 AMENDATORY ENDORSEMENT - COLORADO CO BT0806 AAIS 05.13 AMENDATORY ENDORSEMENT - CONNECTICUT CT BT0861 AAIS 05.13 AMENDATORY ENDORSEMENT - DELAWARE DE BT0860 AAIS 05.13 AMENDATORY ENDORSEMENT - DISTRICT OF COLUMBIA DC BT0810 AAIS 05.13 AMENDATORY ENDORSEMENT - GEORGIA GA BT0852 AAIS 05.13 AMENDATORY ENDORSEMENT - HAWAII HI BT0864 AAIS 05.13 AMENDATORY ENDORSEMENT - IDAHO ID BT0812 AAIS 05.13 AMENDATORY ENDORSEMENT - ILLINOIS IL BT0813 AAIS 08.13 AMENDATORY ENDORSEMENT - INDIANA IN BT0814 AAIS 05.13 AMENDATORY ENDORSEMENT - IOWA IA BT0815 AAIS 10.17 AMENDATORY ENDORSEMENT - KANSAS KS BT0816 AAIS 05.13 AMENDATORY ENDORSEMENT - KENTUCKY KY BT0817 AAIS 05.13 AMENDATORY ENDORSEMENT - LOUISIANA LA BT0818 AAIS 05.13 AMENDATORY ENDORSEMENT - MAINE ME BT0819 AAIS 05.13 AMENDATORY ENDORSEMENT - MARYLAND MD BT0820 AAIS 05.13 AMENDATORY ENDORSEMENT - MASSACHUSETTS MA BT0821 AAIS 05.13 AMENDATORY ENDORSEMENT - MICHIGAN MI BT0822 AAIS 05.13 AMENDATORY ENDORSEMENT - MINNESOTA MN BT0823 AAIS 05.13 AMENDATORY ENDORSEMENT - MISSISSIPPI MS BT0824 AAIS 10.13 AMENDATORY ENDORSEMENT - MISSOURI MO BT0825 AAIS 05.13 AMENDATORY ENDORSEMENT - MONTANA MT BT0826 AAIS 05.13 AMENDATORY ENDORSEMENT - NEBRASKA NE BT0827 AAIS 05.08 AMENDATORY ENDORSEMENT - NEVADA NV BT0862 AAIS 05.13 AMENDATORY ENDORSEMENT - NEVADA NV BT0828 AAIS 05.13 AMENDATORY ENDORSEMENT - NEW HAMPSHIRE NH BT0829 AAIS 05.13 AMENDATORY ENDORSEMENT - NEW JERSEY NJ BT0830 AAIS 05.13 AMENDATORY ENDORSEMENT - NEW MEXICO NM PAGE 2 of 5 WOLTERS KLUWER Customer Support: 800-382-2424
BT0832 AAIS 05.13 AMENDATORY ENDORSEMENT - NORTH CAROLINA NC BT0833 AAIS 05.13 AMENDATORY ENDORSEMENT - NORTH DAKOTA ND BT0834 AAIS 05.13 AMENDATORY ENDORSEMENT - OHIO OH BT0835 AAIS 07.18 AMENDATORY ENDORSEMENT - OKLAHOMA OK BT0836 AAIS 05.13 AMENDATORY ENDORSEMENT - OREGON OR BT0858 AAIS 03.17 AMENDATORY ENDORSEMENT - PUERTO RICO PR BT0838 AAIS 05.13 AMENDATORY ENDORSEMENT - RHODE ISLAND RI BT0839 AAIS 05.13 AMENDATORY ENDORSEMENT - SOUTH CAROLINA SC BT0840 AAIS 05.13 AMENDATORY ENDORSEMENT - SOUTH DAKOTA SD BT0863 AAIS 05.13 AMENDATORY ENDORSEMENT - TENNESSEE TN BT0842 AAIS 05.13 AMENDATORY ENDORSEMENT - TEXAS TX BT0843 AAIS 05.13 AMENDATORY ENDORSEMENT - UTAH UT BT0844 AAIS 05.13 AMENDATORY ENDORSEMENT - VERMONT VT BT0845 AAIS 05.13 AMENDATORY ENDORSEMENT - VIRGINIA VA BT0846 AAIS 05.13 AMENDATORY ENDORSEMENT - WASHINGTON WA BT0847 AAIS 05.13 AMENDATORY ENDORSEMENT - WEST VIRGINIA WV BT0848 AAIS 05.13 