This endorsement modifies such insurance as is afforded by the provisions of the policy relating to the following:

| POLICY NO. | EFFECTIVE DATE | AGENCY NO. | ADD'L PREMIUM $ | RETURN PREMIUM $ |
|------------|----------------|------------|-----------------|-------------------|
| GA 8596100 |                |            |                 |                   |

**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.

**CONDITIONS**

1. **PREMIUM**
   THE PREMIUM STATED IN THE DECLARATIONS IS AN ESTIMATED PREMIUM ONLY.
   
   ON EACH ANNIVERSARY, OR ON TERMINATION OF THIS ENDORSEMENT, THE EARNED PREMIUM SHALL BE COMPUTED IN ACCORDANCE WITH THE PREMIUM BASIS AND RATE STATED IN THE DECLARATIONS. IF THE EARNED PREMIUM THUS COMPUTED EXCEEDS THE ESTIMATED ADVANCE PREMIUM PAID, THE INSURED SHALL PAY THE EXCESS TO THE COMPANY; IF LESS, THE COMPANY SHALL RETURN TO THE INSURED THE UNEARNED PORTION OF THE PREMIUM PAID.
   
   THE INSURED SHALL MAINTAIN RECORDS OF THE INFORMATION NECESSARY FOR PREMIUM COMPUTATION.

![Image](https://example.com/image.png)

ZURICH INSURANCE COMPANY  
AMERICAN GUARANTEE AND LIABILITY INSURANCE COMPANY

Countersigned:  
**Vicál Nigro**  
**Banyaga**  
**ATTORNEY-IN-FACT**  
Form 117 50M 5-68  
United States Manager (Zurich)  
President (American Guarantee)  
Secretary (American Guarantee)  
Z 007044