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0049-GLD-000052643
POLICY
GLD052044
0049-GLD-000052044
-r\*VTrif+<*.- *
X
/ |ee Hartford Accident and indemnity Company
3H Hartford Casualty Insurance Company
Hartford Ptazi, Hartford, Connecticut 08115
The INSURER shall be The Company
as designated herein by Co. Code:
DECLARATIONS
Previous Policy No.
Items
1/14/MAW/SH 10 HU EK01hj
i
I
1. Named Insured and Mailing Address--------------------------
The Named Insured is: Individual
Corporation
Partnership L. Other__________
2. Policy Period:--------------------------------------------------------------- *-
; Producer's Name and Address Producer's Code
MARSH & KC LENNAN
252898
THE H
POLICY NO.
HU HE 1700
SCM CORPORATION
)-U3rf
299 PARK AVENU, NEW YORK, N.y 10171
1/I/8l
, /1 /au
Inception (Mo. Day Yr.)
Expiration (Mo. Day Yr.)
12:01 A.M. standard time at the address of the named insured as stated herein.
i_
3. Premium:
________ ________________
| Advance Premium
Minimum Premium
1$ 155,000.00 ' '$
_J
Rate .
Per
Premium Base
4. Self-insured Retention
5. Limits of Liability each occurrence aggregate-----------
$ 100,000 *"
$$
, *9 000,000 , '9 000,000 x
6. Schedule of Underlying Insurance Policies
SEE ATTACHED EXTENSION SCHEDULE OF UNDERLYING INSURANCE POLICIES FORMING A PART OF POLICY.
The above numbered UmbreSa policy is completed by: (a) this Declarations, Form XL-10-0; (b) the Policy Provisions, Form XL-12-0; (c) the Policy Jacket Form 6153; (d) any Endorsements forming part of the policy at issue.
Form Numbers of Endorsements Forming Partof Poicy At Issue:
XL 224-0
XL 257-1
G-2240 (NMD INS.) (FF AIRCRAFT) (AUTO COV') (NOTICE OF CANC) (JOINT VENTURE)
Date 1/14/83
Agency at
NYC
*0-0 Printed in U.SA
Countersignedby
^ AuthorizedAgent
-------------------------------------------------
V.
GLD052045
0049-GLD-000052045
Extension Schedule of Underlying Insurance Policies
Policy Number 10 HU HE 1700
This extension schedule forms a part of the policy desig nated herein.
THE HARTFORD
Named Insured and Address
Carrier, Policy Number & Period Type of Coverage
Ajpplicable Limits
(a) CNA
CCP089657845-'
1/1/83-84-
Employers' Liability " $ 1 ,000 , 0 0 0ELOD JONES ACT^
F.E.l.A. U.S.L. & H
Employers' Liability each accident*
(b> CNA
CCP089657845'
1/1/83-84 -
Comprehensive --
Bodily Injury Liability
Automobile Liability
$ ,000
each person
Inducing
$ ,000
eachoccurrence
Property Damage Liability
O owned automobiles $
,000
eachoccurrence
O non-owned
Bodily Injury and Property Damage liability Combined
automobiles
XU hired automobiles $ 1 ,000 , 00 0
.eachoccurrence
<c) CNA
CCP089657845 -
1/1/83-84'
General Liability " including
1
jp products-completed S
operations Liability $
Bodily Injury Liability
.000 ,000
each occurrence aggregates
E contractual Liability
1 personal injury
$
Liability
$
Property Damage Liability
,000
each occurrence
.000
aggregate
<d)
(9> FEDERAL IGW47359
jp employees as
Bodily Injury and Property Damage Liability Combined
additional insureds $ 1 ,000,0 0 0
each occurrence "
E Liquor Law Liability $ 1 ,000 , 00 0
aggregate-
SP ADVERTISERS L AB 1 ,000,000 EA. OCC CSL
Es t o p g a p l ia b . 1,000,000 CSL EA PERSON 1,000,000 EA.
Watercraft Liability--
Bodily Injury Liability
OCC.
