COMMERCIAL GENERAL LIABILITY FORMS – IA, MN, NE, ND, OK

<<<<< COMMERCIAL GENERAL LIABILITY FORMS – IA, MN, NE, ND, OK, SD, WI >>>>> The key listed below shows the letter designation assigned for the appropriate program(s). These letters are listed under the column titled PROGRAM USED IN. L = COMMERCIAL GENERAL LIABILITY Q = CHURCH PROTECTOR X = CONTRACTORS PROTECTOR FORM NUMBERS & EDITION DATES

Z = COMMERCIAL MULTI-LINE 2 = GARAGE PROTECTOR

PROG. USED IN

TITLE

COMPUTER GENERATED COMPUTER GENERATED IL C 001 11-11 ISO

LQXZ2 LQXZ2 LQXZ2

COMMON POLICY DECLARATIONS COMMERCIAL LIABILITY DECLARATIONS CERTIFICATE OF COMMERCIAL LIABILITY INSURANCE (IA, NE,

LIC-01G

01-11

MNDOL

LXZ

CG 00 01 *IL 00 03 *IL 00 03 CG 00 09

04-13 09-08 08-07 04-13

ISO ISO ISO ISO

LQXZ2 LQXZ2 LQXZ2 LZ

*IL 00 17 *IL 00 21

11-98 09-08

ISO ISO

LQXZ2 LQXZ2

ACORD 25 CG 00 33 CG 00 37

03-16 04-13 04-13

ACORD ACORD ISO

LQXZ2 LZ LQXZ2

ACORD 45 CG 01 09

03-16 11-85

ACORD ISO

LQXZ2 LQXZ2

07-98 01-93

ISO ISO

LQXZ LQXZ2

ACORD 125 03-16

ACORD

LQXZ2

ACORD 126 CG 01 28 CG 01 44 CG 01 58

09-16 07-98 10-11 04-13

ACORD ISO ISO ISO

LZ LQXZ2 LQXZ2 LQXZ2

*IL 01 65

09-08

ISO

LQXZ2

*IL 01 79 CG 02 06

10-02 10 14

ISO ISO

LQXZ2 LQXZ2

*IL 02 32

09-08

ISO

LQXZ2

*IL 02 34

09-17

ISO

LQXZ2

*IL 02 36

09-07

ISO

LQXZ2

*NS-236

08-08

NSM

Q

COMP.

K

ND, OK, SD, WI)

CERTIFICATE OF INSURANCE – MINNESOTA DEPARTMENT OF LABOR AND INDUSTRY (MN) COMMERCIAL GENERAL LIABILITY COVERAGE FORM CALCULATION OF PREMIUM (IA, MN, ND, OK, SD, WI) CALCULATION OF PREMIUM (NE) OWNERS & CONTRACTORS PROTECTIVE LIAB. COV. FORM COVERAGE FOR OPERATIONS OF DESIGNATED CONTRACTOR COMMON POLICY CONDITIONS NUCLEAR ENERGY LIAB. EXCLUSION ENDORSEMENT (BROAD FORM) CERTIFICATE OF LIABILITY INSURANCE (IA, MN, NE, ND, SD, WI) LIQUOR LIABILITY COVERAGE PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE FORM ADDITIONAL INTEREST KANSAS AND OKLAHOMA CHANGES-TRANSFER OF RIGHTS (OK)

CG 01 20 * CG 01 24

MINNESOTA CHANGES – TOWNHOUSES (MN) WISCONSIN CHANGES – AMENDMENT OF POLICY CONDITIONS (WI) COMMERCIAL INSURANCE APPLICATION – APPLICANT INFORMATION SECTION COMMERCIAL GENERAL LIABILITY SECTION MINNESOTA CHANGES – CONDOMINIUMS (MN) SOUTH DAKOTA CHANGES (SD) OKLAHOMA CHANGES-ADDITIONAL INSURED (ENGINEERS OR ARCHITECTS) (OK) NORTH DAKOTA CHANGES - EXAMINATION OF YOUR BOOKS & RECORDS (ND) OKLAHOMA NOTICE (Fraud – guilty of a felony) (OK) IOWA CHANGES – NOTICE OF CANCELLATION FOR CONTRACTORS (IA) SOUTH DAKOTA CHANGES – CANCELLATION AND NONRENEWAL (SD) NORTH DAKOTA CHANGES - CANCELLATION AND NONRENEWAL (ND) OKLAHOMA CHANGES-CANCELLATION AND NONRENEWAL (OK)

OKLAHOMA CHANGES – CANCELLATION AND NONRENEWAL (OK)

*IL 02 45

09-08

ISO

LQXZ2

MINNESOTA CHANGES - CANCELLATION AND NONRENEWAL

CF-253

01-18

NSM

LZ

GENERAL LIABILITY APPLICATION

(MN)

* Indicates a mandatory form

Page 1 of 9

<<<<< COMMERCIAL GENERAL LIABILITY FORMS – IA, MN, NE, ND, OK, SD, WI >>>>> The key listed below shows the letter designation assigned for the appropriate program(s). These letters are listed under the column titled PROGRAM USED IN. L = COMMERCIAL GENERAL LIABILITY Q = CHURCH PROTECTOR X = CONTRACTORS PROTECTOR FORM NUMBERS & EDITION DATES *IL 02 59

12-17

COMP.

