71-XX - Chanhassen Estates 2nd Add SUB pt 4IOWA NATIONAL
MUTUAL INSURANCE COMPANY POLICY NUMBER ENDORSEMENT EFFECTIVE
68 188 105 I 4-5-71
ISSUED 0
CWanhassen Holding Company
This endorsement modifies the provisions of the:
General Liability -Automobile Policy relating to Coverage Parts X'd be
_ A. All Coverage Parts
B. Automobile Physical Damage Insurance
_ C. Comprehensive Automobile Liability Insurance
_ D.
E.
In Consideration of
❑ An Additional Premium of $
A Return vremium of 23
IT 15 AGREED THAT THE:
1
Named Insured
10
_
Bodily Injury Liability
2
Address of Insured
11
_
Property Damage Liability
3
Occupation
12
Medical Payments
41
Policy Period
13
Comprehensive
5
Change Automobile
14 _
Collision or Upset
6
Add Automobile
IN _
Uninsured Motorist
7
Eliminate Automobile
16 _
Identification Number
ai!
Mortgage or Lien Holder
17 1x
9I -j
Rating Classification
Is (Are) Amended To Read As Follows:
Ja - HP 5545 - Part 5 is deleted.
17b - Total advance premium to read: $65.
❑ A Premium Adjusti
at Audit
Description of Substituted or Additional Automobile
Year Trade Name Model Body Type
Rating Symbol Rating Classification High Performance Cost New
Any loss hereunder is payable as interest may appear To The Named Insured And
Description of Auto Ellminateds
Coverages
Bodily Injury
Property Damag-
Medical Paymen
Comprehensive
Collision
Fire
Theft
Windstorm
Com'd Add'] Co,
Unins. Motorist
Year Trade Name Body Type
Only items Marked ZC are affected by this enttorsement.
All other terms and conditinns of this nnlinv rwmain unnhannarl.