# GENERAL CHANGE ENDORSEMENT

This endorsement forms a part of and is for attachment to the following designated policy:

- **Affiliated FM Insurance Company**
  - **POLICY NO:** XL 98107
  - **ISSUED TO:** [Blank]
  - **EFFECTIVE DATE:** [Blank]
  - **ENDT NO.:** 2
  - **BY:** [Blank]
  - **AUTHORIZED REPRESENTATIVE:** [Blank]

All Terms and Conditions remain unchanged except:
- Additional premium due now $ (pro rata of $)
- Return premium due now $ (pro rata of $)
- Prem. on subje to audit

It is agreed that the Company's limit of liability shall apply excess of loss as follows:

- $5,000,000. per occurrence / $5,000,000. annual aggregate where applicable
- Part of $50,000,000. per occurrence / $50,000,000. annual aggregate where applicable
- Excess of $80,000,000. per occurrence / $80,000,000. annual aggregate where applicable
- And $5,000,000. per occurrence / $5,000,000. annual aggregate where applicable
- Part of $45,000,000. per occurrence / $45,000,000. annual aggregate where applicable
- Excess of $130,000,000. per occurrence / $130,000,000. annual aggregate where applicable
- Excess of the schedule of underlying insurance described in the policies listed in Item 4 of the Declarations Page.

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