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• <br />Policy Number AS2-631-0041 12-074 <br />ITEM TWO — Schedule of Coverages and Covered Autos <br />This policy provides only those coverages where a charge is shown in the premium column below. Each of these <br />coverages will apply only to those "autos" shown as covered "autos". "Autos" are shown as covered "autos" for a <br />particular coverage by the entry of one or more of the symbols from the COVERED AUTOS Section of the <br />Business Auto Coverage Form next to the name of the coverage, <br />Coverage <br />Covered Autos <br />Limit <br />Premium <br />Liability (LIAB)* <br />01 <br />$2,000,000 <br />$205,940 <br />Compulsory Bodily Injury <br />(MA only) <br />$ 20,000 Each Person <br />$ 40,000 Each Accident <br />Optional Bodily Injury <br />(MA only) <br />Each Person <br />Each Accident <br />Property Damage <br />(Compulsory Limit <br />$5,000) (MA only) <br />Each Accident <br />Personal Injury Protection <br />(PIP) (or equivalent <br />No -Fault Coverage) <br />05 <br />Separately stated in each PIP <br />Endorsement <br />$108 <br />Added Personal Injury <br />Protection (PIP) (or <br />equivalent added <br />No -Fault Coverage) <br />Separately stated in each Added PIP <br />Endorsement <br />Extraordinary Medical <br />Benefits Coverage (EMB) <br />(PA only) <br />Separately stated in the EMB <br />Endorsement <br />Optional Basic Economic <br />Loss Coverage (OBEL) <br />(NY only) <br />Separately stated in the OBEL Schedule <br />Property Protection <br />Insurance (PPI) (MI only) <br />Separately stated in the PPI <br />Endorsement <br />Medical Expense and <br />Income Loss Benefits <br />(ME/ILB) (VA only) <br />Separately stated in the Medical <br />Expense and Income Loss Benefits <br />Endorsement <br />Auto Medical Payments <br />SMED) <br />Uninsured Motorists (UM) <br />06 <br />See UM/UIM Schedule <br />INCL <br />Underinsured Motorists <br />(UIM) (When not included <br />in Uninsured Motorists <br />Coverage) <br />06 ** <br />See UM/UIM Schedule <br />Supplementary <br />UninsuredlUnderinsured <br />Motorists (SUM) (NY <br />only) <br />See state Schedule of Limits for SUM <br />insurance <br />Uninsured Motorists <br />(Compulsory Limits <br />$20,000l$40,000) <br />(MA only) <br />See UMIUIM Schedule <br />" New York only - Includes Supplemental Spousal Liability (SSL) if CA 04 20 is attached to this policy. <br />"*Premium is INCL <br />AC 00 03 02 13 <br />® 2012 Liberty Mutual Insurance. At rights reserved. <br />Includes copyrighted material of Insurance Services Office, Inc. <br />with its permission. <br />Page 2 of 3 <br />93 <br />