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LS Forms List

  Form #  Description

Edition Dates

  LS-1

Premises/Operations Liability Insurance

1/88

9/02

4/20

   
  LS-1S Premises/Operations Liability Ins. Schedule

1/88

9/02

4/20

 
  LS-2 Coverage M - Premises Med. Pay.

1/88

9/02

   
  LS-3 Manufacturers & Contractors Liability

1/88

9/02

4/20  

 
  LS-3S M&C Liability Insurance Schedule

1/88

9/02

4/20  

 
  LS-4 Storekeepers Liability Insurance

1/88

9/02

4/20  

 
  LS-4S Storekeepers Liability Insurance Schedule

1/88

9/02

4/20  

 
  LS-5 Business General Liability Ins.

3/93

1/88 9/02 4/20  
  LS-5S Business General Liability Ins. Schedule

1/88

9/02

4/20

 
  LS-6 Business General Liability Ins. (Extra Cov.) 

1/88

9/02

4/20

 
  LS-8 Owners & Contractors Prot. Liab. Ins. 

1/88

9/02

4/20

 
  LS-8S Owners  & Contractors Prot. Liab. Ins. Schedule 

1/88

9/02

4/20

 
  LS-10 Amendment of Limits of Liability 

1/88

9/02

5/13

   
  LS-11 Real Estate Agents 

1/88

9/02

4/20

 
  LS-12 Waiver of Subrogation

8/12

4/20

     
  LS-12A Waiver of Subrogation (Automatic)

/4/20

   
  LS-13 Cold Storage Locker Establishments 

1/88

9/02

   
  LS-14 Exclusion (Athletic Participants) 

1/88

9/02

4/20

 
  LS-14A Athletic Participants Exclusion (All Activities or Contest)

4/20

  LS-15 Exclusion (Laundry & Dry Cleaning) 

1/88

9/02

4/20

 
  LS-16 Exclusion (Named Insured's Products) 

1/88

9/02

4/20

 
  LS-16B Exclusion (Products/Comp. Ops. Hazard) 

8/98

1/88 9/02 4/20
  LS-16C Products Hazard Redefinition

4/20

  LS-16D Exclusion (Named Insured's Products) 

1/88

9/02

8/09

   
  LS-16D-DISC Disclosure Notice (For LS-16D (8/09)) 

10/09

     
  LS-16E Exclusion (Completed Operations) 

8/98

1/88 9/02

4/20  

  LS-17 Excl. (All Haz. at Designated Premises) 

1/88

9/02

4/20

 
  LS-18 Operations Exclusion

8/98

1/88 9/02 4/20
  LS-19 Add'l Insured  (Prem. Leased to Ins.)

7/98

1/88 9/02 4/20  
  LS-20 Add'l Insured - Volunteers (Direct Liability)

9/02

4/20

   
  LS-20A Add'l Insured - Volunteers (Vicarious Liability)

9/02

   
  LS-21 Additional Insured - Employees (Direct)

1/88

9/02

4/20

 
  LS-21A Additional Insured - Employees (Vicarious)

9/02

   
  LS-22 Additional Insured

1/88

9/02

4/20

 
  LS-22A Additional Insured (Secured Creditors) 6/04

4/20

   
  LS-23 Additional Insured (Club Members)

1/88

9/02

4/20

 
  LS-24 Additional Insured-Contractual Oblig.

7/00

9/02

   
  LS-24A Additional Insured-Contractual Oblig.

7/00

9/02

4/20

 
  LS-25 Additional Insured  (State or Political Subdivision)

7/98

1/88 9/02 4/20
  LS-25A Additional Insured  (State or Political Subdivision)

5/17

4/20

   
  LS-26 Explosion, Collapse, U/G Prop. Dam.

