LS Forms

FORM NUMBERDESCRIPTIONEDITION DATE
LS-1Premises/Operations Liability Insurance4/209/021/88
  LS-1SPremises/Operations Liability Insurance Schedule4/209/021/88
  LS-2Coverage M – Premises Medical Payments9/021/88
  LS-3Manufacturers & Contractors Liability4/209/021/88
  LS-3SM&C Liability Insurance Schedule4/209/021/88
  LS-4Storekeepers Liability Insurance4/209/021/88
  LS-4SStorekeepers Liability Insurance Schedule4/209/021/88
  LS-5Business General Liability Insurance4/209/023/931/88
  LS-5SBusiness General Liability Insurance Schedule4/209/021/88
  LS-6Business General Liability Insurance (Extra Coverage) 4/209/021/88
  LS-8Owners & Contractors Protective Liability Insurance 4/209/021/88
  LS-8SOwners  & Contractors Protective Liability Insurance Schedule 4/209/021/88
  LS-10Amendment of Limits of Liability 5/139/021/88
  LS-11Real Estate Agents 4/209/021/88
  LS-12Waiver of Subrogation4/208/12
  LS-12AWaiver of Subrogation (Automatic)4/20
  LS-13Cold Storage Locker Establishments 9/021/88
  LS-14Exclusion (Athletic Participants) 4/209/021/88
  LS-14AAthletic Participants Exclusion (All Activities or Contest)4/20
  LS-15Exclusion (Laundry & Dry Cleaning) 4/209/021/88
  LS-16Exclusion (Named Insured’s Products) 4/209/021/88
  LS-16BExclusion (Products/Completed Operations Hazard) 4/209/028/981/88
  LS-16CProducts Hazard Redefinition4/20
  LS-16DExclusion (Named Insured’s Products) 8/099/021/88
  LS-16D-DISCDisclosure Notice (For LS-16D (8/09)) 10/09
  LS-16EExclusion (Completed Operations) 4/209/028/981/88
  LS-17Exclusion (All Hazards at Designated Premises) 4/209/021/88
  LS-18Operations Exclusion4/209/028/981/88
  LS-19Additional Insured  (Premises Leased to Insured)4/209/027/981/88
  LS-20Additional Insured – Volunteers (Direct Liability)4/209/02
  LS-20AAdditional Insured – Volunteers (Vicarious Liability)9/02
  LS-21Additional Insured – Employees (Direct)4/209/021/88
  LS-21AAdditional Insured – Employees (Vicarious)9/02
  LS-22Additional Insured4/209/021/88
  LS-22AAdditional Insured (Secured Creditors)4/206/04
  LS-23Additional Insured (Club Members)4/209/021/88
  LS-24Additional Insured-Contractual Obligation9/027/00
  LS-24AAdditional Insured-Contractual Obligation4/209/027/00
  LS-25Additional Insured  (State or Political Subdivision)4/209/027/981/88
  LS-25AAdditional Insured  (State or Political Subdivision)4/205/17
  LS-26Explosion, Collapse, Underground Property Damage4/209/021/88
  LS-27Products-Designated Operations4/209/021/88
  LS-28Exclusion (Camps)4/209/021/88
  LS-29Boats (Described Watercraft)4/209/021/88
  LS-30Host Liquor Law Coverage9/021/88
  LS-31Modification of Liquor Liability Exclusion9/026/90
  LS-32Clubs4/209/021/88
  LS-33Hotels and Motels Coverage4/209/028/981/88
  LS-34Liquor Liability4/209/021/88
  LS-34ALiquor Liability (Designated Premises)4/20
  LS-35Exclusion (Farms)4/209/021/88
  LS-36Exclusion (Fairs)4/209/028/92
  LS-37Colleges or Schools4/209/021/88
  LS-38Manufactured Home Parks4/209/021/88
  LS-39Primary and Non-Contributory Coverage4/203/13
  LS-40Sexual Misconduct Liability Coverage4/207/14
