**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.:** 86-68-700
- **Eff. Date of Pol:** [Not specified]
- **Eff. Date of End:** [Not specified]
- **Agency No.:** [Not specified]
- **Add'l Premium:** $ [Not specified]
- **Known Premium:** $ [Not specified]

**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.

**Notice Requirement:**

In the event of cancellation or material change affecting the interest of the government, 10 days prior written notice shall be given to the Department of the Army, United States Army Electronics Command, Fort Monmouth, New Jersey, 07703.

(Contract - AMSEL - PP-CN-EA-9)

**Insurers:**

- Zurich Insurance Company
- American Guarantee and Liability Insurance Company

**Countersigned:**

- [Name] (Duly authorized agent)
- [Name] (Attorney in fact)

**Form:** 116-G 50M 10-69

**IBM:** 062378