S .000
each person
including
$. ,000
. each occurrence
Property Damage Liability
owned watercraft S
.000
each occurrence
Bodily Injury and Property Damage Liability Combined
non-owned watercraft
S ,000
each occurrence
Other (Specify) AIRCRAFT LIAB.
50,000,000 CSL1
9/1/81/84
An "X" marked in the box indicates the coverage is provided in the Underlying Policies.
Note Maintenance of Underlying Insurance Condition.
"Except that in any jurisdiction where the amount of Employers Liability Coverage afforded by the underlying insurer is by taw unlimited, the limit stated does not apply and the policy of which this extension schedule forms a part shall afford no insurance with respect to Employers Liability in such jurisdiction.
/ Form XL-11-0 Printed in u S A INS)
GLD052046
0049-GLD-000052046
Extension Schedule of Underlying Insurance Policies
Policy Number 10 HU HE 1700
This extension schedule forms a part of Ihe policy desig* nated herein.
THE HARTFORD
Named Insured and Address
Carrier, Policy Number & Period Type of Coverage (a)
Employers' Liability
Applicable Limits $ ` ,000
Employers' Liability each accident*
1t
(b)
(c) CNA
CCP089657845 1/1/83-84
Comprehensive Automobile Liability including
$ $
owned automobiles $ non-owned
automobiles hired automobiles $
Bodily Injury Liability
,000
' eaoh person
,000
each occurrence
Property Damage Liability
,000
each occurrence
Bodily injury and Property Damage Liability Combined
,000
each occurrence
General Liability including
products-completed $ operations Liability $
Bodily Injury Liability
,000 ,000
each occurrence aggregates
contractual Liability
Property Damage Liability
personal injury
$ ,000
each occurrence
Liability
$ ,000
aggregate
employees as
Bodily Injury and Property Damage Liability Combined
additional insureds $
,000
each occurrence
Liquor Law Liability $
,000
aggregate
G9 EMPLOYEE BENE FITS 1,000,000 EA. OCC. 1,000,000 AGG,
(i(| EMPLOYERS HAL PRACTICE 1,000,000 EA. OCC CSL
<d>
Watercraft Liability
Bodily Injury Liability
S ,000
each person
including
S .000
each occurrence
Property Damage Liability
owned watercraft S
.000
each occurrence
non-owned watercraft
Bodily Injury and Property Damage Liability Combined
S ,000
each occurrence
(0) PROTECTIVE
T.B.A.
Other (Specify)
EXCESS WORKERS COMPENSATION
2,000,000 EA. OCC XS OF
1/1/83-84
250.000 SIR PER ACCIDENT
An "X" marked in the box indicates the coverage is provided ih the Underlying Policies.
Note Maintenance of Underlying Insurance Condition.
Except that in any jurisdiction where the amount of Employers Liability Coverage afforded by the underlying insurer is by law unlimited, the limit stated does not apply and the policy of which this extension schedule forms a part shall afford no insurance with respect to Employers Liability in such jurisdiction. --------------------------------------------------------------------------------------------------------------------------------------------------------- 1----------------------------------------------------------
Form XL-11-0 Primed in U S A INS)
GLD052047
0049-GLD-000052047
Extension Schedule of Underlying Insurance Policies
Policy Number 10 HU HE1700
This extension schedule forms a part of the policy deslg^ nated herein.
THE HARTFORD
Named Insured and Address
Carrier, Policy Number & Period Type of Coverage
(a) Employers' Liability
Applicable Limits
$ ,000
Employers' Liability each accident*
(b>
Comprehensive
Bodily Injury Liability
Automobile Liability including
$ . ,000 $ ,000
each person each occurrence
Property Damage Liability
owned automobiles $
,000
each occurrence
non*owned
Bodily Injury and Property Damage Liability Combined
automobiles
hired automobiles $
,000
e&ch occurrence
(c)
General Liability
Bodily Injury Liability '
including
products-completed $
,000
each occurrence
operations Liability $
,000
aggregates
contractual Liability
Property Damage Liability
personal injury S .000
each occurrence
Liability
$ ,000
aggregate
(d)
(e) CNA
CCP089657845 1/1/83-84
employees as
additional insureds $ Liquor Law Liability $
Watercraft Liability
nicluding
$ $
owned watercraft S
non-owned watercraft
Other (Specify)
$
Bodily Injury and Property Damage Liability Combined
,000
each occurrence
,000
aggregate
Bodily Injury Liability ,
.000
each person
,000
each occurrence
Property Damage Liability
,000
each occurrence
Bodily Injury and Property Damage Liability Combined
,000
each occurrence
LAWYER'S PROFES^ I0NAL 230,000 EACH CLAIM-500,000 AGG
LIABILITY
EXCEPT 1,000,000 FOR SPECIFICALLY
NAMED LAWYERS
An "X" marked in the box indicates the coverage is provided in the Underlying Policies.
