# Standard Provisions Endorsement

**Endorsement 4**

**Effective Date:** 5/21/76

**IT IS HEREBY UNDERSTOOD AND AGREED THAT:**

- 1. RATE
- 2. PREMIUM
- 3. DEPOSIT PREMIUM
- 4. INSTALLMENT
- 5. AUDIT-PREMIUM ADJUSTMENT
- 6. AMOUNT OF COVERAGE
- 7. TERM OF COVERAGE
- 8. INCEPTION DATE
- 9. EXPIRATION DATE
- 10. NAME OF ASSURED
- 11. ADDRESS OF LOCATION OF PROPERTY
- 12. ADDRESS OF ASSURED
- 13. DESCRIPTION OF PROPERTY COVERED
- 14. COVERAGE
- 15. THE FOLLOWING IS NAMED AS AN ADDITIONAL ASSURED
- 16. ENDORSEMENT
- 17. SECURITY
- 18. OTHER

**IS CORRECTED OR CHANGED TO READ AS FOLLOWS**
- IS AMENDED TO READ AS FOLLOWS
- IS CHARGED FOR THE PERIOD
- ONLY AS RESPECTS THE OPERATIONS OF THE NAMED ASSURED
- ONLY AS RESPECTS THE PREMISES LOCATED AT

**THE POLICY PREMIUM OF $2,500.00 AS STATED IN THE DECLARATIONS IS ALLOCATED AS FOLLOWS:**

- **$96.00 CANADA**
- **$2,404.00 UNITED STATES**

**Premium**

| State Tax | % | $ |
|-----------|---|---|
| Federal Tax | % | $ |
| Stamping Fee | % | $ |

**$**

**All other terms and conditions remain unchanged. This endorsement is attached to and made part of M832000 OF THE MISSION INSURANCE CO. ISSUED TO INTERNATIONAL BUSINESS MACHINES, CORPORATION DATED AT NEW YORK, NEW YORK JUNE 25TH, 1976 SAYRE & TOSO, INC. By John B. Johnson, Jr.**

**S&G 919 (Rev. 2/75)**