# Great American Spirit Ins. Company

**USX 8012 (Ed. 02/18)**

## THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.

### NON FOLLOWING FORM ENDORSEMENT

This endorsement modifies insurance provided under the following:

- U.S. SHORT EXCESS FORM

The following is added to **CONDITIONS, 5. NON FOLLOW FORM**:

Coverage under this Policy does not apply to coverage provided by the "Followed Policy" for the following:

- **Underlying Coverages/Terms/Exposures**: UM/UIM Accident/Crisis Response
- **Endorsement Number (if applicable) or Policy Form Number**

All other Policy terms and conditions remain unchanged.

**USX 8012 (Ed. 02/18)**

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