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 6 WOLTERS KLUWER Customer Support: 800-382-2424
-------------------------------------------------------- GENERAL USE/STATE SPECIFIC -------------------------------------------------------- (A) YT4800 AAIS 09.10 ACTUAL CASH VALUE SETTLEMENT PROVISION - PROPERTY COVERAGE AK, AL, AR, AZ, CA, CO, CT, DC, YT6001 AAIS 09.10 ADDITIONAL INSURED AK, AL, AR, AZ, CA, CO, CT, DC, YT6000 AAIS 09.10 ADDITIONAL INTERESTS AK, AL, AR, AZ, CA, CO, CT, DC, YT0801 AAIS 06.13 AMENDATORY ENDORSEMENT - ALABAMA AL YT0854 AAIS 06.13 AMENDATORY ENDORSEMENT - ALASKA AK YT0802 AAIS 06.13 AMENDATORY ENDORSEMENT - ARIZONA AZ YT0803 AAIS 06.13 AMENDATORY ENDORSEMENT - ARKANSAS AR YT0804 AAIS 01.12 AMENDATORY ENDORSEMENT - CALIFORNIA CA YT0804 AAIS 06.13 AMENDATORY ENDORSEMENT - CALIFORNIA CA YT0859 AAIS 06.13 AMENDATORY ENDORSEMENT - COLORADO CO YT0806 AAIS 09.10 AMENDATORY ENDORSEMENT - CONNECTICUT CT YT0861 AAIS 06.13 AMENDATORY ENDORSEMENT - DELAWARE DE YT0860 AAIS 06.13 AMENDATORY ENDORSEMENT - DISTRICT OF COLUMBIA DC YT0809 AAIS 06.13 AMENDATORY ENDORSEMENT - FLORIDA FL YT0810 AAIS 06.13 AMENDATORY ENDORSEMENT - GEORGIA GA YT0852 AAIS 06.13 AMENDATORY ENDORSEMENT - HAWAII HI YT0852 AAIS 09.10 AMENDATORY ENDORSEMENT - HAWAII HI YT0864 AAIS 06.13 AMENDATORY ENDORSEMENT - IDAHO ID YT0812 AAIS 06.13 AMENDATORY ENDORSEMENT - ILLINOIS IL YT0813 AAIS 09.13 AMENDATORY ENDORSEMENT - INDIANA IN YT0814 AAIS 06.13 AMENDATORY ENDORSEMENT - IOWA IA YT0815 AAIS 11.17 AMENDATORY ENDORSEMENT - KANSAS KS YT0816 AAIS 06.13 AMENDATORY ENDORSEMENT - KENTUCKY KY YT0817 AAIS 06.13 AMENDATORY ENDORSEMENT - LOUISIANA LA YT0818 AAIS 06.13 AMENDATORY ENDORSEMENT - MAINE ME YT0819 AAIS 06.13 AMENDATORY ENDORSEMENT - MARYLAND MD YT0820 AAIS 06.13 AMENDATORY ENDORSEMENT - MASSACHUSETTS MA YT0820 AAIS 09.10 AMENDATORY ENDORSEMENT - MASSACHUSETTS MA YT0821 AAIS 06.13 AMENDATORY ENDORSEMENT - MICHIGAN MI YT0822 AAIS 06.13 AMENDATORY ENDORSEMENT - MINNESOTA MN YT0823 AAIS 06.13 AMENDATORY ENDORSEMENT - MISSISSIPPI MS YT0824 AAIS 10.13 AMENDATORY ENDORSEMENT - MISSOURI MO YT0825 AAIS 06.13 AMENDATORY ENDORSEMENT - MONTANA MT YT0826 AAIS 06.13 AMENDATORY ENDORSEMENT - NEBRASKA NE YT0827 AAIS 06.13 AMENDATORY ENDORSEMENT - NEVADA NV YT0828 AAIS 06.13 AMENDATORY ENDORSEMENT - NEW HAMPSHIRE NH YT0829 AAIS 06.13 AMENDATORY ENDORSEMENT - NEW JERSEY NJ YT0830 AAIS 06.13 AMENDATORY ENDORSEMENT - NEW MEXICO NM YT0831 AAIS 06.13 AMENDATORY ENDORSEMENT - NEW YORK NY PAGE 2 of 6 WOLTERS KLUWER Customer Support: 800-382-2424
