**POLICY NO.:** 8791601  
**EFF DATE OF POL:** 1-18-77  
**EFF DATE OF END:** 1-18-77  
**AGENCY NO.:** $  
**ADD'L PREMIUM:** $  
**RETURN PREMIUM:** $  

**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.

**Contractual liability - following form**

It is agreed that except insofar as coverage is available to the insured in the underlying insurance as set forth in the schedule of underlying insurances of the policy, this policy shall not apply under coverages A & B to any liability assumed by the insured under any written or oral contract or agreement.

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

**Countersigned:** [Signature]  
**Authorized agent:** [Signature]

**FORM 110-G REV. 11-78**