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

- ☐ Comprehensive General Liability Insurance
- ☐ Comprehensive Automobile Liability Insurance
- ☐ Automobile Physical Damage Insurance
- ☐ Excess Third Party Liab.Pol.

PREMIUM ADJUSTMENT: ☐ NONE ☐ IN POLICY PREMIUM ☐ ADDITIONAL $__________

Waived or Included: ☐

Payable: ☐ SEE BELOW OR - Advance $__________ First Installment $__________ Second Installment $__________

Johnson & Higgins 032-034344

ATTACH

NON-MONEY
8/16/79

It is hereby agreed that the Producer of Record is to read:
Johnson & Higgins

CLASS CODE - 3181
SUBLINE - SX

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.
12 | 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
International Business Machines Corp., Etal | 5/21/79
H.O. COPY
Countersigned by | Authorized Agent

BLANK ENDORSEMENT
G-33467-F