**Atlantic Insurance Company**

**Endorsement**

The information provided above is required to be completed only when the endorsement is issued for attachment to the policy subsequent to its effective date.

**J.B.M.**

IT IS HEREBY UNDERSTOOD AND AGREED THAT THE PREMIUM SHOWN UNDER ITEM 4 IS A THREE YEAR PREMIUM AND IS SUBJECT TO ANNUAL NEGOTIATION.

All other terms and conditions of this insurance remain unchanged.

**John J. Markowski**
**President**

**C. Montefusco**
**Authorized Representative**