YT0832 AAIS 06.13 AMENDATORY ENDORSEMENT - NORTH CAROLINA NC YT0833 AAIS 06.13 AMENDATORY ENDORSEMENT - NORTH DAKOTA ND YT0834 AAIS 06.13 AMENDATORY ENDORSEMENT - OHIO OH YT0835 AAIS 06.13 AMENDATORY ENDORSEMENT - OKLAHOMA OK YT0836 AAIS 06.13 AMENDATORY ENDORSEMENT - OREGON OR YT0837 AAIS 06.13 AMENDATORY ENDORSEMENT - PENNSYLVANIA PA YT0858 AAIS 03.17 AMENDATORY ENDORSEMENT - PUERTO RICO PR YT0838 AAIS 06.13 AMENDATORY ENDORSEMENT - RHODE ISLAND RI YT0839 AAIS 06.13 AMENDATORY ENDORSEMENT - SOUTH CAROLINA SC YT0840 AAIS 06.13 AMENDATORY ENDORSEMENT - SOUTH DAKOTA SD YT0863 AAIS 06.13 AMENDATORY ENDORSEMENT - TENNESSEE TN YT0842 AAIS 06.13 AMENDATORY ENDORSEMENT - TEXAS TX YT0843 AAIS 06.13 AMENDATORY ENDORSEMENT - UTAH UT YT0844 AAIS 06.13 AMENDATORY ENDORSEMENT - VERMONT VT YT0845 AAIS 06.13 AMENDATORY ENDORSEMENT - VIRGINIA VA YT0845 AAIS 09.10 AMENDATORY ENDORSEMENT - VIRGINIA VA YT0846 AAIS 06.13 AMENDATORY ENDORSEMENT - WASHINGTON WA YT0847 AAIS 06.13 AMENDATORY ENDORSEMENT - WEST VIRGINIA WV YT0848 AAIS 06.13 AMENDATORY ENDORSEMENT - WISCONSIN WI YT0849 AAIS 06.13 AMENDATORY ENDORSEMENT - WYOMING WY CL0346 AAIS 11.08 ATTORNEY'S FEES COVERAGE NOTICE - ALASKA AK (B) YT3501 AAIS 09.10 BUSINESS MEETING AND ENTERTAINMENT COVERAGE AK, AL, AR, AZ, CA, CO, CT, DC, (C) CL0810 AAIS 08.17 CANNABIS ITEMS AND ACTIVITIES EXCLUSION - OREGON OR YT4001 AAIS 06.13 CAPTAIN AND CREW COVERAGE AK, AL, AR, AZ, CO, DC, DE, FL, GA, IA, ID, IL, IN, KS, KY, LA, MD, ME, MI, MN, MO, MS, MT, NC, ND, NE, NH, NJ, NM, NV, NY, OH, OK, OR, PA, RI, SC, SD, TN, TX, YT3502 AAIS 09.10 CHARTERING COVERAGE AK, AL, AR, AZ, CA, CO, CT, DC, 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 CL0491 AAIS 01.08 CIVIL UNIONS AMENDMENT - NEW HAMPSHIRE NH CL0321 AAIS 01.07 CIVIL UNIONS AMENDMENT - NEW JERSEY NJ CL0680 AAIS 12.11 CIVIL UNIONS AMENDMENT - RHODE ISLAND RI CL0453 AAIS 12.00 CIVIL UNIONS AMENDMENT - VERMONT VT (D) CL0105 AAIS 07.07 DOMESTIC PARTNERSHIP AMENDMENT - OREGON OR (E) YT4501 AAIS 09.10 ELECTRONIC EQUIPMENT DEDUCTIBLE AK, AL, AR, AZ, CA, CO, CT, DC, PAGE 3 of 6 WOLTERS KLUWER Customer Support: 800-382-2424
