**POLICY NO:** 8359700  
**EFFECTIVE DATE:**  
**AGENCY NO:**  
**ADD'L PREMIUM:** $  
**RETURN PREMIUM:** $  

**Named Insured**

This endorsement is issued by the 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.

**CANCELLATION CLAUSE**

IT IS AGREED THAT NOTWITHSTANDING ANYTHING TO THE CONTRARY CONTAINED IN THE POLICY, IF THE COMPANY ELECTS TO CANCEL THIS POLICY, THE COMPANY WILL MAIL TO THE NAMED INSURED AT THE ADDRESS SHOWN IN THE POLICY, WRITTEN NOTICE STATING WHEN, NOT LESS THAN THIRTY (30) DAYS THEREAFTER, SUCH CANCELLATION SHALL BE EFFECTIVE.

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

**Countersigned:**

**Form 116-G**
**room 342**
**100 EMM**

**END. #9**

**Z 006813**