PROG. USED IN

ISO

LQXZ2


TITLE

K

NEBRASKA CHANGES - CANCELLATION AND NONRENEWAL (NE)

*IL 02 76 * IL 02 83

09-07 09-07

ISO ISO

LQXZ2 LQXZ2

IOWA CHANGES – CANCELLATION AND NONRENEWAL (IA) WISCONSIN CHANGES – CANCELLATION AND NONRENEWAL

01-96

ISO

LQXZ2

DEDUCTIBLE

(WI)

CG 03 00

LIABILITY

INSURANCE

(Applies

to

CGL

and

Prod/Completed Operations Liab. Cov. Parts)

CG 04 40

11-03

ISO

LQXZ2

STOP GAP – EMPLOYERS LIABILITY COVERAGE ENDORSEMENT (ND) CHURCH PROTECTOR POLICY COVER SHEET COMMERCIAL MULTILINE POLICY COVER SHEET LIQUOR LIABILITY SECTION INTERNATIONAL LIABILITY EXPOSURE SUPPLEMENT EXCLUSION (PUNITIVE, EXEMPLARY OR MULTIPLE DAMAGES) COMMERCIAL GENERAL LIABILITY POLICY COVER SHEET NORTH STAR CHURCH PROTECTOR EXTENSION ENDORSEMENT NON-OWNED AUTO LIABILITY (IA, MN, NE, ND, OK, SD) FARM EMPLOYERS LIAB. & FARM EMPLOYEES MED. PAY. INS. BASIC FARM PREMISES LIABILITY CONTRACTORS PROTECTOR APPLICATION CONTRACTORS PROTECTOR POLICY COVER SHEET DIRECTORS & OFFICERS LIAB. COV. SEXUAL MISCONDUCT LIAB. COV. PASTORS COUNSELING LIAB. COV. Claims-Made Coverage SUPPLEMENTAL EXTENDED REPORTING PERIOD ENDORSEMENT MINNESOTA CHANGES (Examination of Your Books and Records, Prejudgment Interest and Transfer of Rights of Recovery Against Others to Us) (MN) (Applies to D&O, Sexual Misconduct and

*CF-455 *CF-531 ACORD 803 ACORD 815 CF-846

03-17 03-17 03-16 06-05 08-00

NSM NSM ACORD ACORD NSM

Q Z LZ LQXZ2 LQXZ2

*CF-914 *CF-918

03-17 03-15

NSM NSM

LQXZ2 Q

CF-920 CF-935

08-08 11-05

NSM NSM

LZ LQXZ2

CF-936 CF-1092 *CF-1094 CF-1140

11-05 01-18 03-17 11-05

NSM NSM NSM NSM

LQXZ2 X X Q

CF-1142

05-91

NSM

Q

*CF-1181

11-05

NSM

Q

*CF-1183

12-03

NSM

Q

08-11

NSM

LQXZ2

AMENDATORY ENDORSEMENT - YOUR RIGHT TO CLAIM AND "OCCURRENCE" INFORMATION (MN, ND) NOTICE CONCERNING POLICYHOLDER RIGHTS IN AN INSOLVENCY UNDER THE MINNESOTA INSURANCE GUARANTY ASSOCIATION LAW (MN) (This notice must be given with the application. The notice must be given in writing or in the same medium as the application for insurance. This notice would only be attached to renewal certificates if the renewal increases the dollar amount of a coverage by more than 100%.) (The NSCF-1243 will not show on the dec.!) HIRED AUTO AND NON-OWNED AUTO LIABILITY (IA, MN, NE, ND, OK, SD) DIRECTORS AND OFFICERS LIABILITY COVERAGE (IA, MN, NE, ND, SD)

Pastors Counseling Liab. Cov. Part)

NSCF-1243

CF-1496

08-08

NSM

LQXZ

CF-1517

04-10

NSM

LXZ2

*CF-1557 *CF-1736

08-08 01-15

NSM NSM

LQXZ2 LQXZ2


AMENDATORY ENDORSEMENT CERTIFIED TERRORISM LOSS COVERAGE; NON-CERTIFIED TERRORISM LOSS EXCLUSION; NUCLEAR, BIOLOGICAL, Page 2 of 9


COMP.

