# UNINTENTIONAL FAILURE TO DISCLOSE

| Named Insured | Endorsement Number |
|---------------|--------------------|
| Policy Symbol  | Policy Number       | Policy Period to | Effective Date of Endorsement |
| Issued By (Name of Insurance Company) | | |

Insert the policy number. The remainder of the information is to be completed only when this endorsement is issued subsequent to the preparation of the policy.

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

This endorsement modifies all insurance provided under the following:

**COMMERCIAL UMBRELLA LIABILITY POLICY**

Your failure to disclose all hazards or prior "occurrences" existing as of the inception date of this policy shall not prejudice the coverage afforded by this policy provided such failure to disclose all hazards or prior "occurrences" is not intentional.

All other terms and conditions of this policy remain unchanged.

Authorized Agent

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