Alphabetical Index Forms are listed alphabetically by form title. Important Note: The forms shown herein for each state may not be a complete listing of all the financial responsibility forms that are required for the state. Some forms are not stocked by WOLTERS KLUWER FINANCIAL SERVICES because of their infrequent use (resulting in little demand) or because supplies are available from a state source. The state usage indicated for the various forms was based on the best information we had at the time of publication. You should be guided by individual state requirements. When using Acord Forms, user should be guided by instruction from the Acord Corporation. PAGE MC 1 of 12 WOLTERS KLUWER FINANCIAL SERVICES Customer Care: 800-382-2424
-------------------------------------------------------- MULTI-STATE AAMVA FORMS -------------------------------------------------------- These forms are based on text suggested by the American Association of Motor Vehicle Administrators (AAMVA) for multi-state application. Numerous states have adopted these forms and such is so indicated in the state listings herein, except as noted for SR-21 and SR-24. SR-23 does not apply in the county of Honolulu. * (F) R1302 A 10/91 SR221091 FINANCIAL RESPONSIBILITY INSURANCE CERTIFICATE AK, AL, AR, AZ, CA, CO, CT, DC, DE, FL, GA, HI, IA, ID, IL, IN, KS, KY, LA, MA, MD, ME, MI, MN, MO, MS, MT, NC, ND, NE, NH, NJ, NM, NV, NY, OH, OK, OR, PA, RI, SC, SD, TN, TX, UT, VA, VT, WA, WI, WV, WY (N) R1303 A 10/91 SR23 NOTICE FOR FLEETS AK, AL, AR, AZ, CO, CT, DC, FL, GA, HI, IA, ID, IN, LA, MS, MT, ND, NH, NM, NV, OH, OK, OR, RI, SC, TN, TX, VA, WA, WI, WV, WY R1307 A 10/91 SR26 NOTICE OF CANCELLATION OR TERMINATION AK, AL, AR, AZ, CA, CO, CT, DC, DE, FL, GA, HI, IA, ID, IL, IN, KS, KY, LA, MA, MD, ME, MI, MN, MO, MS, MT, NC, ND, NE, NH, NJ, NM, NV, NY, OH, OK, OR, PA, RI, SC, SD, TN, TX, UT, VA, VT, WA, WI, WV, WY R1305 A 10/91 SR24 NOTICE OF CHANGE AK, AL, AR, AZ, CA, CO, CT, DC, DE, FL, GA, HI, IA, ID, IL, IN, KS, KY, LA, MA, MD, ME, MI, MN, MO, MS, MT, NC, ND, NE, NH, NJ, NM, NV, NY, OH, OK, OR, PA, RI, SC, SD, TN, TX, UT, VA, VT, WA, WI, WV, WY R1300 A 10/91 SR21 NOTICE OF POLICY (UNIFORM HAS NO INDICATION OF THE STATE USAGE FOR THIS FORM, BUT THERE CONTINUES TO BE A SUBSTANTIAL DEMAND FOR IT AND, THEREFORE, WE WILL MAINTAIN IT AS A STOCK ITEM.) -------------------------------------------------------- GENERAL USE/STATE SPECIFIC -------------------------------------------------------- Alabama ACORD50AL 10/07 ACORD50AL 10/07 ALABAMA INSURANCE IDENTIFICATION R1451 A 07/01 ALABAMA MOTOR VEHICLE INSURANCE R1496 03/06 SR-21 PROOF OF LIABILITY INSURANCE - ALABAMA R1459 07/01 TEMPORARY MOTOR VEHICLE INSURANCE Alaska PAGE MC 2 of 12 WOLTERS KLUWER FINANCIAL SERVICES Customer Care: 800-382-2424
