**MEDICAL PAYMENTS ENDORSEMENT**

**POLICY NO.:** 8506100  
**EFFECTIVE DATE:**  
**AGENCY NO.:**  
**ADD'L PREMIUM:** $ INCL. IN  
**COMPOSITE RATE:**  

**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.

**Schedule**

| Description of Hazards | Code Number | Premium Basis | Rates | Advance Premiums |
|------------------------|-------------|---------------|-------|-------------------|
| (a) Area (sq. ft.)     |             | (a) Per 100 sq. ft. of area |        |                   |
| (b) Number             |             | (b) Per unit    |        |                   |
| (c) Remuneration       |             | (c) Per $100 remuneration |        |                   |
| (d) Number             |             | (d) Per elevator |        |                   |

**EXCLUSION "B" OF THIS ENDORSEMENT IS HEREBY VOIDED.**

IT IS AGREED THAT THIS ENDORSEMENT APPLIES ONLY AT LOCATIONS COVERED UNDER THIS POLICY AT ENDICOTT, POUGHKEEPSIE, SANDS POINT AND KINGSTON, NEW YORK AS RESPECTS COUNTRY CLUBS, AND HOMESTEAD OPERATIONS 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.

**Limits of Liability:** $2,000,000 each person $25,000,000 each accident

The company agrees with the named insured to pay all reasonable expenses incurred within one year from the date of accident for necessary medical, surgical and dental services, including prosthetic devices, and necessary ambulance, hospital professional nursing and funeral services, to or for each person who sustains bodily injury, sickness or disease, caused by accident and arising out of the ownership, maintenance or use of premises by the named insured and the ways immediate adjoining, or operations of the named insured, subject to the following provisions:

(Continued on reverse side)

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

Countersigned:  
Victor D. Nigro  
Duly authorized agent  
AT MANUEL KELLY  
ATTORNEY IN FACT

Form 2657-D. 10M 442  
(For use with policy series 916, 917, 919, 7016, 7031 and 7035)  
100-00W  
Z 006886