Back to Home Back to Form Index
LS Forms List
Form # Description Edition Dates
LS-1
Premises/Operations Liability Insurance LS-1S Premises/Operations Liability Ins. Schedule LS-2 Coverage M - Premises Med. Pay. LS-3 Manufacturers & Contractors Liability LS-3S M&C Liability Insurance Schedule LS-4 Storekeepers Liability Insurance LS-4S Storekeepers Liability Insurance Schedule LS-5 Business General Liability Ins. 1/88 9/02 4/20 LS-5S Business General Liability Ins. Schedule LS-6 Business General Liability Ins. (Extra Cov.) LS-8 Owners & Contractors Prot. Liab. Ins. LS-8S Owners & Contractors Prot. Liab. Ins. Schedule LS-10 Amendment of Limits of Liability LS-11 Real Estate Agents LS-12 Waiver of Subrogation LS-12A Waiver of Subrogation (Automatic) /4/20
LS-13 Cold Storage Locker Establishments LS-14 Exclusion (Athletic Participants) LS-14A Athletic Participants Exclusion (All Activities or Contest) LS-15 Exclusion (Laundry & Dry Cleaning) LS-16 Exclusion (Named Insured's Products) LS-16B Exclusion (Products/Comp. Ops. Hazard) 1/88 9/02 4/20 LS-16C Products Hazard Redefinition LS-16D Exclusion (Named Insured's Products) LS-16D-DISC Disclosure Notice (For LS-16D (8/09)) LS-16E Exclusion (Completed Operations) 1/88 9/02 LS-17 Excl. (All Haz. at Designated Premises) LS-18 Operations Exclusion 1/88 9/02 4/20 LS-19 Add'l Insured (Prem. Leased to Ins.) 1/88 9/02 4/20 LS-20 Add'l Insured - Volunteers (Direct Liability) LS-20A Add'l Insured - Volunteers (Vicarious Liability) LS-21 Additional Insured - Employees (Direct) LS-21A Additional Insured - Employees (Vicarious) LS-22 Additional Insured LS-22A Additional Insured (Secured Creditors) 6/04 LS-23 Additional Insured (Club Members) LS-24 Additional Insured-Contractual Oblig. LS-24A Additional Insured-Contractual Oblig. LS-25 Additional Insured (State or Political Subdivision) 1/88 9/02 4/20 LS-25A Additional Insured (State or Political Subdivision) LS-26 Explosion, Collapse, U/G Prop. Dam. LS-27 Products-Designated Operations LS-28 Exclusion (Camps) LS-29 Boats (Described Watercraft) LS-30 Host Liquor Law Coverage LS-31 Modification of Liquor Liability Exclusion LS-32 Clubs LS-33 Hotels and Motels Coverage 1/88 9/02 4/20 LS-34 Liquor Liability LS-34A Liquor Liability (Designated Premises) LS-35 Exclusion (Farms) LS-36 Exclusion (Fairs) LS-37 Colleges or Schools LS-38 Manufactured Home Parks LS-39 Primary and Non-Contributory Coverage LS-40 Sexual Misconduct Liability Coverage LS-41 Total Liquor Liability Exclusion /4/20
LS-42 Prod/Comp. Ops. (Food/Bev.) LS-1&3 LS-42A Prod/Comp. Ops. (Food/Bev.) LS-5&6 LS-43 Prod/Com. Ops. (No Food/Bev.) LS-1&3 8/09 4/20 LS-44 Barber/Beauty Shop Liability LS-44A Barber/Beauty Shop Liability /4/08
LS-45 Clergyperson Prof. Legal Liability Coverage LS-46 Morticians' or Cemetery Coverage LS-47 Druggists' Liability Coverage LS-48 Fire Legal Liability LS-48A Fire Legal Liability LS-48B Fire Legal Liability - Property Coverage LS-49 Personal Injury 1/88 LS-50 Employers Non-Ownership Liability LS-50A Hired & Non-owned Auto Coverage LS-51 Directors and Officers Liability LS-52 Canoes and Rowboats /4/20
LS-53 Liquor Liability /4/20
LS-53A Liquor Liability /4/20
LS-55 Deductible Liability Coverage LS-56 Deductible Liability Coverage (Prop. Dam) LS-57 Lead Exclusion 7/14 LS-57-DISC Policyholder Disclosure Notice - Lead Exclusion 7/14 LS-58 Overspray or Spillage Exclusion 4/14 LS-58-DISC Policyholder Disclosure Notice - Overspray Exclusion 4/14 LS-59 Lead Exclusion LS-59 DISC Policyholder Disclosure Notice - Lead Exclusion 6/07 LS-60 Change Endorsement 1/88 LS-61 Change Endorsement LS-62 Customer's Goods Legal Liability /4/20
LS-63 Sale and Disposal Legal Liability /4/20
