EXCESS OVERLAYER INDUSTRY POLICY
(AMENDMENT OF DISCRIMINATION COVERAGE)

IT IS AGREED THAT SUCH INSURANCE AS IS AFFORDED BY THE PERSONAL INJURY LIABILITY DOES NOT APPLY TO INJURIES SUSTAINED BY ANY PERSON AS A RESULT OF DISCRIMINATION OR INDIRECTLY RELATED TO THE EMPLOYMENT OF SUCH PERSON BY THE INSURED.

This endorsement, issued by one of the below-named companies, forms a part of the policy to which attached effective on the inception date of the policy unless otherwise stated herein.

(The information below is required only when this endorsement is issued subsequent to preparation of policy.)

Endorsement effective Policy No Endorsement No.
Named Insured Additional Premium $ Return Premium $ BI PD
In Advance $
1st Anniv. $
2nd Anniv. $

The Etna Casualty and Surety Company
The Standard Fire Insurance Company
Hartford, Connecticut

Countersigned by (Authorized Representative)
(XN-13106-6)