**POLICY NO.**
86-68-700

**EFF DATE OF POL.**
[Blank]

**EFF DATE OF END.**
[Blank]

**AGENCY NO.**
[Blank]

**ADD'L PREMIUM**
$ [Blank]

**RETURN PREMIUM**
$ [Blank]

**Named Insured**

This endorsement is issued by that company named below which is the insurer under the policy designated above issued to the Named Insured and forms a part of said policy as of the effective date hereof, at the hour stated in the policy Declarations.

IT IS AGREED THAT THE PREMISES MEDICAL PAYMENTS INSURANCE COVERAGE PART APPLIES ONLY AT LOCATIONS COVERED UNDER THIS POLICY AT ENIDCOTT, POUGHKEEPSIE, SANDS POINT, KINGSTON AND ARMONK, NEW YORK AS RESPECTS COUNTRY CLUBS, HOMESTEAD OPERATIONS AND RECREATIONAL FACILITIES ON OR OFF THE PREMISES OR ANY COUNTRY CLUB OR HOMESTEAD WHICH MAY BE ACTIVATED IN THE FUTURE.

IT IS FURTHER AGREED THAT SUCH INSURANCE AS IS AFFORDED BY THIS ENDORSEMENT SHALL APPLY TO ORGANIZED SOCIAL ACTIVITIES OF THE OTHER I.B.M. PLANT CLUBS OR OFF PREMISES AS RESPECTS FIELD DAYS AND CHRISTMAS PARTIES.

**ZURICH INSURANCE COMPANY**
**AMERICAN GUARANTEE AND LIABILITY INSURANCE COMPANY**

**Countersigned:**
[Signature]
BY: [Name]
ATTORNEY IN FACT

Form 116-G 50M 10-69

**IBM 062384**