Kentucky Anti Theft

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                                           KENTUCKY
                              AUTOMOBILE SUPPLEMENTAL APPLICATION
                                   VEHICLE ANTI-THEFT DEVICES
Kentucky state legislation requires us to offer you a discount on your comprehensive coverage premium on vehicles with
eligible anti-theft devices installed.

To determine whether your anti-theft device meets the statutory criteria for a discount, this form must be completed and
forwarded to us. This anti-theft discount shall apply to the power plant portion for your vehicle which includes all the
equipment that constitutes a single unit power source. If an auto is equipped with more than one qualifying device, only the
highest discount will apply.

Please review the following descriptions and indicate the appropriate type code on the schedule below.

                                   ANTI-THEFT DEVICE DESCRIPTION AND TYPE CODES

An anti-theft device discount on comprehensive coverage must be made available for commercial autos if the auto is
equipped with:

-        an alarm only device which sounds an audible alarm that can be heard at a distance of at least 300 feet.

-        an active or passive disabling device or other approved anti-theft devices.

    CODE                                                                  DESCRIPTION


    1.                                Vehicles with Alarm Only Device


                                      Vehicles with any of the following Active Disabling Devices (a separate manual
                                      step is required to engage the device):
    2.                                     Ignition or Starter Cutoff Switch which disables the vehicles by making the starter or
                                           ignition system inoperative, additionally must have flush or tapered door lock
                                           buttons; or a Steering Column Armored Collar which clamps on the steering column
                                           over the ignition lock.
    3.                                     Fuel Cutoff Device which disables the vehicles by making the fuel system
                                           inoperative or a Steering Wheel Lock, permanently attached, consisting of a steel
                                           collar and barrel whose lock is operated by a tubular key; or an Armored Cable
                                           Hood Lock and Ignition Cutoff Switch.

    4.                                     Armored Ignition Cutoff Switch, which resists tampering and prevents hot-wiring,
                                           operated by either a tubular key and installed inside the vehicle, or with an
                                           electronic keyless device; or an Armored Cable or Electrically Operated Hood Lock
                                           and Ignition Cutoff Switch, which is a supplemental hood lock operated from within
                                           the motor vehicle.




G-142648-A                                                  Page 1 of 3
(ED. 05/02)
                          Vehicles with the following Passive Disabling Device (a separate manual step is
                          not required to engage the device):
  5.                      Devices which disable the vehicle by making the fuel, ignition or starting system
                          inoperative.


                          Vehicles with Other Anti-Theft Devices:

  6.                          Window Identification System in which the identification letters or numbers are
                              etched into all windows of the vehicle other than the small vent windows.

  7.                          High Security Ignition Replacement Lock, conforms to federal standards and
                              cannot be removed using a conventional slide hammer or lock puller equipment.

  8.                          Internally Operated Alarms including a passive disabling device which disables the
                              vehicle by making the ignition or starting system inoperative.

  9.                          Alarm which operates with the following criteria:

                               Hood lock which can be released only from inside the vehicle by a key or
                                electronic keyless device; and

                               Maintain a self resetting, 8 minute maximum alarm installed within the engine
                                compartment; and

                               The system shall be disarmed by a tubular lock or electronic keyless device; and

                               Automatic ignition or starter cutoff device.



                                              SCHEDULE


VEHICLE YEAR/MAKE/MODEL                                         VEHICLE IDENTIFICATION NUMBER

ALARM TYPE CODE                              ALARM MANUFACTURER



VEHICLE YEAR/MAKE/MODEL                                         VEHICLE IDENTIFICATION NUMBER

ALARM TYPE CODE                              ALARM MANUFACTURER



VEHICLE YEAR/MAKE/MODEL                                         VEHICLE IDENTIFICATION NUMBER

ALARM TYPE CODE                              ALARM MANUFACTURER




                                              SCHEDULE


VEHICLE YEAR/MAKE/MODEL                                         VEHICLE IDENTIFICATION NUMBER


G-142648-A                                    Page 2 of 3
(ED. 05/02)
ALARM TYPE CODE                                        ALARM MANUFACTURER



VEHICLE YEAR/MAKE/MODEL                                                  VEHICLE IDENTIFICATION NUMBER

ALARM TYPE CODE                                        ALARM MANUFACTURER



VEHICLE YEAR/MAKE/MODEL                                                  VEHICLE IDENTIFICATION NUMBER

ALARM TYPE CODE                                        ALARM MANUFACTURER


        I have Anti-Theft device(s) installed in my vehicle(s) as indicated above.



I understand these coverage selections will apply to all future renewals, continuations, and changes in my policy unless I
notify you otherwise.

It is unlawful to knowingly provide false, incomplete, or misleading facts or information to an insurance company for the
purpose of defrauding or attempting to defraud the company. Penalties may include imprisonment, fines, denial of
insurance and civil damages.



    Signature of Authorized Representative                                                Date


               Name of Insured                                                       Policy Number




G-142648-A                                              Page 3 of 3
(ED. 05/02)