**MEDICAL PAYMENTS ENDORSEMENT**

**POLICY NO:** 8448300  
**EFFECTIVE DATE:**  
**AGENCY NO:**  
**ADD'L PREMIUM:** $ INCL. IN  
**COMPOSITE RATE:**  

**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 Schedule.

**Schedule**

| Description of Hazards | Code Number | Premium Basis | Rate | Advance Premiums |
|------------------------|-------------|---------------|------|-------------------|
| (a) Area (sq. ft.)     |             |               |      |                   |
| (b) Frontage           |             |               |      |                   |
| (c) Elevator           |             |               |      |                   |
| (d) Number             |             |               |      |                   |

EXCLUSION "B" OF THIS ENDORSEMENT IS HEREBY VOIDED.

IT IS AGREED THAT THIS ENDORSEMENT APPLIES ONLY AT LOCATIONS COVERED UNDER THIS POLICY AT ENIDCOTT, POUGHKEEPSIE, SANDS POINT AND KINGSTON, NEW YORK AS RESPECTS COUNTRY CLUBS, AND HOMESTEAD OPERATIONS 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 ON OR OFF PREMISES AS RESPECTS FIELD DAYS AND CHRISTMAS PARTIES.

**Limits of Liability:** $2,000.00 each person $25,000.00 each accident

The company agrees with the named insured to pay all reasonable expenses incurred within one year from the date of accident for necessary medical, surgical and dental services, including professional services, and necessary ambulance, hospital, professional nursing and funeral services, to or for each person who sustains bodily injury, sickness or disease, caused by accident and arising out of the ownership, maintenance, use of premises by the named insured and the ways immediately adjoining, or operations of the named insured, subject to the following provisions:

(Continued on reverse side)

**ZURICH INSURANCE COMPANY**  
**AMERICAN GUARANTEE AND LIABILITY INSURANCE COMPANY**

Countersigned:  
Duly authorized agent ATTORNEY IN FACT

Form 2657-D. 10M 6-61  
(For use with policy series 916, 917, 919, 7016, 7021 and 7031)

100 copy

Z 006855