# Excess Overlay Indemnity Policy

## Amendment of Discrimination Coverage

It is agreed that such insurance as is afforded by the PERSONAL INJURY LIABILITY coverage does not apply to injuries sustained by any person as a result of discrimination directly or indirectly related to the employment of such person by the insured.

This endorsement, issued by one of the below named companies, forms a part of the policy to which attached, effective on the inception date of the policy unless otherwise stated herein.

(The information below is required only when this endorsement is issued subsequent to preparation of policy.)

| Endorsement effective | Policy No. | Endorsement No. 3 |
|----------------------|------------|--------------------|
| Named Insured         |            |                    |
| Additional Premium $  | Return Premium $ | BI PD |
|                      |             | In Advance $       | $   |
|                      |             | 1st Anniv. $       | $   |
|                      |             | 2nd Anniv. $       | $   |

The Aina Casualty and Surety Company<br>
The Standard Fire Insurance Company<br>
Hartford, Connecticut

Countersigned by (Authorized Representative)