# EXCLUSION OF LIABILITY IMPOSED BY THE EMPLOYEE RETIREMENT INCOME SECURITY ACT OF 1974

It is agreed that this insurance does not apply to liability imposed by the Employees Retirement Income Security Act of 1974 (or any amendment or addition thereto) or any state statute or common law rule which imposes fiduciary duties and responsibilities with respect to an employee benefit program.

This endorsement, which forms a part of and is for attachment to the following described policy issued by the company designated therein, takes effect on the effective date of said policy, unless another effective date is shown below, at the hour stated in said policy and expires concurrently with said policy.

| Must Be Completed |
| --- |
| ENDT. NO. | POLICY NO. |
| 4 | RDX 1789014 |

Complete Only When This Endorsement Is Not Prepared with the Policy Or Is Not to be Effective with the Policy

| ISSUED TO | EFFECTIVE DATE OF THIS ENDORSEMENT |

**INSURANCE FROM**

**CNA**

Countersigned by _______

Authorized Agent

Blank Endorsement

G-33461-F