LS-64 Care Provided for Others LS-64A Care Provided for Others LS-69 Sudden and Accidental Pollution End. LS-70 Business Premises Exclusion LS-70A Cov. Appl. to Designated Premises or Project LS-71 Additional Insured - Vendors Broad Form LS-72 Exclusion (Saddle Animals) LS-73 Assault & Battery Exclusion / LS-73-DISC Policyholder Disclosure Notice - Assault & Battery Exclusion 1/18 LS-75 Water Damage Exclusion (NYC only) LS-76 Exclusion (Certain Skin Care Services) LS-76A Exclusion (Certain Skin Care Services) LS-76B Exclusion (Certain Skin Care Services) LS-76B-DISC Policyholder Disclosure Notice -
Exclusion (Certain Skin Care Services)LS-77 Aggregate Limits Applicable at Each Loc. LS-78 Exclusion of Certain Roofing Operations 3/96 LS-79 Exclusion of Snow/Ice Control Operations LS-79A Exclusion of Snow/Ice Control Operations LS-79A-DISC Policyholder Disclosure Notice LS-80 Redefinition of Insured LS-81 Redefinition of Insured LS-82 Redefinition of Insured LS-83 Redefinition of Insured LS-84 New York Amendatory Endorsement LS-85 Exclusion of Known Loss or Damage LS-87 Exclusion (Asbestos, Dioxin & PCB) LS-88 Discrimination Clarification LS-89 Extended Pollution Exclusion LS-91 Exclusion of Newly Acquired Entities LS-92 Contractual Liability Limitation LS-93 Employment Practices Exclusion LS-94 Cov. Applicable to Designated Ops. Only LS-95 Limitation of Cov. for Additional Insureds LS-96 Excess Limits of Liability LS-97 Exclusion of Work Pref. from Scaffolding LS-98 Exclusion of Hot Appl. Roofing Ops. LS-99 Calendar Date Exclusion LS-100 Supplemental App. Broad Form CGL LS-101 Pension Plan Clarification LS-105 Exclusion-Seed Dealer's Liability 2/04 LS-118 Silica Exclusion LS-118 DISC Disclosure Notice - Silica Exclusion LS-120 Exterior Insulation Exclusion LS-120 DISC Disclosure Notice - Exterior Insulation Exclusion LS-122 Exclusion of Unmanned Aircraft
(For use with 9/02 LS series)LS-123 Exclusion of Unmanned Aircraft
(For use with 1/88 LS series)LS-130 Employee Benefits Liability Coverage 7/20 LS-139 Communicable Disease Exclusion 4/20 LS-139A Communicable Disease Exclusion Clarification 6/22 LS-140 Defense of an Indemnitee 4/20 LS-141 Employer's Liability Exclusion (Third Party Action Over) 4/20 LS-141 DISC Policy holder Disclosure Notice for LS-141 (4/20) 4/20 LS-141A Employer's Liability Exclusion 6/22 LS-141A DISC Policyholder Disclosure Notice 6/22 LS-141B Employer's Liability Exclusion 6/22 LS-141B DISC Policyholder Disclosure Notice 6/22 LS-142 Cross Liability Exclusion 4/20 LS-144 Beauty or Barber Shop Professional Liability 4/20 LS-144A Beauty or Barber Shop Professional Liability 4/20 LS-145 Clergyperson Professional Liability 4/20 LS-146 Mortician or Cemetery Professional Liability 4/20 LS-147 Pharmacist Professional Liability 4/20 LS-150 Non-Owned Automobile Liability 4/20 LS-150A Hired Automobile & Non-Owned Automobile Liability 4/20 LS-177 Each Project Aggregate Limit of Liability 4/20 LS-187 Asbestos Exclusion LS-187 DISC Disclosure Notice - Asbestos Exclusion LS-373 Excl. of Canine Related Injuries or Damages LS-373 DISC Disclosure Notice - Excl. of Canine Related Injuries or Damages LS-400 Amendatory Endorsement LS-411 Farm Employees Liab. Cov. Schedule LS-413 Custom Farming LS-414 Farm Pollution Liability LS-415 Additional Insured 1/88 LS-418 Ins. Liab. Emp. by Other-Non farm LS-419 Add'l Residence Rented to Others LS-420 Exclusion of Farm Emp. Illegally Employed LS-439 Farm Premises Med. Pay. LS-470 Add'l Res. Prem. - Rented to Others LS-475 Watercraft LS-550 Agribusiness Pursuits 10/19 LS-DISC Policyholder Disclosure Notice 9/02 LS-DISC-1 Policyholder Disclosure Notice