# ENDORSEMENT

The following spaces preceded by an asterisk (*) need not be completed if this endorsement and the policy have the same inception date.

**ATTACHED TO AND FORMING PART OF POLICY NO.:** 505XA0492  
**EFFECTIVE DATE OF ENDORSEMENT:**  
**ISSUED TO:**  

It is hereby agreed that Item 4. Primary Insurance: reads as follows:

**Insurer's Name**

1) Insurance Co. of North America  
2) Travelers Ind. Co.  
3) Home Ins. Co.  
4) Federal Ins. Co.  
5) American Re-Insurance Co.  
6) General Reinsurance Corp.  
7) Continental Casualty Co.  
8) American Home Assurance Co.  
and all Underlying Primary Insurers.

Nothing herein contained shall be held to vary, alter, waive or extend any of the terms, conditions, provisions, agreements or limitations of the above mentioned Policy, other than as above stated.

*Agency Name and Address*

In Witness Whereof, the Company has caused this endorsement to be signed by its President and countersigned by a duly authorized representative of the Company.

**President:**  
**Authorized Representative:**