HomeMy WebLinkAboutEndorsement for addl ins (2)
IMPORTANT – ATTACH TO YOUR POLICY
CHURCH MUTUAL INSURANCE COMPANY
CHANGE ENDORSEMENT
THIS ENDORSEMENT FORMS A PART OF THE POLICY NUMBERED BELOW:
ENDORSEMENT EFFECTIVE DATE: 05/21/2019 POLICY NO.: 0261856-02-145609
POLICY EFFECTIVE DATE: 09/01/2018
FELLOWSHIP OF CHRISTIAN ATHLETES
OKLAHOMA CHAPTER OF FELLOWSHIP OF CHRISTIAN
ATHLETES; GREATER DALLAS FELLOWSHIP OF
CHRISTIAN ATHLETES INC
8701 LEEDS RD
KANSAS CITY MO 64129
SUMMARY CHANGES TO YOUR POLICY
FORM A 220(01-98) ADDITIONAL INSURED – DESIGNATED PERSON OR ORGANIZATION ENDORSEMENT.
SCHEDULE OF DESIGNATED PERSONS OR ORGANIZATIONS IS ADDED FOR KITTITAS COUNTY.
PREMIUM:
NO ADDITIONAL PREMIUM DUE
AGENT: 35-345
TRUSS LLC
4551 W 107TH ST 3RD FL
OVERLAND PARK KS 66207
(913) 341-8998
UN 412(06-86) CHANGE ENDORSEMENT PAGE 1 ISSUED DATE: 12/07/2018