(G) CL0167 AAIS 05.05 GUARANTY ASSOCIATION COVERAGE LIMITATIONS - MISSOURI (I) YT2700 AAIS 09.10 ICE DAMAGE OR FREEZING COVERAGE AK, AL, AR, AZ, CA, CO, CT, DC, YT6501 AAIS 09.10 INSTALLMENT PREMIUM PAYMENTS AK, 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, YT0157 AAIS 09.10 INSURANCE CONSULTATION SERVICES EXEMPTION ACT - PA NOTICE - PENNSYLVANIA (L) YT2000 AAIS 09.10 LIMITED NAVIGATION PERIOD AK, AL, AR, AZ, CA, CO, CT, DC, CL0465 AAIS 01.01 LOSS PAYABLE ENDORSEMENT - WASHINGTON WA YT6002 AAIS 09.10 LOSS PAYEE PROVISION AK, AL, AR, AZ, CA, CO, CT, DC, DE, FL, GA, HI, IA, ID, IN, KS, KY, LA, MA, MD, ME, MI, MO, MT, NC, ND, NE, NM, NV, NY, OH, OK, OR, PA, PR, RI, SC, SD, TN, TX, YT1613 AAIS 09.10 LOSS PAYEE PROVISION - ILLINOIS IL YT1611 AAIS 09.10 LOSS PAYEE PROVISION - MINNESOTA MN YT1601 AAIS 09.10 LOSS PAYEE PROVISION - MISSISSIPPI MS YT1607 AAIS 09.10 LOSS PAYEE PROVISION - NEW HAMPSHIRE NH YT1605 AAIS 09.10 LOSS PAYEE PROVISION - NEW JERSEY NJ (N) YT4500 AAIS 09.10 NAMED STORM DEDUCTIBLE AK, AL, AR, AZ, CA, CO, CT, DC, (O) CL0276 AAIS 03.99 OKLAHOMA NOTICE OK (P) YT3000 AAIS 09.10 PERSONAL EFFECTS COVERAGE AK, AL, AR, AZ, CA, CO, CT, DC, YT0901 AAIS 09.16 POLICY CONDITIONS - ALABAMA AL MO PAGE 4 of 6 WOLTERS KLUWER Customer Support: 800-382-2424
YT0954 AAIS 02.15 POLICY CONDITIONS - ALASKA AK YT0902 AAIS 05.14 POLICY CONDITIONS - ARIZONA AZ YT0903 AAIS 09.10 POLICY CONDITIONS - ARKANSAS AR YT0904 AAIS 10.13 POLICY CONDITIONS - CALIFORNIA CA YT0900 AAIS 09.10 POLICY CONDITIONS - CANCELLATION AND NONRENEWAL CO, DE, HI, IN, NC, OK, OR, PA, RI, SD, TN, TX, UT, VT, WA, WI, WV, WY YT0906 AAIS 09.10 POLICY CONDITIONS - CONNECTICUT CT YT0908 AAIS 09.10 POLICY CONDITIONS - DISTRICT OF COLUMBIA DC YT0909 AAIS 02.16 POLICY CONDITIONS - FLORIDA FL (New) YT0910 AAIS 07.18 POLICY CONDITIONS - GEORGIA GA YT0911 AAIS 05.13 POLICY CONDITIONS - IDAHO ID YT0912 AAIS 11.17 POLICY CONDITIONS - ILLINOIS IL YT0914 AAIS 06.11 POLICY CONDITIONS - IOWA IA YT0915 AAIS 05.13 POLICY CONDITIONS - KANSAS KS YT0916 AAIS 05.13 POLICY CONDITIONS - KENTUCKY KY YT0917 AAIS 03.17 POLICY CONDITIONS - LOUISIANA LA YT0918 AAIS 09.10 POLICY CONDITIONS - MAINE ME YT0919 AAIS 10.14 POLICY CONDITIONS - MARYLAND MD YT0920 AAIS 09.10 POLICY CONDITIONS - MASSACHUSETTS MA YT0921 AAIS 09.10 POLICY CONDITIONS - MICHIGAN MI YT0922 AAIS 06.13 POLICY CONDITIONS - MINNESOTA MN YT0922 AAIS 09.10 POLICY CONDITIONS - MINNESOTA MN YT0923 AAIS 09.10 POLICY CONDITIONS - MISSISSIPPI MS YT0924 AAIS 09.13 POLICY CONDITIONS - MISSOURI MO YT0925 AAIS 09.10 POLICY CONDITIONS - MONTANA MT YT0926 AAIS 09.10 