2016-08-29_PERMIT FILE - C1981035A ‎(45)‎

• 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

Policy Number
BAP 6551242-05
THIS ENDORSEMENT CHANGES THE POLICY.
PLEASE READ IT CAREFULLY.
COMMON POLICY CHANGE ENDORSEMENT
Endorsement No. 002
ZURICH AMERICAN INSURANCE COMPANY
Named Insured GCC ENERGY LLC Effective Date: 09-01-14
12:01 A.M., Standard Time
Agent Name AON RISK SERVICES SOUTHWEST, INC. Agent No. 14340-000
This endorsement will not be used to decrease coverages, increase rates or deductibles or alter any terms or
conditions of coverage unless at the sole request of the insured.
COVERAGE PART INFORMATION - Coverage parts affected by this change as indicated by 0 below.
Commercial Property
Commercial General Liability
Commercial Crime
❑ Commercial Inland Marine
1-7-1
BUSINESS AUTOMOBILE NO CHARGE
El
The following item(s):
Insured's Name Insured's Mailing Address
Policy Number Company
Effective/ Expiration Date Insured's Legal Status/Business of Insured
Payment Plan Premium Determination
aAdditional Interested Parties ❑ Coverage Forms and Endorsements
Limits/ Exposures F� Deductibles
Covered Property/ Location Description a Classification/Class Codes
Rates 0 Underlying Exposure/ Insurance
is (are) changed to read {See Additional Page(s) }
THE FOLLOWING FORM(S) HAS BEEN ADDED:
U -CA -811-A CW 05-10 NOTIF TO OTHERS OF CANC NONRNW RED
The above amendments result in a change in the premium as follows:
This prernilurn does not include taxes and su
No Changes
[] To be Adjusted at Audit
I Additional NO CHARGE
ReturnNO CHARGE
Tax and Surcharge Changes
Additional Return
Countersigned By:
AUTHORIZED AGENT
U -GU -614-A CW (10/02)