**End. #13**

**Policy No:** 86-68-700  
**Eff. Date of Pol.:** [Not specified]  
**Eff. Date of End:** [Not specified]  
**Agency No.:** [Not specified]  
**Add'l Premium:** $50,000. INCL  
**Return Premium:** $  

**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.

**IT IS AGREED THAT THE FOLLOWING PREMIUM FOR THE PERIOD 12/31/70 - 1/1/72 IS COLLECTIBLE UNDER FORM S76, NON-OWNED AUTOMOBILES, CLASS I PERSONS:**

$50,000.00

**ZURICH INSURANCE COMPANY**
**AMERICAN GUARANTEE AND LIABILITY INSURANCE COMPANY**

Countersigned:
[Signature]

Form 116-G 50M 10-69
ATTORNEY IN FACT

W. J. Colvin
[Signature]
American Guardian

IBM 062383