**The Atlantic Companies**

**Insurance Company**

**Effective**  
(As the time stated in the policy)  
**issued to**  
by  
**Insurance Company**  

(The information provided for above is required to be completed only when this endorsement is issued for attachment to the policy subsequent to its effective date.)

**ENDORSEMENT**

**FOLLOWING FORM - EMPLOYEE BENEFITS**

EXCEPT INsofar AS COVERAGE IS AVAILABLE TO THE INSURED AS PROVIDED BY UNDERLYING INSURANCE AS SET FORTH IN THE SCHEDULE OF UNDERLYING INSURANCE, THIS POLICY DOES NOT APPLY TO PERSONAL INJURY LIABILITY OR PROPERTY DAMAGE LIABILITY ARISING OUT OF EMPLOYEE BENEFITS.

All other terms and conditions of this insurance remain unchanged.

**G16908 (1/79)**

**President**  
**Authorized Representative**