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DocuSign Envelope ID:897E46E3-FA01-48C0-AD59-05BF8E64A105 <br /> BUSINESS AUTO <br /> SCHEDULE(S) <br /> NATIONWIDE INSURANCE CO OF AMERICA <br /> ONE NATIONWIDE PLAZA <br /> COLUMBUS,'OH 43215-2220 <br /> The following schedule(s) is/are a continuation of the declarations. <br /> Number: ACP BAFB 2264894216 Effective from 05/07/2017 to 05/Oyi/2018 <br /> Named Insured: GONZALEZ PAINTERS & CONTRACTORS INC Agency Name: All About Insurance <br /> SCHEDULE OF FORMS AND ENDORSEMENTS <br /> Form No. Date Title Premium <br /> AC9954 (04/05) AMENDMENT OF COVERED AUTO SYMBOL 7 <br /> CA0001 (0 3/1 0) BUSINESS AUTO COVERAGE FORM <br /> CA0126 (07/10) NORTH CAROLINA CHANGES <br /> CA2018 (1 2/9 3) PROFESSIONAL SERVICES NOT COVERED <br /> CA2107 (12/93) SPLIT UNINSURED MOTORISTS COVERAGE LIMITS <br /> CA2116 (04/1 0) NORTH CAROLINA UNINSURED MOTORISTS COVERAGE <br /> CA2301 (1 2/9 3) EXPLOSIVES <br /> CA2304 (1 0/01) ROLLING STORES <br /> CA2384 (01/0 6) EXCLUSION OF TERRORISM <br /> CA2394 (03/06) SILICA OR SILICA -RELATED DUST EXCL FOR COV AUTOS EXPOSURE <br /> CA9903 (03/06) AUTO MEDICAL PAYMENTS COVERAGE <br /> CA9927A (01/87) SPLIT LIABILITY LIMITS <br /> IL0003 (09/08) CALCULATION OF PREMIUM <br /> IL0017 (11/98) COMMON POLICY CONDITIONS <br /> IL0021 (09/08) NUCLEAR ENERGY LIABILITY EXCLUSION <br /> SCHEDULE OF IMPORTANT NOTICES <br /> Form No. Date T i t l e <br /> IN5017FB (03/11) IMPORTANT NOTICE FOR RENEWAL POLICIES <br /> IN5246 (03/11) NORTH CAROLINA REINSURANCE FACILITY <br /> IN5247 (03/11) NOTICE OF RIGHT TO PURCHASE HIGHER LIMITS OF UM/UIM <br /> IN5278 (12/13) IMPORTANT NOTICE FAIR CREDIT REPORTING ACT <br /> PHSCHED (01-97) <br /> DIRECT BILL EAH067 L734 2017067 AGENT COPY ACP BAFB2264894216 981503132 35 0008577 <br />