PROG. USED IN

*CF-1791

12-03

NSM

Q

CF-1829 CF-1844 CF-1845

01-18 03-06 03-06

NSM NSM NSM

Q LQXZ2 LQXZ2

CF-1846

03-06

NSM

LQXZ2

CF-1887

04-10

NSM

LQXZ2

CF-1888

04-10

NSM

LQXZ2

*CF-1895 *CF-1897

01-15 01-15

NSM NSM

LQXZ2 LQXZ2

*CF-1898

01-15

NSM

LQXZ2

CF-1902

08-08

NSM

Q

CF-2001

01-11

NSM

LQXZ2

CG 20 02 CG 20 03

11-85 04-13

ISO ISO

LZ LZ

CG 20 04 CF-2005

11-85 01-11

ISO NSM

LZ LXZ2

CG 20 05 CG 20 07

04-13 04-13

ISO ISO

LZ LZ

CG 20 08 CG 20 10

04-13 04-13

ISO ISO

LZ LZ

CG 20 11

04-13

ISO

LZ

CG 20 12

04-13

ISO

LZ

09-11

NSM

LQXZ2

*CF-2013



TITLE

K

CHEMICAL AND RADIOLOGICAL EXCLUSION; WAR AND MILITARY ACTION EXCLUSION (MN, NE, ND, OK, SD) AMENDATORY ENDORSEMENT – CANCELLATION AND NONRENEWAL FOR DIRECTORS AND OFFICERS LIABILITY, SEXUAL MISCONDUCT LIABILITY AND PASTORS COUNSELING LIABILITY (IA, MN, NE, ND, SD, WI) CHURCH PROTECTOR APPLICATION CUSTOM FARM WORK (IA, MN, NE, ND, SD, WI) FARM POLLUTION AND CLEAN UP COVERAGE (LIMITED COVERAGE) (IA, NE, ND, SD, WI) FARM POLLUTION AND CLEAN UP COVERAGE (LIMITED COVERAGE) (MN) SOUTH DAKOTA CHANGES – DEFENSE IN ADDITION TO LIMITS OF INSURANCE (SD) SUPPLEMENTAL EXTENDED REPORTING PERIOD ENDORSEMENT (IA, MN, NE, ND, SD) NOTICE OF TERRORISM INSURANCE (MN, NE, ND, OK SD) CERTIFIED TERRORISM LOSS COVERAGE; NON-CERTIFIED TERRORISM LOSS EXCLUSION (WITH LIMITED EXCEPTION); NUCLEAR, BIOLOGICAL, CHEMICAL AND RADIOLOGICAL EXCLUSION; WAR AND MILITARY ACTION EXCLUSION (IA, WI) NOTICE TO POLICYHOLDERS – NOTICE OF TERRORISM INSURANCE (IA, WI) SOUTH DAKOTA CHANGES – DEFENSE IN ADDITION TO LIMITS OF INSURANCE (SD) CANCELLATION OR NONRENEWAL NOTICE TO BE SENT TO MINNESOTA DEPARTMENT OF LABOR AND INDUSTRY (MN) ADDITIONAL INSURED-CLUB MEMBERS ADDITIONAL INSURED-CONCESSIONAIRES TRADING UNDER YOUR NAME ADDITIONAL INSURED-CONDOMINIUM UNIT OWNERS CANCELLATION OR NONRENEWAL NOTICE TO BE SENT TO CERTIFICATE OF INSURANCE HOLDER WHEN REQUIRED BY LAW ADDITIONAL INSURED-CONTROLLING INTEREST ADDITIONAL INSURED - ENGINEERS, ARCHITECTS, OR SURVEYORS ADDITIONAL INSURED-USERS OF GOLFMOBILES ADDITIONAL INSURED-OWNERS, LESSEES OR CONTRACTORS (FORM B) ADDITIONAL INSURED-MANAGERS OR LESSORS OF PREMISES ADDITIONAL INSURED-STATE OR GOVERNMENTAL AGENCY OR SUBDIVISION OR POLITICAL SUBDIVISION – PERMITS OR AUTHORIZATIONS DRYWALL EXCLUSION

Page 3 of 9


COMP.

