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2016-08-29_PERMIT FILE - C1981035A (45)
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2016-08-29_PERMIT FILE - C1981035A (45)
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Last modified
10/5/2023 9:48:18 AM
Creation date
10/19/2016 10:15:44 AM
Metadata
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Template:
DRMS Permit Index
Permit No
C1981035A
IBM Index Class Name
PERMIT FILE
Doc Date
8/29/2016
Doc Name
Insurance: Personal Injury & Property Damage
Section_Exhibit Name
KI Appendix 14
Media Type
D
Archive
Yes
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Policy Number <br />GLO 6551241-05 <br />THIS ENDORSEMENT CHANGES THE POLICY. <br />PLEASE READ IT CAREFULLY. <br />COMMON POLICY CHANGE ENDORSEMENT <br />Endorsement No. 0 O i <br />AMERICAN ZURICH INSURANCE COMPANY <br />Named Insured GCC ENERGY LLC Effective Date: 09-01-14 <br />12:01 A.M., Standard Time <br />Agent Name AON RISK SERVICES SOUTHWEST, INC. Agent No. 14340-000 <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❑ below. <br />❑ Commercial Property <br />❑ Commercial General Liability NO CHARGE <br />❑ Commercial Crime <br />❑ Commercial Inland Marine <br />The following item(s): <br />F-1 Insured's Name F7 Insured's Mailing Address <br />F-1 Policy Number Company <br />Effective/ Expiration Date Insured's Legal Status/Business of Insured <br />Payment Plan F7 Premium Determination <br />Additional Interested Parties ❑ Coverage Forms and Endorsements <br />Limits/ Exposures F7 Deductibles <br />F-1 Covered Property/ Location Description a Classification/Class Codes <br />0 Rates 0 Underlying Exposure/ Insurance <br />is (are) changed to read (See Additional Page(s) ) <br />THE FOLLOWING FORM(S) HAS BEEN ADDED: <br />U -GL -1447-A CW 05-10 NOTIF TO OTHERS OF CANC NONR OR REDUCT <br />The above amendments result in a change in the premium as follows: <br />This prerniurn does not include taxes and surcharges. <br />No Changes <br />❑ To be Adjusted at Audit <br />I Additional NO CHARGE <br />ReturnNO CHARGE <br />Tax and Surcharge Changes <br />Additional Return <br />Countersigned By: <br />AUTHORIZED AGENT <br />U -GU -614-A CW (10/02) <br />
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