1/88

9/02

4/20

 
  LS-27 Products-Designated Operations

1/88

9/02

4/20

 
  LS-28 Exclusion (Camps)

1/88

9/02

4/20

 
  LS-29 Boats (Described Watercraft)

1/88

9/02

4/20

 
  LS-30 Host Liquor Law Coverage

1/88

9/02

   
  LS-31 Modification of Liquor Liability Exclusion

6/90

9/02

   
  LS-32 Clubs

1/88

9/02

4/20

 
  LS-33 Hotels and Motels Coverage

8/98

1/88 9/02 4/20  
  LS-34 Liquor Liability

1/88

9/02

4/20

 
  LS-34A Liquor Liability (Designated Premises)

4/20

   
  LS-35 Exclusion (Farms)

1/88

9/02

4/20

 
  LS-36 Exclusion (Fairs)

8/92

9/02

4/20

 
  LS-37 Colleges or Schools

1/88

9/02

4/20

 
  LS-38 Manufactured Home Parks

1/88

9/02

4/20  

 
  LS-39 Primary and Non-Contributory Coverage

3/13

4/20

   
  LS-40 Sexual Misconduct Liability Coverage

7/14

4/20

   
  LS-41 Total Liquor Liability Exclusion

/4/20

   
  LS-42 Prod/Comp. Ops. (Food/Bev.) LS-1&3

1/88

9/02

5/05  

   
  LS-42A Prod/Comp. Ops. (Food/Bev.) LS-5&6

1/88

9/02

5/05  

   
  LS-43 Prod/Com. Ops. (No Food/Bev.) LS-1&3

1/88

9/02

5/05  

8/09 4/20
  LS-44 Barber/Beauty Shop Liability

1/88

9/02

4/20

 
  LS-44A Barber/Beauty Shop Liability

/4/08

4/20

   
  LS-45 Clergyperson Prof. Legal Liability Coverage

1/88

9/02

7/14

4/20

  LS-46 Morticians' or Cemetery Coverage

1/88

9/02

4/20

 
  LS-47 Druggists' Liability Coverage

1/88

9/02

4/20

 
  LS-48 Fire Legal Liability

1/88

9/02

4/20

 
  LS-48A Fire Legal Liability

12/98

9/02

4/20

 
  LS-48B Fire Legal Liability - Property Coverage

2/10

4/20

   
  LS-49 Personal Injury

9/95

1/88

9/02

4/20

  LS-50 Employers Non-Ownership Liability

1/88

9/02

4/20

 
  LS-50A Hired & Non-owned Auto Coverage

4/95

9/02

4/20

 
  LS-51 Directors and Officers Liability

10/00

9/02

4/20

 
  LS-52 Canoes and Rowboats

/4/20

   
  LS-53 Liquor Liability

/4/20

   
  LS-53A Liquor Liability

/4/20

   
  LS-55 Deductible Liability Coverage

1/88

9/02

4/20

 
  LS-56 Deductible Liability Coverage (Prop. Dam)

1/88

9/02

4/20

 
  LS-57 Lead Exclusion 7/14

4/20

   
  LS-57-DISC Policyholder Disclosure Notice - Lead Exclusion 7/14        
  LS-58 Overspray or Spillage Exclusion 4/14

4/20

   
  LS-58-DISC Policyholder Disclosure Notice - Overspray Exclusion 4/14        
  LS-59 Lead Exclusion

11/92

9/02

4/20

8/22

  LS-59 DISC Policyholder Disclosure Notice - Lead Exclusion 6/07        
  LS-60 Change Endorsement

10/88

1/88

9/02

4/20

  LS-61 Change Endorsement

1/88

9/02

4/20

 
  LS-62 Customer's Goods Legal Liability

/4/20

   
  LS-63 Sale and Disposal Legal Liability

/4/20

   
  LS-64 Care Provided for Others

1/88

9/02

4/20

 
  LS-64A Care Provided for Others

11/99

   
  LS-69 Sudden and Accidental Pollution End.

1/88

   
  LS-70 Business Premises Exclusion

3/89

9/02

4/20

 
  LS-70A Cov. Appl. to Designated Premises or Project

5/97

9/02

4/20

 
  LS-71 Additional Insured - Vendors Broad Form

3/89

9/02

4/20

 
  LS-72 Exclusion (Saddle Animals)

3/89

9/02

4/20

 
  LS-73 Assault & Battery Exclusion

11/89

9/02

4/20

 
/ LS-73-DISC Policyholder Disclosure Notice - Assault & Battery Exclusion 1/18        
  LS-75 Water Damage Exclusion (NYC only)

3/90

9/02

4/20

 
  LS-76 Exclusion (Certain Skin Care Services)

7/91

9/02

4/20

 
  LS-76A Exclusion (Certain Skin Care Services)

5/97

9/02

4/20

 
  LS-76B Exclusion (Certain Skin Care Services)

3/12

4/20

   
  LS-76B-DISC Policyholder Disclosure Notice -
Exclusion (Certain Skin Care Services)

5/12

     
  LS-77 Aggregate Limits Applicable at Each Loc.

