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<br />ADDITIONAL COVERAGE CHECKLIST <br /> <br />I Insured <br />Date <br /> <br />Producer: <br /> <br />I <br /> <br />Please advise if "ou would like ouotations for increased lim"t of liability, or for coveraaes listed below: <br /> <br /> <br />nI!J~ <br />I c:=J c:=J c:=J <br />I c:=J c:=J c:=J <br />I c:=J c:=J c:=J <br />I c:=J c:=J c:=J <br />I c:=J c:=J c:=J <br />I c:=J c:=J c:=J <br />I c:=J c:=J c:=J <br />I c:=J c:=J c:=J <br />I c:=J c:=J c:=J <br />I c:=J c:=J c:=J <br />I c:=J c:=J c:=J <br />I c:=J c:=J c:=J <br />I c:=J c:=J c:=J <br />I c:=J c:=J c:=J <br />I c:=J c:=J c:=J <br />I c:=J c:=J c:=J <br />I c:=J c:=J c:=J <br />I c:=J c:=J c:=J <br />I c:=J c:=J c:=J <br />I c:=J c:=J c:=J <br />I c:=J c:=J c:=J <br />I c:=J c:=J c:=J <br />I c:=J c:=J c:=J <br />I c:=J c:=J c:=J <br />I c:=J c:=J c:=J <br />I c:=J c:=J c:=J <br />I c:=J c:=J c:=J <br />I c:=J c:=J c:=J <br />I c:=J c:=J c:=J <br /> <br />c:=J C:=J c:=J I Automobile <br />c:=J C:=J c:=J I Bailees CoveraQe <br />c:=J C:=J C:=J I Boiler & MaChinery <br />c:=J c:=J c:=J Broadened PIP <br />c:=J c:=J c:=J Builders Risk <br />c:=J c:=J c:=J BuildinQ Ordinance or Law <br />c:=J c:=J c:=J Business Income <br />c:=J C:=J c:=J CarQo <br />c:=J C:=J c:=J ComputerlEDP <br />c:=J C:=J c:=J Contractors' Equipment <br />c:=J C:=J C:=J Crime <br />c:=J C:=J C:=J I Difference in Conditions <br />c:=J c:=J c:=J I Directors' & Officers <br />c:=J c:=J c:=J I Drive Other Car CoveraQe <br />c:=J c:=J c:=J I Employee Benefits Liability <br />c:=J c:=J c:=J Employee Dishonesty - 1" Party <br />c:=J c:=J c:=J Employee Dishonesty - 3'. Party <br />c:=J C:=J c:=J Employment Related Practices <br />c:=J C:=J c:=J ERISA Bond <br />c:=J C:=J c:=J <br />c:=J C:=J C:=J <br />c:=J C:=J C:=J <br />c:=J c:=J c:=J <br />c:=J c:=J c:=J <br />c:=J c:=J c:=J <br />c:=J c:=J c:=J <br />c:=J c:=J c:=J <br />c:=J c:=J c:=J <br />c:=J c:=J c:=J <br /> <br />Errors & Omissions Liability <br />Extra Expense <br />Fiduciary Liability <br />Flood (excess) <br />Flood (primary) <br />ForQery & Alteration <br />GaraQe Liability <br />GaraQekeepers Liability <br />General Liability <br />Glass <br /> <br />Quote: <br /> <br />1. <br />2. <br />3. <br /> <br />Hired/Non-Owned Liability <br />Hired Car Physical DamaQe <br />Installation Floater <br />International/ForeiQn Exposure <br />Internet Liability <br />Kidnap & Ransom <br />Leasehold Improvements <br />Liquor Liability <br />Mobile Equipment <br />Money & Securities <br />Ocean Marine <br /> <br />Off Premises Power Interruption <br />Owners'IContractors Prot Liab. <br />Pollution Liability <br />Professional Liability <br />Product Recall <br />Properly <br />Rental ReimbursemenVTowinQ <br />Rental I ncome <br />SpoilaQe <br />Transit or Transportation <br />Umbrella <br />Uninsured Motorist (primary) <br />Uninsured Motorist (excess) <br /> <br />USL&H <br /> <br />Valuable Papers & Records <br />Watercraft Liability <br />Workers' Compensation <br />Other (Describe) <br /> <br />Producer <br /> <br />10 <br />