This endorsement modifies such insurance as is afforded by the following designated insurance:

- WRAP AROUND EXCESS

**AMENDATORY ENDORSEMENT**

IN CONSIDERATION OF THE RATE AND PREMIUM AT WHICH THIS POLICY IS WRITTEN IT IS HEREBY UNDERSTOOD AND AGREED THAT, WHEREVER THE POLICY DECLARATIONS OR PRINTED TERMS AND CONDITIONS MAY CONFLICT WITH THE TERMS AND CONDITIONS OF THE WRAP AROUND EXCESS FORM ATTACHED TO THIS POLICY, THE TERMS AND CONDITIONS OF THE WRAP AROUND EXCESS FORM SHALL SUPERCEDE ALL SUCH PRINTED TERMS AND CONDITIONS EXCEPT THAT THIS COMPANY'S PARTICIPATION SHALL NOT EXCEED $2,500,000. PART OF $100,000,000 EACH OCCURRENCE AND IN THE AGGREGATE ANNUALLY WITH RESPECT TO ALL UNDERLYING COVERAGES COMBINED.

**COLLECTION INFORMATION**

- **MONEY**
- **NON-MONEY**

| Br. | Producer | Policy No. | Co. |
| --- | --- | --- | --- |
| 885 |  |  | 4 |

| Exp Mo./Day/Yr | Pr. Pt. | Comm Rate | Cash | Installment |
| --- | --- | --- | --- | --- |

**This endorsement forms a part of and is for attachment to the following described policy issued by the company designated therein, takes effect on the effective date of said policy, unless another effective date is shown below, at the hour stated in said policy and expires concurrently with said policy.**

| Must Be Completed | Complete Only When This Endorsement Is Not Prepared with the Policy Or Is Not to be Effective with the Policy |
| --- | --- |
| ENDT. NO. | ISSUED TO | EFFECTIVE DATE OF THIS ENDORSEMENT |
| 3 | FSC 513 69 62 | INTERNATIONAL BUSINESS MACHINES | 1-1-80 |

Columbia Casualty Company
CNA
Blank Endorsement
C 17013-A