**Kemper Insurance**

**07 40994**

IN CONSIDERATION OF A RETURN PREMIUM OF $179.00, IT IS UNDERSTOOD THAT THE PREMIUM FOR THIS POLICY HAS BEEN BILLED BY THE CANADA OFFICE

**NEW YORK**

**D/R OUT**
**APR 4 1974**
**NO. CORR**

The effective date and hour of this endorsement is stated below and reference to hour shall be Standard Time at the address of the named insured as stated in the policy. The endorsement shall terminate with the policy.

This endorsement is subject to the declarations, conditions, and other terms of the policy which are not inconsistent herewith, and when countersigned by an authorized representative of the company, forms a part of the policy described below.

**LUMBERMEN'S MUTUAL AMERICAN MOTORISTS AMERICAN MANUFACTURERS FEDERAL MUTUAL KEMPER SECURITY SEQUOIA AMERICAN PROTECTION CASUALTY COMPANY INSURANCE COMPANY MUTUAL INSURANCE COMPANY INSURANCE COMPANY INSURANCE COMPANY INSURANCE COMPANY**

**ISSUED TO**
**INTERNATIONAL BUSINESS MACHINES CORP. (CANADA)**
**POLICY NUMBER**
**3SX 010 123 R**
**ENDORSEMENT NUMBER**
**3**
**ENDORSEMENT EFFECTIVE HOUR**
**12:01 A.M.**
**MONTH DAY YEAR**
**5 21 73**
**PRODUCER'S NUMBER**
**38 7684**
**COUNTERSIGNATURE OF LICENSED RESIDENT AGENT**
**NEW YORK, N.Y.**
**COUNTERSIGNATURE DATE**
**1 8 74**
**V. DAWSON**

**FOR CO. USE**
**NAME CODE:**
**AK 1430 7-73 200M**

**STATE CITY WESTERN HOMEOWNERS CLASS (INSURANCE)**
**EXP. K COMMERCIAL**
**TOTAL**
**B.I.**
**P.D.**
**STATE CITY EASTERN HOMEOWNERS CLASS (INSURANCE)**
**COV. EXP. K COMMERCIAL**
**TOTAL**
**COLL.**
**OTHER**