**INA**

**Named Insured:**

**Policy Symbol:** X(1P
**Policy Number:** 144106
**Policy Period:** 
**Effective Date of Endorsement:** 

**Issued By (Name of Insurance Company):**

**Primary Insurance Endorsement**

**Item 4**

**Primary Carrier** | **Policy Number** | **Policy Period**
--- | --- | ---
Centennial Ins. Co. | T.B.A. | 5/21/81 - 82
National Union | " | "
North Brooke | " | "
Aetna C & S | " | "
A I U | " | "
Federal | " | "
National Union | " | "
Employers Mutual | " | "
First State | " | "
National Union | " | "
City Ins. | " | "
Gibraltar | " | "
Federal | " | "

**Ptd. in U.S.A.**
**Authorized Agent:**

**ORIGINAL**