PROG. USED IN

CG 20 13

04-13

ISO

LZ

CF-2014 CG 20 15 CG 20 17 CG 20 18

01-12 04-13 10-93 04-13

NSM ISO ISO ISO

LXZ LZ LZ LQXZ2

CG 20 22 CG 20 23

10-01 04-13

ISO ISO

Q LZ

CG 20 24

04-13

ISO

LZ

CF-2025 CG 20 25

03-15 11-85

NSM ISO

2 LZ

CG 20 26

04-13

ISO

LQXZ2

CG 20 27 CG 20 28 CG 20 29 *CF-2031 CG 20 31

04-13 04-13 04-13 11-12 04-13

ISO ISO ISO NSM ISO

LQXZ2 LQXZ2 LXZ2 2 LZ

*CF-2032 CG 20 32

11-12 04-13

NSM ISO

2 LZ

*CF-2033 CG 20 33

11-12 04-13

NSM ISO

2 LZ

*CF-2034

11-12

NSM

2

CG 20 34

04-13

ISO

LZ

CG 20 35

04-13

ISO

LZ

CG 20 37

04-13

ISO

LZ

CF-2041

11-12

NSM

2

*CF-2042 CF-2043 CF-2046

03-17 01-18 02-13

NSM NSM NSM

2 2 LZ

* CF-2076

02-14

NSM

LQXZ2


TITLE

K

ADDITIONAL INSURED-STATE OR GOVERNMENTAL AGENCY OR SUBDIVISION OR POLITICAL SUBDIVISION – PERMITS OR AUTHORIZATIONS RELATING TO PREMISES EXTENDED PROPERTY DAMAGE ENDORSEMENT ADDITIONAL INSURED-VENDORS ADDITIONAL INSURED-TOWNHOUSE ASSOCIATIONS ADDITIONAL INSURED-MORTGAGEE, ASSIGNEE, OR RECEIVER ADDITIONAL INSURED-CHURCH MEMBERS AND OFFICERS ADDITIONAL INSURED-EXECUTORS, ADMINISTRATORS, TRUSTEES OR BENEFICIARIES ADDITIONAL INSURED-OWNERS OR OTHER INTERESTS FROM WHOM LAND HAS LEASED GARAGE PROTECTOR PLUS ENDORSEMENT ADD'L INSURED-ELECTIVE OR APPOINTIVE EXEC. OFFICERS OF PUBLIC CORP ADDITIONAL INSURED - DESIGNATED PERSON OR ORGANIZATION ADDITIONAL INSURED-CO-OWNER OF INSURED PREMISES ADDITIONAL INSURED - LESSOR OF LEASED EQUIPMENT ADDITIONAL INSURED-GRANTOR OF FRANCHISE IOWA CHANGES (IA) (Applies to Garagekeepers Coverage Part) ADDITIONAL INSURED – ENGINEERS, ARCHITECTS OR SURVEYORS MINNESOTA CHANGES (MN) (Applies to Garagekeepers Coverage Part) ADDITIONAL INSURED – ENGINEERS, ARCHITECTS OR SURVEYORS NOT ENGAGED BY THE NAMED INSURED NEBRASKA CHANGES (NE) (Applies to Garagekeepers Coverage Part) ADDITIONAL INSURED – OWNERS, LESSEES OR CONTRACTORS – AUTOMATIC STATUS WHEN REQUIRED IN CONSTRUCTION AGREEMENT WITH YOU SOUTH DAKOTA CHANGES (SD) (Applies to Garagekeepers Coverage Part)


ADDITIONAL INSURED – LESSOR OF LEASED EQUIPMENT – AUTOMATIC STATUS REQUIRED IN LEASE AGREEMENT WITH YOU ADDITIONAL INSURED – GRANTOR OF LICENSES – AUTOMATIC STATUS WHEN REQUIRED BY LICENSOR ADDITIONAL INSURED – OWNERS, LESSEES OR CONTRACTORS – COMPLETED OPERATIONS BROADENED GARAGE LIABILITY – DEFECTIVE PRODUCTS AND FAULTY WORK GARAGE PROTECTOR COVER SHEET GARAGE PROTECTOR APPLICATION EXCLUSION – TREATMENT, ERRONEOUS DELIVERY OR MIXTURE AND RESULTING FAILURE OF SEED TO GERMINATE – SEED MERCHANTS EXCLUSION – FIREWORKS OR PYROTECHNICS Page 4 of 9


COMP.

PROG. USED IN

02-14

NSM

LQXZ2

CG 21 00

07-98

ISO

LQXZ2

CG 21 01 CF-2102

11-85 09-15

ISO NSM

LQXZ2 LQXZ2

CG 21 04 CF-2106

11-85 09-15

ISO NSM

LQXZ2 LQXZ2

CF-2107

09-15

NSM

LQXZ2

* CG 21 07

05-14

ISO

LQXZ2

CF-2108

09-15

NSM

LQXZ2

CF-2109

09-15

NSM

LQXZ2

CF-2110 CF-2111 CF-2112 CF-2113 CG 21 16 CG 21 17 CF-2123

09-15 09-15 09-15 03-16 04-13 07-98 03-16

NSM NSM NSM NSM ISO ISO NSM

LQXZ2 LQXZ2 LQXZ2 LQXZ2 LQXZ2 LQXZ2 LQXZ2

CF-2125

03-16

NSM

LQXZ2

CF-2127 CF-2128 CF-2129

03-16 03-16 03-16

NSM NSM NSM

LQXZ2 LQXZ2 LQXZ2

* CF-2132 CG 21 33 CG 21 34 CG 21 35 CG 21 36 CG 21 37 CG 21 38 CG 21 39 CG 21 41 CG 21 42

03-16 11-85 01-87 10-01 03-05 10-01 11-85 10-93 11-85 12-04

NSM ISO ISO ISO ISO ISO ISO ISO ISO ISO

LQXZ2 LQXZ2 LQXZ2 LQXZ2 LQXZ2 LQXZ2 LQXZ2 LQXZ2 LQXZ2 LQXZ2

CG 21 43

12-04

ISO

LQXZ2

* CF-2077


TITLE

K

NOTICE TO POLICYHOLDERS – FIREWORKS OR PYROTECHNICS EXCLUSION-ALL HAZARDS IN CONNECTION WITH DESIGNATED PREMISES EXCLUSION-ATHLETIC OR SPORTS PARTICIPANTS EMPLOYMENT PRACTICES LIABILITY INSURANCE COVERAGE PART ENDORSEMENT (IA, MN, NE, ND, OK, WI) EXCLUSION-PRODUCTS-COMPLETED OPERATIONS HAZARD EMPLOYMENT PRACTICES LIABILITY INSURANCE COVERAGE PART ENDORSEMENT (SD) SPLIT LIMITS PRIOR ACTS COVERAGE ENDORSEMENT (IA, MN, NE, ND, OK, WI)