R1355 SR-22 CERTIFICATE OF INSURANCE ACORD50 02/07 ACORD50200702 INSURANCE AC5012 A 02/07 ACORD500207 INSURANCE (2 UP) AC5011 A 02/07 ACORD500207 INSURANCE Arizona ACORD50AZ 03/10 ACORD50AZ 03-10 ARIZONA INSURANCE IDENTIFICATION R1371 C 06/01 INSURANCE ACORD50 02/07 ACORD50200702 INSURANCE AC5012 A 02/07 ACORD500207 INSURANCE (2 UP) AC5011 A 02/07 ACORD500207 INSURANCE Arkansas ACORD50AR 10/07 ACORD50AR 10/07 ARKANSAS PROOF OF INSURANCE R1320 C 09/07 R1320C 09/07 AUTOMOBILE INSURANCE AC5012 A 02/07 ACORD500207 INSURANCE (2 UP) AC5011 A 02/07 ACORD500207 INSURANCE R1443 A 08/05 SR10805 MOTOR VEHICLE ACCIDENT REPORT R1458 08/01 PROOF OF LIABILITY INSURANCE FOR MOTORBOAT OR WATERCRAFT California ACORD51CA 07/04 ACORD51CA200407 CALIFORNIA EVIDENCE OF LIABILITY INSURANCE ACORD50CA 07/04 ACORD50CA0704 CALIFORNIA INSURANCE R1406 P 09/08 SR10908 CALIFORNIA TRAFFIC ACCIDENT REPORT R1449 03/00 COMMERCIAL/FLEET AUTOMOBILE INSURANCE R1331 C 08/91 SR75 EMPLOYER'S INSURANCE CERTIFICATE R1435 A 01/04 REG890AREV597 EVIDENCE OF LIABILITY INSURANCE R1349 B 06/00 SR22SR1P INSURANCE PROOF CERTIFICATE R1332 D 11/91 SR76 NOTICE OF CANCELLATION R1330 G 10/07 SR-26/SR-1PF NOTICE OF CANCELLATION INSURANCE PROOF CERTIFICATE R1448 03/00 PRIVATE PASSENGER AUTOMOBILE INSURANCE R1465 A 12/07 SR19C1207 REQUEST FOR INFORMATION (INSURANCE INFORMATION, UNINSURED MOTORIST CERTIFICATION, PHOTO COPY OF SR1 REPORT) R1469 08/04 REG481REV82003 SALVAGE VEHICLE NOTICE OF RETENTION BY OWNER PAGE MC 3 of 12 WOLTERS KLUWER FINANCIAL SERVICES Customer Care: 800-382-2424
Colorado ACORD50CO 03/07 ACORD50CO200703 COLORADO AUTO INSURANCE R1321 A 07/03 (FOR USE WITH POLICIES ISSUED 7/1/03 OR AFTER) ACORD50 02/07 ACORD50200702 INSURANCE AC5012 A 02/07 ACORD500207 INSURANCE (2 UP) AC5011 A 02/07 ACORD500207 INSURANCE Connecticut ACORD50CT 01/09 ACORD50CT CONNECTICUT INSURANCE R1311 E 10/08 (PERMANENT) R1317 C 02/01 (TEMPORARY) R1399 A 05/10 INSURANCE (PERMANENT - FOR COMMERCIAL MOTOR VEHICLES) R1325 D 06/06 IRB3613C SPECIAL FINANCIAL RESPONSIBILITY INSURANCE CERTIFICATE GU1327 G 07/09 IRB 3616D SPECIAL NOTICE OF CANCELLATION OR TERMINATION MC1721 12/00 VANPOOL INSURANCE CERTIFICATE Delaware R1358 01/91 FR4 01/94 ASSIGNED RISK INSURANCE CERTIFICATE REQUEST R1492 10/08 DELAWARE INSURANCE COMMERCIAL/ FLEET R1388 A (New) R1356 A 09/07 FR19 INSURANCE CERTIFICATE R1362 01/91 LETTER OF TRANSMITTAL (FOR USE WITH R1350) R1350 01/91 LISTING OF VEHICLES INSURED R1359 A 09/07 FR4 09/07 NOTICE OF CANCELLATION OR TERMINATION OF POLICY R1353 01/91 FR10490 UNINSURED VEHICLE REPORT District of Columbia ACORD50 02/07 ACORD50200702 INSURANCE AC5012 A 02/07 ACORD500207 INSURANCE (2 UP) AC5011 A 02/07 ACORD500207 INSURANCE Florida R1340 01/74 AUTOMOBILE INSURANCE BINDER R1314 06/71 SR22 06/71 FINANCIAL RESPONSIBILITY FORM ACORD51FL 07/09 ACORD51FL(2009/07) FLORIDA COMMERCIAL AUTO INSURANCE R1410 D (AUTOMOBILE INSURANCE) R1384 PAGE MC 4 of 12 WOLTERS KLUWER FINANCIAL SERVICES Customer Care: 800-382-2424
