Orange County NC Website
Browse       Search
POLICY NUMBER.AXXS05100447-13 COMMERCIAL LIABILITY UMBRELLA <br /> CU 22 40 12 04 <br /> THIS ENDORSEMENT CHANGES THE POLICY PLEASE READ IT CAREFULLY <br /> POLICY CHANGES <br /> This endorsement modifies insurance provided under the following <br /> COMMERCIAL LIABILITY UMBRELLA COVERAGE PART <br /> COMMERCIAL EXCESS LIABILITY COVERAGE PART <br /> Effective Date of Change 12/01/13 <br /> Change Endorsement No 01 <br /> Named Insured- Disabled Sports USA, Inc. <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 /> X❑ Limits/Exposures ❑ Self-Insured Retention <br /> ❑ Covered Property/Located Description ❑ Classification/Class Codes <br /> ❑ Rates ❑ Underlying Insurance <br /> is (are) changed to read{See Additional Page(s)) <br /> The above amendments result in a change in the premium as follows. <br /> X] NO CHANGES ❑ TO BE ADJUSTED ADDITIONAL PREMIUM RETURN PREMIUM <br /> AT AUDIT $ $ <br /> Endorsement Effective see above Countersigned By- <br /> Named Insured: see above Authorized Representative), <br /> CU 22 40 12 04 ©ISO Properties, Inc., 2004 Page 1 of 2 ❑ <br />