EXCLUSION – ACCESS OR DISCLOSURE OF CONFIDENTIAL OR PERSONAL INFORMATION AND DATA-RELATED LIABILITY – LIMITED BODILY INJURY EXCEPTION NOT INCLUDED SUPPLEMENTAL EXTENDED REPORTING PERIOD ENDORSEMENT COVERAGE WAIVER – EMPLOYMENT PRACTICES LIABILITY INSURANCE MINNESOTA CHANGES (MN) NORTH DAKOTA CHANGES (ND) SOUTH DAKOTA CHANGES (SD) NORTH DAKOTA DISCLOSURE AND ACKNOWLEDGMENT (ND) EXCLUSION-DESIGNATED PROFESSIONAL SERVICES EXCLUSION-MOVEMENT OF BUILDINGS OR STRUCTURES CYBER LIABILITY INSURANCE COVERAGE PART ENDORSEMENT SUPPLEMENTAL EXTENDED REPORTING PERIOD ENDORSEMENT IOWA CHANGES (IA) SOUTH DAKOTA CHANGES (SD) COVERAGE WAIVER CYBER LIABILITY INSURANCE (IA, MN, NE, ND, OK, SD)


NOTICE TO POLICYHOLDERS (IA, MN, NE, ND, OK, SD) EXCLUSION-DESIGNATED PRODUCTS EXCLUSION-DESIGNATED WORK EXCLUSION-COVERAGE C-MEDICAL PAYMENTS EXCLUSION-NEW ENTITIES EXCLUSION-EMPLOYEES AS INSUREDS EXCLUSION-PERSONAL AND ADVERTISING INJURY CONTRACTUAL LIABILITY LIMITATION EXCLUSION-INTERCOMPANY PRODUCTS SUITS EXCLUSION-EXPLOSION, COLLAPSE AND UNDERGROUND PROPERTY DAMAGE HAZARD (SPECIFIED OPERATIONS) EXCLUSION-EXPLOSION, COLLAPSE AND UNDERGROUND PROPERTY DAMAGE HAZARD (SPECIFIED OPERATIONS EXCEPTED) Page 5 of 9


COMP.

PROG. USED IN

CG 21 44

07-98

ISO

LQXZ2

CG 21 45 CF-2146 CF-2147 CG 21 47 CF-2148 CG 21 52 CF-2153

07-98 09-16 09-16 12-07 09-16 04-13 9-16

ISO NSM NSM ISO NSM ISO NSM

LQXZ2 LZ LZ LQXZ2 LZ LQXZ2 LQXZ2

CG 21 53 CG 21 54

01-96 01-96

ISO ISO

LQXZ2 LQXZ2

*CG 21 55

09-99

ISO

LQXZ2

CG 21 56 CG 21 57 CG 21 58 *CG 21 65

04-13 04-13 04-13 12 04

ISO ISO ISO ISO

LQXZ2 LQXZ2 LQXZ2 LQXZ2

CG 21 67 CF-2169 CF-2170

12-04 01-18 01-18

ISO NSM NSM

LQXZ2 LQXZ LQXZ

CF-2182

03-18

NSM

Q

CG 21 86 CG 21 96 CG 21 97

12-04 03-05 12-07

ISO ISO ISO

LQXZ2 LQXZ2 LQXZ2

CG 21 98

12-07

ISO

LQXZ2

CG 22 24

04-13

ISO

LQXZ2

CG 22 28

12-04

ISO

LQXZ2

CG 22 29 CG 22 30 CG 22 31

11-85 07-98 07-98

ISO ISO ISO

LQXZ2 LQXZ2 LQXZ2

CG 22 33

04-13

ISO

LQXZ2

CG 22 34

04-13

ISO

LQXZ2

CG 22 36

04-13

ISO

LQXZ2


TITLE

K

LIMITATION OF COVERAGE TO DESIGNATED PREMISES OR PROJECT EXCLUSION-FIRE DAMAGE LEGAL LIABILITY IOWA CHANGES – LIQUOR LIABILITY COVERAGE (IA) LIQUOR LIABILITY SUPPLEMENTAL APPLICATION EMPLOYMENT - RELATED PRACTICES EXCLUSION MINNESOTA CHANGES – LIQUOR LIABILITY COVERAGE (MN) EXCLUSION – FINANCIAL SERVICES EMPLOYMENT PRACTICES LIABILITY INSURANCE APPLICATION EXCLUSION – DESIGNATED ONGOING OPERATIONS EXCLUSION – DESIGNATED OPERATIONS COVERED BY A CONSOLIDATED WRAP-UP INSURANCE PROGRAM TOTAL POLLUTION EXCLUSION WITH HOSTILE FIRE EXCEPTION (IA, MN, ND, OK, SD, WI) EXCLUSION – FUNERAL SERVICES EXCLUSION – COUNSELING SERVICES EXCLUSION – PROFESSIONAL VETERINARIAN SERVICES TOTAL POLLUTION EXCLUSION WITH A BUILDING HEATING, COOLING AND DEHUMIDIFYING EQUIPMENT EXCEPTION AND HOSTILE FIRE EXCEPTION (NE) FUNGI OR BACTERIA EXCLUSION WISCONSIN – NON-OWNED AUTO LIABILITY (WI) WISCONSIN – HIRED AUTO AND NON-OWNED AUTO LIABILITY (WI) OKLAHOMA CHANGES – YOUR RIGHT TO CLAIM AND OCCURRENCE INFORMATION (OK) EXCLUSION – EXTERIOR INSULATION AND FINISH SYSTEMS SILICA OR SILICA-RELATED DUST EXCLUSION ABUSE OR MOLESTATION EXCLUSION – SPECIFIED PROFESSIONAL SERVICES TOTAL POLLUTION EXCLUSION ENDORSEMENT (IA, NE, ND, OK, SD, WI)