  LS-41Total Liquor Liability Exclusion4/20
  LS-42Products/Completed Operations (Food/Beverage) LS-1&35/059/021/88
  LS-42AProducts/Completed Operations (Food/Beverage) LS-5&65/059/021/88
  LS-43Products/Completed Operations (No Food/Beverage)LS-1&38/095/059/021/88
  LS-44Barber/Beauty Shop Liability4/209/021/88
  LS-44ABarber/Beauty Shop Liability4/204/08
  LS-45Clergyperson Professional Legal Liability Coverage4/207/149/021/88
  LS-46Morticians’ or Cemetery Coverage4/209/021/88
  LS-47Druggists’ Liability Coverage4/209/021/88
  LS-48Fire Legal Liability4/209/021/88
  LS-48AFire Legal Liability4/209/0212/98
  LS-48BFire Legal Liability – Property Coverage4/202/10
  LS-49Personal Injury4/209/029/951/88
  LS-50Employers Non-Ownership Liability4/209/021/88
  LS-50AHired & Non-owned Auto Coverage4/209/024/95
  LS-51Directors and Officers Liability4/209/0210/00
  LS-52Canoes and Rowboats4/20
  LS-53Liquor Liability4/20
  LS-53ALiquor Liability4/20
  LS-55Deductible Liability Coverage4/209/021/88
  LS-56Deductible Liability Coverage (Property Damage)4/209/021/88
  LS-57Lead Exclusion4/207/14
  LS-57-DISCPolicyholder Disclosure Notice – Lead Exclusion7/14
  LS-58Overspray or Spillage Exclusion4/204/14
  LS-58-DISCPolicyholder Disclosure Notice – Overspray Exclusion4/14
  LS-59Lead Exclusion8/224/209/0211/92
  LS-59 DISCPolicyholder Disclosure Notice – Lead Exclusion6/07
  LS-60Change Endorsement4/209/0210/881/88
  LS-61Change Endorsement4/209/021/88
  LS-62Customer’s Goods Legal Liability4/20
  LS-63Sale and Disposal Legal Liability4/20
  LS-64Care Provided for Others4/209/021/88
  LS-64ACare Provided for Others11/99
LS-65Controlled Substance Exclusion (Use with 4/20)9/24
LS-65AControlled Substance Exclusion (Use with 1/88, 3/93 and 9/02)9/24
LS-65 DISCPolicyholder Disclosure Notice – Controlled Substance Exclusion9/24
LS-65A DISC Policyholder Disclosure Notice – Controlled Substance Exclusion9/24
  LS-69Sudden and Accidental Pollution Endorsement1/88
  LS-70Business Premises Exclusion4/209/023/89
  LS-70ACoverage Applicable to Designated Premises or Project4/209/025/97
  LS-71Additional Insured – Vendors Broad Form4/209/023/89
  LS-72Exclusion (Saddle Animals)4/209/023/89
  LS-73Assault & Battery Exclusion4/209/0211/89
 LS-73-DISCPolicyholder Disclosure Notice – Assault & Battery Exclusion8/18
  LS-75Water Damage Exclusion (NYC only)4/209/023/90
  LS-76Exclusion (Certain Skin Care Services)4/209/027/91
  LS-76AExclusion (Certain Skin Care Services)4/209/025/97
  LS-76BExclusion (Certain Skin Care Services)4/203/12
  LS-76B-DISCPolicyholder Disclosure Notice – Exclusion (Certain Skin Care Services)5/12
  LS-77Aggregate Limits Applicable at Each Location4/204/959/02
  LS-78Exclusion of Certain Roofing Operations4/209/028/983/96
  LS-79Exclusion of Snow/Ice Control Operations4/209/025/97
  LS-79AExclusion of Snow/Ice Control Operations4/206/14
  LS-79A-DISCPolicyholder Disclosure Notice6/14
  LS-80Redefinition of Insured7/96
  LS-81Redefinition of Insured7/96
  LS-82Redefinition of Insured7/96
  LS-83Redefinition of Insured7/96
  LS-84New York Amendatory Endorsement10/97
  LS-85Exclusion of Known Loss or Damage5/99
