**Policy Information:**

- **Policy No.:** 8791601
- **Effective Date of Policy (Eff. Date of Pol):** 1-18-77
- **Effective Date of End (Eff. Date of End):** 1-18-77
- **Agency No.:** 
- **Additional Premium ($):** 
- **Reference Premium ($):** 

**Named Insured:**

This endorsement is issued by the 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.

**Fiduciary Liability - Exclusion:**

In consideration of the reduced premium charged, it is agreed that the insurance afforded by this policy shall not apply with respect to any claim based upon any actual or alleged error or omission or breach of duty, committed or alleged to have been committed in the discharge of fiduciary duties, obligations or responsibilities imposed by the Federal Employee Retirement Income Security Act of 1974 or amendments thereto.

**Insurance Companies:**

- Zurich Insurance Company
- American Guarantee and Liability Insurance Company

**Counter-signed:**

- **Authorized Agent:** [Signature]
- **Secretary:** [Signature]

**Form REV. 11-75**