(FOR USE WITH PRIVATE PASSENGER MOTOR VEHICLE INSURANCE POLICY) R1490 12/07 FR44 1207 UNIFORM FINANCIAL RESPONSIBILITY CERTIFICATE R1491 12/07 FR46 1207 UNIFORM FINANCIAL RESPONSIBILITY CERTIFICATE NOTICE OF CANCELLATION Georgia R1386 01/76 AUTHORIZATION TO OBTAIN DRIVER RECORD INFORMATION FROM GEORGIA DEPARTMENT OF PUBLIC SAFETY (FLEET COMMERCIAL RISKS) R1417 B 12/03 FLEET POLICY INFORMATION ACORD50GA 11/08 ACORD50GA0811 GEORGIA INSURANCE POLICY INFORMATION R1462 12/03 INSURANCE POLICY INFORMATION NON FLEET R1385 A 01/92 REQUEST FOR MOTOR VEHICLE REPORT R1309 D 10/06 SR22A SAFETY RESPONSIBILITY INSURANCE CERTIFICATE Hawaii ACORD50HI 01/08 ACORD50HI0199 HAWAII MOTOR VEHICLE INSURANCE R1304 C 01/99 INSURANCE Idaho R1419 A 07/83 CERTIFICATE OF LIABILITY INSURANCE ACORD50 02/07 ACORD50200702 INSURANCE AC5012 A 02/07 ACORD500207 INSURANCE (2 UP) AC5011 A 02/07 ACORD500207 INSURANCE ACORD50ID 10/07 ACORD50ID 10/07 STATE OF IDAHO LIABILITY INSURANCE Illinois R1328 06/71 SR22A 06/71 (IL) CERTIFICATE R1493 04/09 SR-22 FINANCIAL RESPONSIBILITY CERTIFICATE R1494 04/09 SR-26 FINANCIAL RESPONSIBILITY NOTICE OF CANCELLATION OR TERMINATION ACORD50IL 03/07 ACORD50IL200703 ILLINOIS INSURANCE IDENTIFICATION R1341 A 07/96 INSURANCE Indiana R1461 C 03/05 48483R3 AFFIDAVIT OF CURRENT INSURANCE "SR-50" R1432 C 03/05 48469R5305 CERTIFICATE OF COMPLIANCE R1383 10/94 CERTIFICATE OF COMPLIANCE (WITH CARE LESSOR'S/EMPLOYER'S AFFIDAVIT) ACORD50IN 11/07 ACORD50 IN INDIANA INSURANCE IDENTIFICATION PAGE MC 5 of 12 WOLTERS KLUWER FINANCIAL SERVICES Customer Care: 800-382-2424
R1495 02/06 52441/SR21 INDIANA OPERATOR'S PROOF OF INSURANCE/CRASH REPORT ACORD50 02/07 ACORD50200702 INSURANCE AC5012 A 02/07 ACORD500207 INSURANCE (2 UP) AC5011 A 02/07 ACORD500207 INSURANCE Iowa ACORD50IA 08/07 ACORD50IA0807 INSURANCE R1437 A 11/08 IOWA FINANCIAL LIABILITY COVERAGE Kansas R1368 07/84 SR220784 AAMVA UNIFORM FINANCIAL RESPONSIBILITY FORM R1308 C 07/10 (AUTO LIABILITY INSURANCE) ACORD50 02/07 ACORD50200702 INSURANCE AC5012 A 02/07 ACORD500207 INSURANCE (2 UP) AC5011 A 02/07 ACORD500207 INSURANCE Kentucky ACORD50KY 01/06 ACORD50KY200601 COMMONWEALTH OF KENTUCKY PROOF OF INSURANCE R1322 D 01/09 PROOF OF INSURANCE Louisiana R1318 A 01/96 (AUTO INSURANCE) ACORD50LA 03/08 ACORD50LA(2008/03) LOUISIANA AUTO INSURANCE ID