4/95

9/02

4/20

 
  LS-78 Exclusion of Certain Roofing Operations

8/98

3/96

9/02

4/20

  LS-79 Exclusion of Snow/Ice Control Operations

5/97

9/02

4/20

 
  LS-79A Exclusion of Snow/Ice Control Operations

6/14

4/20

   
  LS-79A-DISC Policyholder Disclosure Notice

6/14

   
  LS-80 Redefinition of Insured

7/96

   
  LS-81 Redefinition of Insured

7/96

   
  LS-82 Redefinition of Insured

7/96

   
  LS-83 Redefinition of Insured

7/96

   
  LS-84 New York Amendatory Endorsement

10/97

   
  LS-85 Exclusion of Known Loss or Damage

5/99

   
  LS-87 Exclusion (Asbestos, Dioxin & PCB)

7/88

4/20

   
  LS-88 Discrimination Clarification

5/97

9/02

   
  LS-89 Extended Pollution Exclusion

5/97

9/02

   
  LS-91 Exclusion of Newly Acquired Entities

5/97

9/02

4/20

 
  LS-92 Contractual Liability Limitation

5/97

9/02

4/20

 
  LS-93 Employment Practices Exclusion

5/97

9/02

   
  LS-94 Cov. Applicable to Designated Ops. Only

6/98

9/02

4/20

 
  LS-95 Limitation of Cov. for Additional Insureds

7/98

9/02

4/20

 
  LS-96 Excess Limits of Liability

7/98

9/02

4/20

 
  LS-97 Exclusion of Work Pref. from Scaffolding

8/99

9/02

4/20

 
  LS-98 Exclusion of Hot Appl. Roofing Ops.

7/98

9/02

4/20

 
  LS-99 Calendar Date Exclusion

5/98

4/20

   
  LS-100 Supplemental App. Broad Form CGL

7/95

9/02

   
  LS-101 Pension Plan Clarification

9/03

4/20

   
  LS-105 Exclusion-Seed Dealer's Liability 2/04

4/20

   
  LS-118 Silica Exclusion

12/08

4/20

   
  LS-118 DISC Disclosure Notice - Silica Exclusion

8/09

   
  LS-120 Exterior Insulation Exclusion

12/08

4/20

   
  LS-120 DISC Disclosure Notice - Exterior Insulation Exclusion

8/09

   
  LS-122 Exclusion of Unmanned Aircraft
(For use with 9/02 LS series)

3/16

   
  LS-123 Exclusion of Unmanned Aircraft
(For use with 1/88 LS series)

3/16

   
  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

6/07

4/20

   
  LS-187 DISC Disclosure Notice - Asbestos Exclusion

11/07

   
  LS-373 Excl. of Canine Related Injuries or Damages

12/11

4/20

   
  LS-373 DISC Disclosure Notice - Excl. of Canine Related Injuries or Damages

12/11

   
  LS-400 Amendatory Endorsement

12/00

   
  LS-411 Farm Employees Liab. Cov. Schedule

1/88

   
  LS-413 Custom Farming

1/88

   
  LS-414 Farm Pollution Liability

1/88

   
  LS-415 Additional Insured

7/98

1/88    
  LS-418 Ins. Liab. Emp. by Other-Non farm

1/88

   
  LS-419 Add'l Residence Rented to Others

1/88

   
  LS-420 Exclusion of Farm Emp. Illegally Employed

1/88

   
  LS-439 Farm Premises Med. Pay.

1/88

   
  LS-470 Add'l Res. Prem. - Rented to Others

1/88

   
  LS-475 Watercraft

1/88

   
  LS-550 Agribusiness Pursuits 10/19        
  LS-DISC Policyholder Disclosure Notice

7/92

9/02        
 LS-DISC-1 Policyholder Disclosure Notice

6/97