EXCLUSION-INSPECTION, APPRAISAL AND SURVEY COMPANIES AMENDMENT-TRAVEL AGENCY TOURS (LIMITATION OF COVERAGE) EXCLUSION-PROPERTY ENTRUSTED EXCLUSION-CORPORAL PUNISHMENT EXCLUSION-RIOT, CIVIL COMMOTION OR MOB ACTION – GOVERNMENTAL SUBDIVISIONS EXCLUSION-TESTING OR CONSULTING ERRORS AND OMISSIONS EXCLUSION-CONSTRUCTION MANAGEMENT ERRORS AND OMISSIONS EXCLUSION-PRODUCTS & PROFESSIONAL SERVICES (DRUGGISTS) Page 6 of 9


COMP.

PROG. USED IN

CG 22 37

04-13

ISO

LQXZ2

CG 22 38

07-98

ISO

LQXZ2

CG 22 39 CG 22 40

04-13 01-96

ISO ISO

LQXZ2 LQXZ2

CG 22 42

11-85

ISO

LQXZ2

CG 22 43

04-13

ISO

LQXZ2

CG 22 44

04-13

ISO

LQXZ2

CG 22 45

04-13

ISO

LQXZ2

CG 22 48 CG 22 50 CG 22 52

04-13 04-13 10-93

ISO ISO ISO

LQXZ2 LQXZ2 LQXZ2

CG 22 53 CG 22 54 CG 22 56 CG 22 58

11-85 11-85 07-98 11-85

ISO ISO ISO ISO

LQXZ2 LQXZ2 LQXZ2 L

CG 22 60 CG 22 63

12-07 01-96

ISO ISO

LQXZ2 LZ

CG 22 64

04-13

ISO

LQXZ2

CG 22 65 CG 22 66 CG 22 67 CG 22 68

09-99 11-85 10-93 09-97

ISO ISO ISO ISO

LZ LZ LQXZ2 LZ

CG 22 69 CG 22 70 CG 22 71 CG 22 72 CG 22 74

04-13 04-13 04-13 04-13 10-01

ISO ISO ISO ISO ISO

LZ LQXZ2 LZ LZ LQXZ2

CG 22 75

04-13

ISO

LQXZ2

CG 22 76

04-13

ISO

LQXZ2

CG 22 77

04-13

ISO

LQXZ2

CG 22 78

07-98

ISO

LXZ



TITLE

K

EXCLUSION-PRODUCTS & PROFESSIONAL SERVICES (OPTICAL & HEARING AID ESTABLISHMENTS) EXCLUSION – FIDUCIARY OR REPRESENTATIVE FINANCIAL INSTITUTIONS EXCLUSION-CAMPS OR CAMPGROUNDS EXCLUSION-MEDICAL PAYMENTS TO CHILDREN DAY CARE CENTERS EXCLUSION-EXISTENCE OR MAINTENANCE OF STREETS, ROADS, HIGHWAYS OR BRIDGES EXCLUSION-ENGINEERS, ARCHITECTS OR SURVEYORS PROFESSIONAL LIAB. EXCLUSION – SERVICES FURNISHED BY HEALTH CARE PROVIDERS EXCLUSION – SPECIFIED THERAPEUTIC OR COSMETIC SERVICES EXCLUSION - INSURANCE AND RELATED OPERATIONS EXCLUSION - FAILURE TO SUPPLY EXCLUSION - MEDICAL PAYMENTS COVERAGE INMATES, PATIENTS OR PRISONERS EXCLUSION - LAUNDRY AND DRY CLEANING DAMAGE EXCLUSION - LOGGING AND LUMBERING OPERATIONS EXCLUSION - INJURY TO VOLUNTEER FIREFIGHTERS EXCLUSION - DESCRIBED HAZARDS (CARNIVALS, CIRCUSES AND FAIRS) LIMITATION OF COVERAGE - REAL ESTATE OPERATIONS STEVEDORING OPERATIONS LIMITED COMPLETED OPERATIONS COVERAGE PESTICIDE OR HERBICIDE APPLICATOR COVERAGE LIMITED POLLUTION COVERAGE OPTICAL & HEARING AID ESTABLISHMENTS MISDELIVERY OF LIQUID PRODUCTS COVERAGE CORPORAL PUNISHMENT OPERATION OF CUSTOMERS AUTOS ON PARTICULAR PREMISES DRUGGISTS REAL ESTATE PROPERTY MANAGED COLLEGES OR SCHOOLS (LIMITED FORM) COLLEGES OR SCHOOLS LIMITED CONTRACTUAL LIABILITY COVERAGE FOR PERSONAL AND ADVERTISING INJURY PROFESSIONAL LIABILITY EXCLUSION - COMPUTER SOFTWARE PROFESSIONAL LIABILITY EXCLUSION - HEALTH OR EXERCISE CLUBS OR COMMERCIALLY OPERATED HEALTH OR EXERCISE FACILITIES PROFESSIONAL LIABILITY EXCLUSION - COMPUTER DATA PROCESSING HAZARDOUS MATERIAL CONTRACTORS Page 7 of 9


