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. GENERAL. CHANGE ENDORSEMENT NCB. i <br />n AMERISURE MUTUAL INSURANCE COMPANY AM SURE INSURANCE COMPANY <br />0 M -1'55 <br />INS1WID <br />' ►1 <br />RESOLUTE i i <br />i <br />ENDORSEMENT I SEE <br />R :s <br />CHAPEL HILL NC 27515 <br />THE POLICY OR DECLARATIONS OF THIS POLICY ARE AMENDED VMERE INDICATED BY AN X AND AS SHOWN BELOW. <br />0 RAME OF INSURED <br />El PREMIUM OWGE IF ANY <br />0 ADDRESS OF **URED <br />AE)JUS7ED BY AUDIT <br />0 TO INCLUDE THE ITEMS SHOM BELOW <br />ADJUSTED BY MONTHLY OR OUARTERLY REPORT <br />A EXCLUDE THE ITEMS SI-IOWN ♦-Y ► <br />• INCLUDE LOSS PAYEE <br />RETURN <br />WEINSURED <br />TO DELETE I= PAYEE <br />!R PRoDucERs mAmE ANDfoR CODE <br />n AMMMALPREMtUM <br />0 POLICY PERIOD <br />DUECOMPANY <br />0 TO NaMDE THE COVERAGES SHOWN BELOW <br />•µµ N t t t <. BELOW <br />0 EP PREMIUM <br />0 LIMITS OF INDICATED <br />0 INCREASED-TO 0 DECREMSED TO <br />0 BODILY <br />w •r <br />0 PROPERTY DAMAGE <br />Each omwlm <br />ON TO e4DORSEMENT <br />IT is AGREED THAT ENDORSEMENT c - cANcELLAnoN NoTtFICATION IS ADDED AND ATTACHED <br />HERETO. <br />I <br />2 57M, <br />I <br />j <br />0 M -1'55 <br />