AMENDATORY ENDORSEMENT - WISCONSIN WI BT0849 AAIS 05.13 AMENDATORY ENDORSEMENT - WYOMING WY (C) (New) CL0811 AAIS 09.18 CANNABIS ITEMS AND ACTIVITIES EXCLUSION AK, AR, AZ, CA, CO, DC, ME, MI, MN, NV, WA CL0810 AAIS 08.17 CANNABIS ITEMS AND ACTIVITIES EXCLUSION - OREGON OR BT1609 AAIS 05.08 CHANGE ENDORSEMENT NH BT1501 AAIS 05.08 CHANGE ENDORSEMENT TX BT6500 AAIS 05.08 CHANGE ENDORSEMENT AL, AR, AZ, CA, CO, CT, DC, DE, MA, MD, ME, MI, MN, MO, MS, MT, NC, ND, NE, NJ, NM, NV, NY, CL0682 AAIS 06.13 CIVIL UNIONS AMENDMENT - COLORADO CO CL0679 AAIS 12.11 CIVIL UNIONS AMENDMENT - DELAWARE DE CL0681 AAIS 01.12 CIVIL UNIONS AMENDMENT - HAWAII HI CL0678 AAIS 07.11 CIVIL UNIONS AMENDMENT - ILLINOIS IL CL0680 AAIS 12.11 CIVIL UNIONS AMENDMENT - RHODE ISLAND RI (E) BT2500 AAIS 05.08 EXPANDED EMERGENCY SERVICE AL, AR, AZ, CA, CO, CT, DC, DE, (I) BT6501 AAIS 05.08 INSTALLMENT PREMIUM PAYMENTS AL, AR, AZ, CA, CO, CT, DC, DE, (L) BT2000 AAIS 05.08 LAY-UP PERIOD LIMITATION AL, AR, AZ, CA, CO, CT, DC, DE, CL0465 AAIS 01.01 LOSS PAYABLE ENDORSEMENT - WASHINGTON WA BT1605 AAIS 05.08 LOSS PAYEE PROVISION NJ BT1611 AAIS 05.08 LOSS PAYEE PROVISION MN BT1601 AAIS 05.08 LOSS PAYEE PROVISION MS BT1607 AAIS 05.08 LOSS PAYEE PROVISION NH PAGE 3 of 5 WOLTERS KLUWER Customer Support: 800-382-2424
(N) BT4500 AAIS 05.08 NAMED STORM DEDUCTIBLE AL, AR, AZ, CA, CO, CT, DC, DE, MA, MD, ME, MI, MN, MO, MS, MT, NC, ND, NE, NH, NM, NV, NY, OH, OR, PA, PR, RI, SC, SD, TN, (P) BT1603 AAIS 05.08 PERSONAL EFFECTS COVERAGE WA BT3000 AAIS 05.08 PERSONAL EFFECTS COVERAGE AL, AR, AZ, CA, CO, CT, DC, DE, TN, TX, UT, VA, VT, WI, WV, WY BT2001 AAIS 05.08 PERSONAL WATERCRAFT EXCLUSION AL, AR, AZ, CA, CO, CT, DC, DE, BT0901 AAIS 09.16 POLICY CONDITIONS - ALABAMA AK BT0902 AAIS 05.14 POLICY CONDITIONS - ARIZONA AZ BT0903 AAIS 05.08 POLICY CONDITIONS - ARKANSAS AR BT0904 AAIS 10.13 POLICY CONDITIONS - CALIFORNIA CA BT0900 AAIS 05.08 POLICY CONDITIONS - CANCELLATION AND NONRENEWAL CO, DE, HI, IN, OK, TN, WV BT0906 AAIS 05.08 POLICY CONDITIONS - CONNECTICUT CT BT0908 AAIS 05.08 POLICY CONDITIONS - DISTRICT OF COLUMBIA DC BT0910 AAIS 07.18 POLICY CONDITIONS - GEORGIA GA BT0911 AAIS 05.13 POLICY CONDITIONS - IDAHO ID BT0912 AAIS 11.17 POLICY CONDITIONS - ILLINOIS IL BT0914 AAIS 06.11 POLICY CONDITIONS - IOWA IA BT0915 AAIS 05.13 POLICY CONDITIONS - KANSAS KS BT0916 AAIS 05.13 POLICY CONDITIONS - KENTUCKY KY BT0917 AAIS 03.17 POLICY CONDITIONS - LOUISIANA LA BT0918 AAIS 05.08 POLICY