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Bureau of Insurance

Commercial Auto Forms (Effective prior to September 1, 2009)

Commercial Auto Forms
Form Number Form Name
CA-00-01-10-01 Business Auto Coverage Form
CA-00-05-10-01 Garage Coverage Form
CA-00-10-10-01 Business Auto Physical Damage Coverage Form
CA-00-12-10-01 Truckers Coverage Form
CA-00-20-10-01 Motor Carrier Coverage Form
CA-00-51-12-04 Changes in Coverage Forms - Mobile Equipment Subject to Motor Vehicle Insurance Laws
CA-01-16-11-06 Virginia Changes - Business Auto Coverage Form
CA-01-21-02-99 Limited Mexico Coverage
CA-01-54-11-07 Virginia Changes - Business Auto Physical Damage Coverage Form
CA-01-55-11-06 Virginia Changes - Motor Carrier and Truckers Coverage Forms
CA-01-95-12-06 Virginia Changes - Garage Coverage Form
CA-02-03-12-05 Virginia Cancellation and Nonrenewal Notice to Designated Person or Organization
CA-02-38-12-93 Reinstatement of Insurance
CA-02-68-12-05 Virginia Changes in Policy - Cancellation and Nonrenewal
CA-02-74-11-02 Virginia Suspension of Insurance
CA-03-02-12-93 Deductible Liability Coverage
CA-03-03-12-93 One Hundred Dollar ($100) Deductible for Completed Operations Does Not Apply
CA-04-10-12-05 Virginia Drive Other Car Coverage - Broadened Coverage for Named Individuals
CA-04-35-05-08 Virginia Physical Damage Coverage - Autos Held for Sale by Non-Dealers
CA-20-02-12-93 Sound Receiving Equipment Coverage - Fire, Police and Emergency Vehicles
CA-20-05-12-93 Drive-Away Contractors
CA-20-06-12-93 Driving Schools
CA-20-07-12-93 Emergency Vehicles - Fellow Volunteer Firefighters and Workers Injuries Exclusion Buyback
CA-20-08-12-93 Farm Tractors and Farm Tractors Equipment
CA-20-09-07-97 Leasing or Rental Concerns - Contingent Coverage
CA-20-10-12-93 Leasing or Rental Concerns - Conversion, Embezzlement or Secretion Coverage
CA-20-11-12-93 Leasing or Rental Concerns - Exclusion of Certain Leased Autos
CA-20-12-10-01 Leasing or Rental Concerns - Rent It There/Leave It Here Autos
CA-20-13-10-01 Leasing or Rental Concerns - Schedule of Limits for Owned Autos
CA-20-14-07-97 Leasing or Rental Concerns - Second Level Coverage
CA-20-16-10-01 Mobile Homes Contents Coverage
CA-20-17-12-93 Mobile Homes Contents Not Covered
CA-20-18-12-93 Professional Services Not Covered
CA-20-19-07-97 Repossessed Autos
CA-20-30-12-93 Emergency Vehicles - Volunteer Firefighters and Workers Injuries Excluded
CA-20-33-10-01 Autos Leased, Hired, Rented or Borrowed with Drivers - Physical Damage Coverage
CA-20-39-11-02 Virginia Lessor - Additional Insured and Loss Payee
CA-20-42-11-02 Virginia Registration Plates Not Issued for a Specific Auto
CA-20-43-08-07 Virginia Mobile Equipment
CA-20-44-11-02 Virginia Snowmobiles
CA-20-47-07-97 Additional Insured - Lessor of Leased Equipment
CA-20-48-02-99 Designated Insured
CA-20-49-07-97 Additional Insured - Garages - Grantor of Franchise
CA-20-54-10-01 Employee Hired Autos
CA-20-70-10-01 Coverage for Certain Operations in Connection with Railroads
CA-20-71-10-01 Auto Loan/Lease Gap Coverage
CA-21-21-11-02 Uninsured Motorists Endorsement (Virginia)
CA-22-46-11-02 Virginia Medical Expense and Income Loss Benefits Endorsement
CA-23-01-12-93 Explosives
CA-23-03-12-93 Multi-Purpose Equipment
CA-23-04-10-01 Rolling Stores
CA-23-05-12-93 Wrong Delivery of Liquid Products
CA-23-08-12-93 Truckers - Excess Coverage for the Named Insured and Named Lessors for Leased Autos
CA-23-09-02-99 Truckers - Insurance for Non-Trucking Use
CA-23-12-12-93 Truckers - Named Lessee As Insured
CA-23-13-12-93 Trailer Interchange Fire and Fire and Theft Coverages
CA-23-17-09-00 Truckers - Uniform Intermodal Interchange Endorsement Form Uiie - 1
CA-23-23-11-02 Virginia Truckers Endorsement
CA-23-24-10-01 Agricultural Produce Trailers - Seasonal