COMP.

PROG. USED IN

CG 22 79 CG 22 85

04-13 12-01

ISO ISO

LXZ LQXZ2

CG 22 88

04-13

ISO

LQXZ2

CG 22 90

04-13

ISO

LQXZ2

CG 22 92 CG 22 93 CG 22 99

12-07 04-13 04-13

ISO ISO ISO

LQXZ2 LQXZ2 LQXZ2

CG 23 01

04-13

ISO

LQXZ2

CG 24 01 CG 24 03 CG 24 04

12-04 11-85 05-09

ISO ISO ISO

LQXZ2 LQZ LQXZ2

CG 24 05 CG 24 07 CG 24 10 CG 24 11 CG 24 12 CG 24 13

12-04 01-96 07-98 12-04 11-85 04-13

ISO ISO ISO ISO ISO ISO

LZ LQXZ2 LZ LQXZ2 LQXZ2 LQXZ2

CG 24 16 CG 24 18

12-07 09-99

ISO ISO

LQXZ2 LZ

CG 24 19

09-99

ISO

LZ

CG 24 20

09-99

ISO

LZ

CG 24 21

09-99

ISO

LZ

CG 25 03

05-09

ISO

LZ

CG 25 04 CG 26 05 CG 26 45 CG 26 56

05-09 02-07 12-04 10-99

ISO ISO ISO ISO

LQXZ2 LQXZ2 LQXZ2 LZ

CG 26 81 CG 28 04 CG 28 05

12-04 10-93 10-01

ISO ISO ISO

LQXZ2 LQXZ2 LQXZ2



TITLE

K

EXCLUSION – CONTRACTORS – PROFESSIONAL LIABILITY MINNESOTA CHANGES – LIMITED CONTRACTUAL LIABILITY COVERAGE FOR PERSONAL AND ADVERTISING INJURY PROFESSIONAL LIABILITY EXCLUSION – ELECTRONIC DATA PROCESSING SERVICES AND COMPUTER CONSULTING OR PROGRAMMING SERVICES PROFESSIONAL LIABILITY EXCLUSION – SPAS OR PERSONAL ENHANCEMENT FACILITIES SNOW PLOW OPERATIONS COVERAGE LAWN CARE SERVICES - LIMITED POLLUTION COVERAGE PROFESSIONAL LIABILITY EXCLUSION – WEB-SITE DESIGNERS EXCLUSION – REAL ESTATE AGENTS OR BROKERS ERRORS OR OMISSIONS NON-BINDING ARBITRATION (MN, ND, OK, WI) WAIVER OF CHARITABLE IMMUNITY WAIVER OF TRANSFER RIGHTS OF RECOVERY AGAINST OTHERS TO US FINANCIAL INSTITUTIONS – FIDUCIARY INTEREST ONLY PRODUCTS/COMPLETED OPERATIONS HAZARD REDEFINED EXCESS PROVISION - VENDORS FIDUCIARIES - FIDUCIARY INTEREST BOATS AMENDMENT OF PERSONAL AND ADVERTISING INJURY DEFINITION CANOES OR ROWBOATS SEED MERCHANTS – COVERAGE FOR ERRONEOUS DELIVERY OR MIXTURE AND RESULTING FAILURE OF SEED TO GERMINATE (Applies to CGL Cov. Part) SEED MERCHANTS – COVERAGE FOR ERRONEOUS DELIVERY OR MIXTURE (RESULTING FAILURE OF SEED TO GERMINATE NOT INCLUDED) (Applies to CGL Cov. Part) SEED MERCHANTS – COVERAGE FOR ERRONEOUS DELIVERY OR MIXTURE AND RESULTING FAILURE OF SEED TO GERMINATE (Applies to Prod/Completed Ops. Cov. Part) SEED MERCHANTS – COVERAGE FOR ERRONEOUS DELIVERY OR MIXTURE (RESULTING FAILURE OF SEED TO GERMINATE NOT INCLUDED) (Applies to Prod/Compl Ops. Cov. Part) DESIGNATED CONSTRUCTION PROJECTS GENERAL AGGREGATE LIMIT DESIGNATED LOCATIONS GENERAL AGGREGATE LIMIT MINNESOTA CHANGES (MN) (Applies to CGL Cov. Part) SOUTH DAKOTA CHANGES – NON-BINDING ARBITRATION (SD) NORTH DAKOTA CHANGES – NOTICE OF CANCELLATION – PESTICIDE APPLICATORS (ND) MINNESOTA CHANGES – DUTIES CONDITION (MN) EARLIER NOTICE OF CANCELLATION PROVIDED BY US PERSONAL INJURY LIABILITY Page 8 of 9