CONDITIONS - MAINE ME BT0919 AAIS 10.14 POLICY CONDITIONS - MARYLAND MD BT0920 AAIS 05.08 POLICY CONDITIONS - MASSACHUSETTS MA BT0921 AAIS 09.10 POLICY CONDITIONS - MICHIGAN MI BT0922 AAIS 05.13 POLICY CONDITIONS - MINNESOTA MN BT0923 AAIS 05.08 POLICY CONDITIONS - MISSISSIPPI MS BT0924 AAIS 09.13 POLICY CONDITIONS - MISSOURI MO BT0925 AAIS 05.08 POLICY CONDITIONS - MONTANA MT BT0926 AAIS 05.08 POLICY CONDITIONS - NEBRASKA NE BT0927 AAIS 05.08 POLICY CONDITIONS - NEVADA NV BT0928 AAIS 10.09 POLICY CONDITIONS - NEW HAMPSHIRE NH BT0929 AAIS 05.08 POLICY CONDITIONS - NEW JERSEY NJ BT0930 AAIS 05.08 POLICY CONDITIONS - NEW MEXICO NM BT0931 AAIS 05.08 POLICY CONDITIONS - NEW YORK NY BT0932 AAIS 09.13 POLICY CONDITIONS - NORTH CAROLINA NC BT0933 AAIS 08.17 POLICY CONDITIONS - NORTH DAKOTA ND BT0934 AAIS 05.08 POLICY CONDITIONS - OHIO OH BT0936 AAIS 05.08 POLICY CONDITIONS - OREGON OR BT0937 AAIS 05.08 POLICY CONDITIONS - PENNSYLVANIA PA BT0958 AAIS 05.08 POLICY CONDITIONS - PUERTO RICO PR BT0938 AAIS 05.08 POLICY CONDITIONS - RHODE ISLAND RI BT0939 AAIS 06.13 POLICY CONDITIONS - SOUTH CAROLINA SC BT0940 AAIS 05.08 POLICY CONDITIONS - SOUTH DAKOTA SD BT0942 AAIS 05.08 POLICY CONDITIONS - TEXAS TX BT0943 AAIS 05.08 POLICY CONDITIONS - UTAH UT BT0944 AAIS 05.08 POLICY CONDITIONS - VERMONT VT PAGE 4 of 5 WOLTERS KLUWER Customer Support: 800-382-2424
BT0945 AAIS 04.13 POLICY CONDITIONS - VIRGINIA VA BT0946 AAIS 03.10 POLICY CONDITIONS - WASHINGTON WA BT0948 AAIS 05.08 POLICY CONDITIONS - WISCONSIN WI BT0949 AAIS 05.08 POLICY CONDITIONS - WYOMING WV BT0954 AAIS 02.15 POLICY CONDITIONS- ALASKA AK CL1060 AAIS 08.17 POLICYHOLDER NOTICE EXPENSE DEPRECIATION AR BT1303 AAIS 07.13 POLLUTANTS - AMENDED DEFINITION IN, MO BT1001 AAIS 05.08 PUNITIVE DAMAGE EXCLUSION AL BT1301 AAIS 05.08 PUNITIVE DAMAGE EXCLUSION AR, AZ, CA, CO, CT, DC, DE, IA, ID, IL, IN, KS, KY, MA, ME, MN, MO, NC, ND, NE, NH, NM, NV, NY, OK, OR, PA, RI, SC, SD, TN, UT, VA, VT, WA, WI, WV, WY BT1302 AAIS 05.11 PUNITIVE OR EXEMPLARY DAMAGES EXCLUSION OH (R) CL0351 AAIS 06.09 REGISTERED DOMESTIC PARTNERSHIP AMENDMENT - NV NEVADA BT6502 AAIS 05.08 RENEWAL PLAN AL, AR, CA, CO, CT, DC, DE, GA, HI, IA, ID, IL, IN, KS, KY, LA, MA, MD, ME, MI, MN, MO, MS, MT, BT1610 AAIS 05.08 RENEWAL PLAN AZ (S) CL0343 AAIS 06.08 STATE REGISTERED DOMESTIC PARTNERSHIP AMENDMENT - WASHINGTON (U) BT1002 AAIS 05.08 UNINSURED BOATER COVERAGE VA WA PAGE 5 of 5 WOLTERS KLUWER Customer Support: 800-382-2424