POLICY CONDITIONS - NEBRASKA NE YT0927 AAIS 09.10 POLICY CONDITIONS - NEVADA NV YT0928 AAIS 09.10 POLICY CONDITIONS - NEW HAMPSHIRE NH YT0929 AAIS 09.10 POLICY CONDITIONS - NEW JERSEY NJ YT0930 AAIS 09.10 POLICY CONDITIONS - NEW MEXICO NM YT0931 AAIS 09.10 POLICY CONDITIONS - NEW YORK NY YT0932 AAIS 09.13 POLICY CONDITIONS - NORTH CAROLINA NC YT0933 AAIS 08.17 POLICY CONDITIONS - NORTH DAKOTA ND YT0934 AAIS 09.10 POLICY CONDITIONS - OHIO OH YT0936 AAIS 09.10 POLICY CONDITIONS - OREGON OR YT0937 AAIS 09.10 POLICY CONDITIONS - PENNSYLVANIA PA YT0958 AAIS 09.10 POLICY CONDITIONS - PUERTO RICO PR YT0938 AAIS 09.10 POLICY CONDITIONS - RHODE ISLAND RI YT0939 AAIS 06.13 POLICY CONDITIONS - SOUTH CAROLINA SC YT0940 AAIS 09.10 POLICY CONDITIONS - SOUTH DAKOTA SD YT0942 AAIS 09.10 POLICY CONDITIONS - TEXAS TX YT0943 AAIS 09.10 POLICY CONDITIONS - UTAH UT YT0944 AAIS 09.10 POLICY CONDITIONS - VERMONT VT YT0945 AAIS 04.13 POLICY CONDITIONS - VIRGINIA VA YT0946 AAIS 09.10 POLICY CONDITIONS - WASHINGTON WA YT0948 AAIS 09.10 POLICY CONDITIONS - WISCONSIN WI YT0949 AAIS 09.10 POLICY CONDITIONS - WYOMING WY CL1060 AAIS 08.17 POLICYHOLDER NOTICE EXPENSE DEPRECIATION AR YT1303 AAIS 07.13 POLLUTANTS - AMENDED DEFINITION IN, MO YT1301 AAIS 09.10 PUNITIVE DAMAGE EXCLUSION AK, AR, AZ, CA, CO, CT, DC, DE, FL, IA, ID, IL, IN, KS, KY, MA, ME, MN, MO, NC, ND, NE, NH, NM, NV, NY, OK, OR, PA, RI, SC, SD, TN, TX, YT1001 AAIS 09.10 PUNITIVE DAMAGE EXCLUSION - ALABAMA AL YT1302 AAIS 05.11 PUNITIVE OR EXEMPLARY DAMAGES EXCLUSION OH (R) CL0351 AAIS 06.09 REGISTERED DOMESTIC PARTNERSHIP AMENDMENT - NV NEVADA CL0442 AAIS 01.08 CA PAGE 5 of 6 WOLTERS KLUWER Customer Support: 800-382-2424
REGISTERED DOMESTIC PARTNERSHIPS AMENDMENT - CALIFORNIA YT6502 AAIS 09.10 RENEWAL PLAN AK, AL, AR, CA, CO, CT, DC, YT1610 AAIS 09.10 RENEWAL PLAN - ARIZONA AZ YT4801 AAIS 09.10 REPLACEMENT COST SETTLEMENT PROVISION - PROPERTY COVERAGE (S) CL0343 AAIS 06.08 STATE REGISTERED DOMESTIC PARTNERSHIP AMENDMENT - WASHINGTON AK, AL, AR, AZ, CA, CO, CT, DC, (U) YT1002 AAIS 09.10 UNINSURED BOATER - VIRGINIA VA (W) YT2001 AAIS 09.10 WATERSKIING EXCLUSION AK, AL, AR, AZ, CA, CO, CT, DC, (Y) YT0050 AAIS 09.10 YACHT COVERAGE - DECLARATIONS AK, 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, YT0100 AAIS 09.10 YACHT COVERAGE FORM AK, 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, WA PAGE 6 of 6 WOLTERS KLUWER Customer Support: 800-382-2424