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

**EFF DATE OF POL:** (Not specified)

**EFF DATE OF END:** (Not specified)

**AGENCY NO.:** (Not specified)

**ADD'L PREMIUM:** $ (Not specified)

**RETURN PREMIUM:** $ (Not specified)

**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.

**IT IS AGREED THAT THE PREMISES MEDICAL PAYMENTS INSURANCE COVERAGE PART APPLIES ONLY AT LOCATIONS COVERED UNDER THIS POLICY AT EDICOTT, POUGHKEEPSIE, SANDS POINT, KINGSTON AND ARMONK, NEW YORK AS RESPECTS COUNTRY CLUBS, HOMESTEAD OPERATIONS AND RECREATIONAL FACILITIES ON OR OFF THE PREMISES OR ANY COUNTRY CLUB OR HOMESTEAD WHICH MAY BE ACTIVATED IN THE FUTURE.**

**IT IS FURTHER AGREED THAT SUCH INSURANCE AS IS AFFORDED BY THIS ENDORSEMENT SHALL APPLY TO ORGANIZED SOCIAL ACTIVITIES OF THE OTHER I.B.M. PLANT CLUBS OR OFF PREMISES AS RESPECTS FIELD DAYS AND CHRISTMAS PARTIES.**

**ZURICH INSURANCE COMPANY**

**AMERICAN GUARANTEE AND LIABILITY INSURANCE COMPANY**

**Countersigned:**

**BY:** (Signature)

**Form 116-G COM 16-ea**

**Z 007119**