# Zurich Insurance Company

## Premises Medical Payments Insurance Endorsement

**Policy No.:** 8650600  
**Effective Date:** [Not specified]  
**Agency No.:** [Not specified]  
**Addl. Premium:** $  
**Return:** $  

**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.

**Premises Medical Payments Insurance**

IT IS AGREED THAT THE PREMISES MEDICAL PAYMENTS INSURANCE COVERAGE PART APPLIES ONLY AT LOCATIONS COVERED UNDER THIS POLICY AT ENDICOTT, POUGHKEEPSIE, SANDS POINT, KINGSTON AND ARMONK, 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 T.B.M. PLANT CLUBS OR OFF PREMISES AS RESPECTS FIELD DAYS AND CHRISTMAS PARTIES.

**4,200 each person - $75,000 each accident**

**Zurich Insurance Company**
**American Guarantee and Liability Insurance Company**

**[Signature]**
**[Date]**