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Policy Number <br />CPO 9265916-02 <br />THIS ENDORSEMENT CHANGES THE POLICY. <br />PLEASE READ IT CAREFULLY, <br />COMMON POLICY CHANGE ENDORSEMENT <br />Endorsement No <br />ZURICH AMERICAN INSURANCE COMPANY <br />NrA-111 :h Irc;urea Effective Date: <br />12:01 A.M.. Standard f mle <br />Agent N<irne t Agent No. <br />This endorsement will not be used to decrease coverages. increase rates or deductibles or alter any terms or <br />condr,ions of coverage unless at the sole re uest of the insured - <br />COVERAGE PART INFORMATION —Coverage parts affected by this change as indicated by below. <br />CJnnnierclal Propel ty <br />ElCurnitier cial G acral Liability <br />Cunxnercial Cnme <br />(� Comnr�,cial Inland Marne <br />The fullowing item(s): <br />LD Insured's Name 17 IrlStlred's Mailing Address <br />EDPolicy Number F-1 Company <br />0 EffoctrvelExpuabun Date Insurcu s Legal Status. Business of Insured <br />t Payment Ptarr Premrrun Determination <br />Adduional Interesteo Partes U Coverage Forms arid Endorsements <br />Limits Exposures F� Deductibles <br />Covetud Pruper1y1_ocatiun Description Class ificationiClass Codes <br />C] Rates o Underlying Exposure/Insurance <br />is tare, cnanaed tc read (See Additional Page(s)) <br />APPROVED AS TO FORM <br />_T)e above amendments resul! in a change in tire premium as follows: <br />_This prerniurn does not include taxes and surcharges. <br />Nc. Changes E] To be Adjusted at Audit Addit oval Return:_ <br />Tax and Surcharge Changes <br />Additional Return <br />coulile!Sigr�ed By. <br />AUTHORIZED AGEN1- <br />...-.-.. v.. k 1 we.; <br />.,r <br />