  LS-87Exclusion (Asbestos, Dioxin & PCB)4/207/88
  LS-88Discrimination Clarification9/025/97
  LS-89Extended Pollution Exclusion9/025/97
  LS-91Exclusion of Newly Acquired Entities4/209/025/97
  LS-92Contractual Liability Limitation4/209/025/97
  LS-93Employment Practices Exclusion9/025/97
  LS-94Coverage Applicable to Designated Operations Only4/209/026/98
  LS-95Limitation of Coverage for Additional Insureds4/209/027/98
  LS-96Excess Limits of Liability4/209/027/98
  LS-97Exclusion of Work Performed from Scaffolding4/209/028/99
  LS-98Exclusion of Hot Application Roofing Operations4/209/027/98
  LS-99Calendar Date Exclusion4/205/98
  LS-100Supplemental Application Broad Form CGL9/027/95
  LS-101Pension Plan Clarification4/209/03
  LS-105Exclusion-Seed Dealer’s Liability4/202/04
  LS-118Silica Exclusion4/2012/08
  LS-118 DISCDisclosure Notice – Silica Exclusion8/09
  LS-120Exterior Insulation Exclusion4/2012/08
  LS-120 DISCDisclosure Notice – Exterior Insulation Exclusion8/09
  LS-122Exclusion of Unmanned Aircraft (For use with 9/02 LS series)3/16
  LS-123Exclusion of Unmanned Aircraft (For use with 1/88 LS series)3/16
  LS-130Employee Benefits Liability Coverage7/20
  LS-139Communicable Disease Exclusion4/20
  LS-139ACommunicable Disease Exclusion Clarification6/22
  LS-140Defense of an Indemnitee4/20
  LS-141Employer’s Liability Exclusion (Third Party Action Over)4/20
  LS-141 DISCPolicy holder Disclosure Notice for LS-141 (4/20)4/20
  LS-141AEmployer’s Liability Exclusion6/22
  LS-141A DISCPolicyholder Disclosure Notice6/22
  LS-141BEmployer’s Liability Exclusion6/22
  LS-141B DISCPolicyholder Disclosure Notice6/22
  LS-142Cross Liability Exclusion4/20
  LS-144Beauty or Barber Shop Professional Liability4/20
  LS-144ABeauty or Barber Shop Professional Liability4/20
  LS-145Clergyperson Professional Liability4/20
  LS-146Mortician or Cemetery Professional Liability4/20
  LS-147Pharmacist Professional Liability4/20
  LS-150Non-Owned Automobile Liability4/20
  LS-150AHired Automobile & Non-Owned Automobile Liability4/20
  LS-177Each Project Aggregate Limit of Liability4/20
  LS-187Asbestos Exclusion4/206/07
  LS-187 DISCDisclosure Notice – Asbestos Exclusion11/07
  LS-373Exclusion of Canine Related Injuries or Damages4/2012/11
  LS-373 DISCDisclosure Notice – Exclusion of Canine Related Injuries or Damages12/11
  LS-400Amendatory Endorsement12/00
  LS-411Farm Employees Liability Coverage Schedule1/88
  LS-413Custom Farming1/88
  LS-414Farm Pollution Liability1/88
  LS-415Additional Insured7/981/88
  LS-418Insured Liability Employee by Other-Non farm1/88
  LS-419Add’l Residence Rented to Others1/88
  LS-420Exclusion of Farm Employees Illegally Employed1/88
  LS-439Farm Premises Medical Payments Insurance1/88
  LS-470Additional Residential Premises – Rented to Others1/88
  LS-475Watercraft1/88
  LS-550Agribusiness Pursuits10/19
  LS-DISCPolicyholder Disclosure Notice9/027/92
 LS-DISC-1Policyholder Disclosure Notice (Skin Care)6/97
LS-DISC-2Policyholder Disclosure Notice (1/88 to 4/20)6/24
LS-DISC-3Policyholder Disclosure Notice (9/02 to 4/20)6/24