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2019-360-E Planning - Friends of Lake Orange waiver indemnification agreement
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2019-360-E Planning - Friends of Lake Orange waiver indemnification agreement
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Last modified
6/25/2019 10:55:39 AM
Creation date
6/25/2019 10:18:55 AM
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Template:
Contract
Date
6/28/2019
Contract Starting Date
6/28/2019
Contract Ending Date
6/28/2022
Contract Document Type
Agreement
Amount
$0.00
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R 2019-360 Planning - Friends of Lake Orange waiver indemnification agreement
(Attachment)
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\Board of County Commissioners\Contracts and Agreements\Contract Routing Sheets\Routing Sheets\2019
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DocuSign Envelope ID:7CF6OB58-F95B-4FFA-9EO3-OFA429EC47E7 <br /> Allianz Underwriters Insurance Company <br /> Named Insured: Vector Diease Acquisition, LLC <br /> Policy Number: U5L00010318 <br /> Effective Date: May 24, 2019 <br /> GENERAL CHANGE ENDORSEMENT <br /> This endorsement modifies insurance provided under the following: <br /> POLLUTION LEGAL LIABILITY <br /> Policy changes are indicated by an ® and amended to read as shown below. <br /> ❑ 1. Named Insured ❑ 14. Mailing Address of Named Insured <br /> ❑ 2. Policy Period ❑ 15. Policy Conditions <br /> ❑ 3. Form of Business ❑ 16. Business Description <br /> ❑ 4. Location(s)of all Premises you own, rent or occupy ❑ 17. Description or location of property <br /> ❑ 5. Location(s) added ❑ 18. Location(s)deleted <br /> ❑ 6. Total Advance Premium ❑ 19. Coverages <br /> ❑ 7. Limit(s) of Insurance ❑ 20. Deductibles <br /> ❑ 8. Covered Auto Symbol(s) ❑ 21. Rating Information <br /> ❑ 9. Additional Insured(s) added ❑ 22. Premium Basis <br /> ❑ 10. Premium Computation ❑ 23. Other <br /> ❑ 11. Audit Period ❑ 24. Forms/Endorsement deleted <br /> ® 12. Forms/Endorsement added ❑ 25. Item(s) listed below deleted from Schedule <br /> ❑ 13. Item(s) listed below added to Schedule <br /> 12. The following endorsement has been added to the policy: <br /> Endorsement 21 — Definition of Insured Amendatory Endorsement, Form#: MANUSCRIPT <br /> ❑ Additional Premium payable at Endorsement Effective Date <br /> ❑ Return Premium payable at Endorsement Effective Date <br /> ❑ Installments amended per attached Premium Installment Endorsement <br /> ® No change in premium <br /> Date of Issue: 05/29/19 <br /> AUI-IL 3001 (06-08) Page 1 of 1 <br />
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