<<<<< COMMERCIAL GENERAL LIABILITY FORMS – IA, MN, NE, ND, OK, SD, WI >>>>> The key listed below shows the letter designation assigned for the appropriate program(s). These letters are listed under the column titled PROGRAM USED IN. L = COMMERCIAL GENERAL LIABILITY Q = CHURCH PROTECTOR X = CONTRACTORS PROTECTOR


FORM NUMBERS & EDITION DATES

COMP.

PROG. USED IN

CG 28 07 CG 28 12

12-07 04-13

ISO ISO

LQXZ2 LQXZ2

CG 28 22

09-02

ISO

LZ

CG 28 26

01-93

ISO

LZ

WISCONSIN CHANGES – AMENDMENT OF POLICY CONDITIONS (WI) (Applies to Owners & Contractors Protective Liab. Cov.

CG 28 43

02-07

ISO

LZ

MINNESOTA CHANGES (MN) (Applies to Owners & Contractors

CG 28 74

12-89

ISO

LZ

NEBRASKA CHANGES - CANCELLATIONS AND NONRENEWAL

CG 29 07

12-10

ISO

LZ

MINNESOTA CANCELLATION AND NONRENEWAL (MN) (Applies

CG 29 21

12-03

ISO

LZ

NORTH DAKOTA CHANGES - CANCELLATION AND NONRENEWAL (ND) (Applies to Owners & Contractors Protective Liab.

CG 29 27 CG 29 33

12-87 10-06

ISO ISO

LZ LZ

IOWA CHANGES – CANCELLATION AND NONRENEWAL (IA) OKLAHOMA CHANGES - CANCELLATION AND NONRENEWAL

CG 29 35

04-13

ISO

LQXZ2

ADDITIONAL INSURED - STATE OR GOVERNMENTAL AGENCY OR SUBDIVISION OR POLITICAL SUBDIVISION – PERMITS OR AUTHORIZATIONS (Applies to Owners & Contractors Protective Liab.

CG 29 51

12-07

ISO

LQXZ2

EMPLOYMENT - RELATED PRACTICES EXCLUSION (MN, ND, OK,

TITLE

K

PRINCIPALS PROTECTIVE LIABILITY COVERAGE PESTICIDE OR HERBICIDE APPLICATOR - LIMITED POLLUTION COVERAGE SOUTH DAKOTA CHANGES - CANCELLATION (SD) (Applies to Owners & Contractors Protective Liab. Cov. Part)

Part) Protective Liab. Cov. Part) (NE) (Applies to Owners & Contractors Protective Liab. Cov. Part) to Liquor Liability Cov. Part)

Cov. Part)

(OK) (Applies to Owners & Contractors Protective Liab. Cov. Part)

Cov. Part) SD) (Applies to Owners and Contractors Protective Liability Coverage Part and Pollution Liability Coverage Part)

CG 29 77

12-90

ISO

LZ

NORTH DAKOTA CHANGES - EXAMINATION OF YOUR BOOKS & RECORDS (ND) (Applies to Owners & Contractors Protective Liab. Cov.

CG 29 88

10-93

ISO

LZ

WAIVER OF TRANSFER OF RIGHTS OF RECOVERY AGAINST OTHERS TO US (Applies to Owners & Contractors Protective Liab. Cov.

CG 29 96

02-07

ISO

LQXZ2

MINNESOTA

CG 31 31

12-04

ISO

LQXZ2

FUNGI OR BACTERIA EXCLUSION (Applies to Owners & Contractors

Part)

Part)

CHANGES (MN) Operations Liability Coverage Part)

(Applies

to

Products/Completed

Protective Liab. Cov. Part and Products/Completed Operations Liability Coverage Part) MINNESOTA CHANGES – PREMIUM AUDIT CONDITION (Applies to Principal Protective Liability Coverage Endorsement CG 28 07)

CG 31 52

11-02

ISO

LQXZ2

CG 31 66

12-04

ISO

LZ

EXCLUSION – EXTERIOR INSULATION AND FINISH SYSTEMS

CG 31 67

12-04

ISO

LQXZ2

EXCLUSION – EXTERIOR INSULATION AND FINISH SYSTEMS

CG 33 70

03-05

ISO

LQXZ2

SILICA OR SILICA-RELATED DUST EXCLUSION (Applies to Owners

(Applies to Owners and Contractors Protective Liab. Cov. Part) (Applies to Prod/Completed Ops. Liab. Cov. Part) and Contractors Prot Liab. Cov. Part and Prod/Completed Ops Liab. Cov. Part)


Page 9 of 9

COMMERCIAL GENERAL LIABILITY FORMS – IA, MN, NE, ND, OK

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