Laserfiche WebLink
Policy Number <br />(20)7361-57-65 <br />COMMON POLICY CHANGE ENDORSEMENT <br />Endorsement No. 001 <br />Named Insured PARTNERS IN CONTROL INC Effective Date: 06-15-2020 <br />12:01 A.M., Standard Time <br />Agent Name ECBM LP Agent No. 50215-999 <br />This endorsement will not be used to decrease coverages, increase rates or deductibles or alter any terms or <br />conditions of coverage unless at the sole request of the insured. <br />COVERAGE PART INFORMATION -Coverage parts affected by this change as indicated by x❑ <br />below. <br />❑ Commercial Property <br />❑ Commercial General Liability <br />❑ Commercial Crime <br />❑ Commercial Inland Marine <br />❑ COMMERCIAL AUTOMOBILE $ 72.00 <br />The following item(s): <br />❑ Insured's Name ❑ Insured's Mailing Address <br />❑ Policy Number ❑ Company <br />Effective/Expiration Date ❑ Insured's Legal Status/Business of Insured <br />❑ Payment Plan Premium Determination <br />❑ Additional Interested Parties ❑ Coverage Forms and Endorsements <br />❑ Limits/Exposures ❑ Deductibles <br />❑ Covered Property/Located Description Classification/Class Codes <br />❑ Rates ❑ Underlying Exposure <br />is (are) changed to read (See Additional Page(s) ) <br />SEE NEXT PAGE <br />The above amendments result in a change in the premium as follows: <br />This premium does not include taxes and surcharges. <br />❑ No Changes <br />❑ To be Adjusted at Audit <br />I Additional $ 72.00 1 <br />Return <br />Tax and Surcharge Changes <br />Additional Return <br />AUTHORIZE <br />16-02-0212 (01197) <br />wary, xlek M1lasugnnaiEDNie[an <br />REVIEWED & APPRovED By. <br />RLsk Management Analyst <br />