# Policy Change Endorsement

**Policy Number:** CEX09600213-00  
**Company:** Berkley National Insurance Company  
**Coverage Parts Affected:** Commercial Excess Liability  
**Effective Date:** May 21, 2013  
**Endorsement No.:** 1  

## POLICY CHANGE ENDORSEMENT

**THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.**

### The following item(s):

- Insured's Name
- Policy Number
- Effective/Expiration Date
- Payment Plan
- Additional Interested Parties:
- Limits/Exposures
- Covered Property/Located Description
- Rates
- Insured's Mailing Address
- Company
- Insured's Legal Status/Business of Insured
- Premium Determination
- Coverage Forms and Endorsements
- Self-Insured Retention
- Classification/Class Codes
- Underlying Insurance

### is (are) changed to read {See Additional Page(s)}:

It is hereby understood and agreed that the Schedule of Underlying Policies is amended to read as follows:

The above amendments result in a change in the premium as follows:

- NO CHANGES
- TO BE ADJUSTED AT AUDIT
- ADDITIONAL PREMIUM $ [Amount]
- RETURN PREMIUM $ [Amount]

**BCIM0300 0713**  
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