**POLICY NO:** 86-68-700

**EFF DATE OF POL:** (Blank)

**EFF DATE OF END:** (Blank)

**AGENCY NO.:** (Blank)

**ADD'L PREMIUM:** $ (Blank)

**RETURN PREMIUM:** $ (Blank)

**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.

**UNINSURED MOTORISTS INSURANCE CHANGE IN LIMITS OF LIABILITY**

IT IS AGREED THAT IF THE ACCIDENT OCCURS IN A STATE WHERE THE LIMITS SET FORTH FOR UNINSURED MOTORISTS INSURANCE EXCEED THE APPLICABLE LIMITS STATED IN THE DECLARATIONS, THE LIMIT OF THE COMPANY'S LIABILITY FOR THE COVERAGE SHALL BE THE APPLICABLE LIMITS SET FORTH IN SUCH LAW.

**ZURICH INSURANCE COMPANY**

**AMERICAN GUARANTEE AND LIABILITY INSURANCE COMPANY**

**Countersigned:**

**Form 110-G SOM 10-69**

**100 CWN**

**END. #10**