Maine R1348 06/71 CERTIFICATE DEALERS R1429 01/88 (MOTOR VEHICLE INSURANCE) ACORD50ME 08/07 ACORD50ME0807 MAINE MOTOR VEHICLE INSURANCE Maryland R1403 E 03/09 FR-19 03/09 INSURANCE CERTIFICATION ACORD50 02/07 ACORD50200702 INSURANCE AC5012 A 02/07 ACORD500207 INSURANCE (2 UP) AC5011 A 02/07 ACORD500207 INSURANCE Massachusetts ACORD50 02/07 ACORD50200702 INSURANCE AC5012 A 02/07 ACORD500207 PAGE MC 6 of 12 WOLTERS KLUWER FINANCIAL SERVICES Customer Care: 800-382-2424
INSURANCE (2 UP) AC5011 A 02/07 ACORD500207 INSURANCE Michigan R1408 A 04/81 CERTIFICATE OF NO-FAULT INSURANCE (NOT FOR USE WHEN POLICY CONTAINS NAMED-DRIVER EXCLUSION) R1440 02/92 FR140292 NOTICE OF CANCELLATION (FINANCIAL RESPONSIBILITY CERTIFICATE) R1439 01/94 FR201A0194 OPERATOR'S POLICY CERTIFICATE R1438 05/75 FR200575 OWNERS POLICY CERTIFICATE ACORD50MI 08/10 ACORD50MI STATE OF MICHIGAN CERTIFICATE OF NO-FAULT INSURANCE Minnesota ACORD50 02/07 ACORD50200702 INSURANCE AC5012 A 02/07 ACORD500207 INSURANCE (2 UP) AC5011 A 02/07 ACORD500207 INSURANCE R1313 A 01/93 MOTOR VEHICLE INSURANCE R1442 02/99 SUPPLEMENT TO MINNESOTA MOTOR VEHICLE INSURANCE IDENTIFICATION (SUMMARY OF CRIMINAL PENALTIES) Mississippi R1450 06/00 INSURANCE ACORD50MS 01/01 ACORD50MS0101 MISSISSIPPI INSURANCE Missouri R1366 06/71 SR22A 06/71 (MO) CERTIFICATE R1428 07/87 (AUTOMOBILE INSURANCE) ACORD50MO 05/07 ACORD50MO200705 MISSOURI AUTO INSURANCE Montana MC1740 12/03 MV-5C REV12/03 CANCELLATION OF CERTIFICATE OF INSURANCE - TOW TRUCKS OPERATIONS R1374 (I.D. STOCKED IN PERFORATED STRIPS OF 3 S. ORDER BY QUANTITY OF S DESIRED NOT BY THE STRIP.) ACORD50 02/07 ACORD50200702 INSURANCE AC5012 A 02/07 ACORD500207 INSURANCE (2 UP) AC5011 A 02/07 ACORD500207 INSURANCE PAGE MC 7 of 12 WOLTERS KLUWER FINANCIAL SERVICES Customer Care: 800-382-2424
Nebraska ACORD50 02/07 ACORD50200702 INSURANCE AC5012 A 02/07 ACORD500207 INSURANCE (2 UP) AC5011 A 02/07 ACORD500207 INSURANCE R1420 01/86 MOTOR VEHICLE LIABILITY INSURANCE CERTIFICATE (I.D. ) ACORD50NE 01/07 ACORD50NE200701 NEBRASKA AUTO LIABILITY INSURANCE Nevada R1351 E 08/10 EVIDENCE OF MOTOR VEHICLE LIABILITY INSURANCE R1456 A 08/10 EVIDENCE OF MOTOR VEHICLE LIABILITY INSURANCE - FOR OPERATOR USE ACORD52NV 05/10 ACORD52NV 2010/05 NEVADA PERMANENT INSURANCE ACORD51NV 05/10 ACORD51NV 2010/05 NEVADA TEMPORARY INSURANCE ID ACORD51NV 11/08 ACORD51NV200811 NEVADA TEMPORARY INSURANCE ID R1354 E 08/10 TEMPORARY EVIDENCE OF MOTOR VEHICLE LIABILITY INSURANCE R1457 A 08/10 TEMPORARY EVIDENCE OF MOTOR VEHICLE LIABILITY INSURANCE - FOR OPERATOR USE New Hampshire ACORD50 02/07 ACORD50200702 INSURANCE AC5012 A 02/07 ACORD500207 INSURANCE (2 UP) AC5011 A 02/07 ACORD500207 INSURANCE New Jersey R1401 