**Document Title:**

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.

**Policy Details:**

- **Policy No:** 0026230
- **Eff Date of Pol:** 1-1-76
- **Eff Date of End:** 1-1-76
- **Agency No:** 
- **Add'l Premium:** $ 
- **Return Premium:** $

**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.

**Coverage Provided:**

In consideration of the premium charged under this contract, coverage is hereby provided for all personal while on assignment at various International Business Machines Corporation locations throughout the United States of America.

**Endorsement Note:**

See Hotel Services m Endorsement H/18

**Insurance Companies:**

- Zurich Insurance Company
- American Guarantee and Liability Insurance Company

**Signature:**

[Signature present but not legible]

**Form Number:**

FORM 118-G REV. 11-75