**THE HARTFORD**

**Named Insured and Address**

**Policy Number:**
10 XS 861919

This endorsement forms a part of the policy as numbered above, issued by THE HARTFORD INSURANCE GROUP company designated therein, and takes effect as of the effective date of said policy unless another effective date is stated herein.

**Effective Date:** Effective hour is the same as stated in the Declarations of the policy.
**Endt. No.:** 1

**FORM NUMBERS ENDORSEMENT**

IT IS AGREED THAT THE FOLLOWING ARE FORM NUMBERS FORMING PART OF THIS POLICY AT ISSUE:

1. G 2240 3 B FORM NUMBERS
2. AL 44-1 NUCLEAR ENERGY EXCL.
3. GH 210-1 AMEND. OF POLICY PROVISIONS N.Y.
4. XL 206-0 PERSONAL PROPERTY C.C.C.
5. XL 207-0 REAL PROPERTY C.C.C.
6. XL 217-1 AIRCRAFT PRODUCTS EXCL.
7. G 2240 3 B PROFESSIONAL LIAB. EXCL. DATA PROCESSING
8. XL 224-0 EMPLOYEE RETIREMENT INCOME SECURITY ACT EXCL.
9. XL 231-0 INS. CO. ENDT.
10. G 2240 3 B POLLUTION EXCL.
11. XL 313 PRODUCTS LIAB. SPECIFIC PRODUCTS EXCL.

Nothing herein contained shall be held to vary, waive, alter or extend any of the terms, conditions, agreements or declarations of the policy, other than as herein stated.

This endorsement shall not be binding unless countersigned by a duly authorized agent of the company; provided that if this endorsement takes effect as of the effective date of the policy and, at issue of said policy, forms a part thereof, countersignature on the declarations page of said policy by a duly authorized agent of the company shall constitute valid countersignature of this endorsement.

Form G-2240-3 B Printed in U.S.A

Countersigned by:
Authorized Agent

IBM-ZRIND 00102