C 05/04 INSURANCE ACORD50NJ 03/07 ACORD 50 NJ NEW JERSEY INSURANCE (WITH WATERMARK) R1472 10/04 TEMPORARY EVIDENCE OF INSURANCE R1402 D 05/04 TEMPORARY NEW JERSEY INSURANCE New Mexico R1352 01/84 (PROOF OF FINANCIAL RESPONSIBILITY) ACORD50 02/07 ACORD50200702 INSURANCE AC5012 A 02/07 ACORD500207 INSURANCE (2 UP) AC5011 A 02/07 ACORD500207 INSURANCE PAGE MC 8 of 12 WOLTERS KLUWER FINANCIAL SERVICES Customer Care: 800-382-2424
New York R1455 A 12/02 MV1031202 DMV ODOMETER AND DAMAGE DISCLOSURE STATEMENT R1393 K 07/05 MV104 05/02 REPORT OF MOTOR VEHICLE ACCIDENT R1464 05/02 MV104B0502 REPORT OF MOTOR VEHICLE ACCIDENT North Carolina R1379 C 09/99 FS1* CERTIFICATE OF LIABILITY INSURANCE R1310 A 10/89 DL1231089 DRIVERS LICENSE LIABILITY INSURANCE CERTIFICATION ACORD50 02/07 ACORD50200702 INSURANCE AC5012 A 02/07 ACORD500207 INSURANCE (2 UP) AC5011 A 02/07 ACORD500207 INSURANCE R1381 D 09/99 FS-4 NOTICE OF TERMINATION OF LIABILITY INSURANCE MC1720 A 02/06 MVR4CREV022006 NOTIFICATION OF OWNER RETAINED VEHICLE North Dakota R1446 A 09/04 SFN 54148 CERTIFICATE OF MOTOR VEHICLE LIABILITY INSURANCE - NORTH DAKOTA ACORD50 02/07 ACORD50200702 INSURANCE AC5012 A 02/07 ACORD500207 INSURANCE (2 UP) AC5011 A 02/07 ACORD500207 INSURANCE ACORD50ND 08/07 ACORD50ND200708 NORTH DAKOTA INSURANCE Ohio R1467 A 09/10 BMV3303 CRASH REPORT ACORD50 02/07 ACORD50200702 INSURANCE R1418 04/95 INSURANCE AC5012 A 02/07 ACORD500207 INSURANCE (2 UP) AC5011 A 02/07 ACORD500207 INSURANCE Oklahoma R1319 C 11/09 (OWNER'S AND OPERATOR'S SECURITY VERIFICATION FORM) ACORD51OK 08/09 ACORD51OK 08-09 OKLAHOMA OPERATORS SECURITY VERIFICATION FORM ACORD50OK 08/09 ACORD50OK 08-09 OKLAHOMA OWNERS SECURITY VERIFICATION FORM MOTOR VEHICLE COPY Oregon ACORD50 02/07 ACORD50200702 INSURANCE PAGE MC 9 of 12 WOLTERS KLUWER FINANCIAL SERVICES Customer Care: 800-382-2424
AC5012 A 02/07 ACORD500207 INSURANCE (2 UP) R1357 11/93 INSURANCE (I.D. STOCKED IN PERFORATED SHEETS OF 12 S. ORDER BY QUANTITIES OF S DESIRED NOT BY SHEET) AC5011 A 02/07 ACORD500207 INSURANCE Pennsylvania R1470 11/04 MV6SV0203 APPLICATION FOR CERTIFICATE OF SALVAGE FOR A STOLEN VEHICLE MV6 A 04/09 MV-6 APPLICATION FOR NON REPAIRABLE OR SALVAGE CERTIFICATE R1413 E 08/98 FINANCIAL RESPONSIBILITY R1378 H 02/94 FR40180 NOTICE OF PROPOSED SUSPENSION OF VEHICLE REGISTRATION ACORD50PA 09/07 ACORD50PA200709 PENNSYLVANIA FINANCIAL RESPONSIBILITY Rhode Island R1431 C 01/08 INSURANCE ACORD50RI 01/08 ACORD50RI200709 RHODE ISLAND INSURANCE GU1338 D 10/07 IRB3676 SPECIAL FINANCIAL RESPONSIBILITY INSURANCE CERTIFICATE South Carolina R1444 01/94 SR 21 FINANCIAL RESPONSIBILITY FORM R1452 10/00 MOTOR VEHICLE INSURANCE R1436 07/97 PROOF OF FINANCIAL RESPONSIBILITY (STOCKED IN PERFORATED STRIPS OF 3 S. ORDER BY QUANTITY OF S DESIRED NOT NUMBER OF STRIPS) ACORD50SC 01/07 ACORD50SC200701 SOUTH CAROLINA INSURANCE South Dakota R1426 (PERMANENT) R1427 (TEMPORARY) ACORD50 02/07 ACORD50200702 INSURANCE AC5012 A 02/07 ACORD500207 INSURANCE (2 UP) AC5011 A 02/07 ACORD500207 INSURANCE ACORD50SD 02/07 ACORD50SD200702 SOUTH DAKOTA INSURANCE Tennessee R1342 A 09/00 JR22 CERTIFICATE (UNDER AGED DRIVERS) R1460 10/01 MOTOR VEHICLE INSURANCE R1343 06/71 JR23 PAGE MC 10 of 12 WOLTERS KLUWER FINANCIAL SERVICES Customer Care: 800-382-2424
NOTICE OF CANCELLATION (UNDER AGED DRIVERS) MC1719 05/00 SF-0395 OWNER/DRIVER REPORT ACORD50TN 02/07 ACORD50TN200702 TENNESSEE INSURANCE Texas R1339 B 11/01 LIABILITY INSURANCE CR1367 A 10/01 LIABILITY INSURANCE (IN ENGLISH/SPANISH) R1367 A 10/01 LIABILITY INSURANCE (IN ENGLISH/SPANISH) R1454 A 05/02 LIABILITY INSURANCE (IN ENGLISH/SPANISH)(WITH PANTO) R1369 09/91 LIABILITY INSURANCE (IN SPANISH) ACORD50TX 11/08 TEXAS INSURANCE IDENTIFICATION Utah R1407 A 03/75 (INSURANCE) ACORD50 02/07 ACORD50200702 INSURANCE AC5012 A 02/07 ACORD500207 INSURANCE (2 UP) AC5011 A 02/07 ACORD500207 INSURANCE Vermont R1424 01/86 (AUTOMOBILE INSURANCE) ACORD50VT 02/07 ACORD50VT200702 VERMONT AUTOMOBILE INSURANCE Virginia R1333 B 02/08 VSA 57 APPLICATION FOR NON-REPAIRABLE CERTIFICATE VIRGINIA R1324 B 12/08 VSA 56 APPLICATION FOR SALVAGE CERTIFICATE VIRGINIA R1344 A 04/93 LSD 03 4/93 CERTIFICATION OF RECOVERED STOLEN VEHICLE R1463 02/03 FR10197 INSURANCE COVERAGE REPORT ACORD50 02/07 ACORD50200702 INSURANCE AC5012 A 02/07 ACORD500207 INSURANCE (2 UP) AC5011 A 02/07 ACORD500207 INSURANCE R1485 01/08 NOTICE OF CANCELLATION OR TERMINATION (FR-46) R1484 01/08 UNIFORM FINANCIAL RESPONSIBILITY CERTIFICATE (FR-44) Washington ACORD50 02/07 ACORD50200702 INSURANCE AC5012 A 02/07 ACORD500207 INSURANCE (2 UP) PAGE MC 11 of 12 WOLTERS KLUWER FINANCIAL SERVICES Customer Care: 800-382-2424
AC5011 A 02/07 ACORD500207 INSURANCE R1471 B 03/09 TD-420-074 TOTAL LOSS CLAIM SETTLEMENT REPORT West Virginia R1346 B 04/84 WV1B CERTIFICATE OF INSURANCE (I.D. STOCKED IN PERFORATED STRIPS OF 3 S. ORDER BY QUANTITY OF S DESIRED NOT BY THE STRIP.) R1360 D 05/08 WV-2B NOTICE OF CANCELLATION/ TERMINATION - WEST VIRGINIA ACORD50WV 04/08 ACORD50WV (04/08) WEST VIRGINIA CERTIFICATE OF INSURANCE Wisconsin ACORD50 02/07 ACORD50200702 INSURANCE AC5012 A 02/07 ACORD500207 INSURANCE (2 UP) AC5011 A 02/07 ACORD500207 INSURANCE Wyoming ACORD50 02/07 ACORD50200702 INSURANCE R1433 10/92 INSURANCE AC5012 A 02/07 ACORD500207 INSURANCE (2 UP) AC5011 A 02/07 ACORD500207 INSURANCE PAGE MC 12 of 12 WOLTERS KLUWER FINANCIAL SERVICES Customer Care: 800-382-2424