CA-23-25-07-97 Coverage for Injury to Leased Workers
CA-24-01-12-93 Farm Labor Contractors
CA-24-02-12-93 Public Transportation Autos
CA-25-01-12-93 Broad Form Products Coverage
CA-25-02-12-93 Dealers Driveaway Collision Coverage
CA-25-03-07-97 False Pretense Coverage
CA-25-04-12-93 Fire, Fire and Theft and Limited Specified Causes of Loss Coverage for Dealers
CA-25-05-07-97 Garage Locations and Operations Medical Payments Coverage
CA-25-07-12-93 Locations and Operations Not Covered
CA-25-09-12-93 Owners of Garage Premises
CA-25-10-10-01 Fire Legal Liability Coverage - Garages
CA-25-11-12-93 Named Driver Collision Coverage
CA-25-13-11-02 Virginia Pollution Exclusion for Garage Operations Other Than Covered Autos
CA-25-33-11-02 Virginia Personal Injury Liability Coverage - Garages
CA-25-34-12-05 Virginia Broadened Coverage - Garages
CA-31-27-12-05 Virginia Split Uninsured Motorists Coverage Limits
CA-99-13-07-97 Fiduciary Liability of Banks
CA-99-14-12-93 Fire, Fire and Theft, Fire, Theft and Windstorm and Limited Specified Causes of Loss Coverage
CA-99-15-12-93 Governmental Bodies Amendatory Endorsement
CA-99-16-12-93 Hired Autos Specified As Covered Autos You Own
CA-99-17-10-01 Individual Named Insured
CA-99-18-12-93 Individual Named Insured - Dealers Only
CA-99-23-12-93 Rental Reimbursement Coverage
CA-99-27-06-05 Split Liability Limits - Virginia
CA-99-28-10-01 Stated Amount Insurance
CA-99-30-10-01 Tapes, Records and Discs Coverage
CA-99-33-02-99 Employees As Insureds
CA-99-34-12-93 Social Services Agencies - Volunteers As Insureds
CA-99-38-06-05 Split Liability Limits - Garages - Virginia
CA-99-40-12-93 Exclusion or Excess Coverage Hazards Otherwise Insured
CA-99-44-12-93 Loss Payable Clause
CA-99-47-07-97 Employee As Lessor
CA-99-52-11-02 Virginia Limited Subrogation Rights
CA-99-54-07-97 Covered Auto Designation Symbol
CA-99-60-10-01 Audio, Visual and Data Electronic Equipment Coverage
CA-99-61-12-93 Loss Payable Clause - Audio, Visual and Data Electronic Equipment
CA-99-62-11-02 Virginia - Federal Employees Using Autos in Government Business
CA-99-63-11-02 District of Columbia Employees Using Government Autos in Government Business - Virginia
CA-99-66-12-05 Commonwealth of Virginia Employees Using Autos in Government Business
CA-99-71-05-08 Virginia Garagekeepers Coverage
CA-99-72-11-02 Virginia Garagekeepers' Coverage - Customers' Sound Receiving Equipment
CA-99-90-10-01 Optional Limits - Loss of Use Expenses
CA-DS-03-02-04 Business Auto Declarations
CA-DS-14-02-03 Truckers Declarations
CA-DS-15-10-01 Business Auto Physical Damage Declarations
CA-DS-21-02-03 Motor Carrier Declarations
CA-DS-22-11-02 Virginia Business Auto Declarations
CA-DS-24-05-08 Virginia Garage Declarations
CA-DS-25-05-08 Virginia Garage Coverage Form - Auto Dealer's Supplementary Schedule
CA-DS-27-11-02 Virginia Truckers Declarations
CA-DS-35-11-02 Virginia Motor Carrier Declarations
CA-DS-38-05-08 Garage Coverage Form - Auto Dealers' Supplementary Schedule
CA-DS-39-05-08 Garage Declarations
IL-00-03-07-02 Calculation of Premium
IL-00-17-11-98 Common Policy Conditions
IL-00-21-07-02 Nuclear Energy Liability Exclusion Endorsement (Broad Form)
IL-09-11-11-85 Supplement to Retrospective Premium Endorsement (Final Premium Computation)
IL-09-17-11-85 Resident Agent Countersignature Endorsement
IL-09-18-10-93 Retrospective Premium Endorsement - One Year Plan - Multiple Lines
IL-09-19-10-93 Retrospective Premium Endorsement - Three Year Plan - Multiple Lines
IL-09-20-10-93 Retrospective Premium Endorsement - Long Term Construction Project - Multiple Lines
IL-09-21-04-84 Retrospective Premium Endorsement - Short Form
IL-09-23-04-84 Retrospective Premium Endorsement - Exclusion of Retrospective Development Factors
IL-12-01-11-85 Policy Changes
IL-DS-00-07-02 Common Policy Declarations