Note Maintenance of Underlying Insurance Condition.
*Except that in any jurisdiction where the amount of Employers Liability Coverage afforded by the underlying insurer is by law unlimited, the limit stated does not apply and the policy of which this extension schedule forms a part shall afford no insurance with respect to Employers Liability in such jurisdiction.
Cnm< Yl.tl.ft
r I I C ft
GLD052048
0049-GLD-000052048
THE HARTFORD
Policy Number
Named Insured and Address
10 HU HE 1700
This endorsement forms a part of the policy as numbered
above, issued by THE HARTFORD INSURANCE GROUP
company designated therein, and takes effect as of the
effective date of said policy unless another effective date
is stated herein.
......... ........................................... ........
Effective Date
Effective hour is the same as stated
in the Declarations of the policy.
Endt. No.
EXTENSION SCHEDULE CONTINUED
IT IS UNDERSTOOD THAT THE FOLLOWING COVERAGES ARE SCHEDULED AS UNDERLYING TO THE COMPREHENSIVE GENERAL LIABILITY POLICY AS ISSUED BY THE CONTINENTAL CASUALTY COMPANY POLICY NUMBER CCP0896578A5. IT IS FURTHER UNDERSTOOD THAT THE COMPREHENSIVE GENERAL LIABILITY WILL BE EXCESS OVER ALL SCHEDULED LIMITS.
COVERAGE
LIMITS OF LIABILITY
A) EMPLOYERS' LIAB, E.L.O.D. JONES ACT, F.E.I.A. & U.S .L. & H
CARRIER
POLICY MO.
ALL STATE POLICY JOTUN-BALTIMORE SYLVACHEM CORP. TEXAS EXPOSURES
b ) WATERCRAFT LIABILITY WATERCRAFT IN JOLIET & BALTIMORE FLORIDA WATERCRAFT
c) CHARTERERS LEGAL LIAB
100,000 100,000 100,000 100,000
EA. EA. EA. EA.
OCC OCC OCC OCC
CNA CNA CNA TEXAS EMPLOYERS INS. ASSOC.
wc 3451539 WC 3451540 WC 3451541 WCA-84311
1,000,000 EA. VESSEL ACCIDENT/OCCURRENCE 1,000,000 EA. ACCIDENT
1,000,000 ANY ONE ACCIDENT OR SERIES OF ACCIDENTS
CONTINENTAL INS. CO
CONTINENTAL INS. CO.
CONTINENTAL INS. CO. 1 .
PIC 81014 XC 362430
HC 036999
0) FOREIGN INSURANCE PER UNDERLYING SCHEDULE
VARIOUS
VARIOUS
VARIOUS
Nothing herein contained shall be held to vary, waive, alter, or extend any of the terms, conditions, agreements or declarations of the policy, other than as herein stated.
This endorsement shall not be binding unless countersigned by a duly authorized agent of the company; provided that if this endorsement takes effect as of the effective date of the policy and, at issue of said policy, forms a part thereof, countersignature on the declarations page of said policy by a duly authorized agent of the company shall constitute valid countersignature of this endorsement.
Form 0*2240*3 B Printed in U.S.A.
y
Countersigned by
Authorized Agent
GZ.D052049
0049-GLD-000052049
EMPLOYEE RETIREMENT INCOME SECURITY ACT LIABILITY EXCLUSION ENDORSEMENT
Policy Number
10 HU HE I 700
This endorsement forms a part of the policy as numbered above, issued by THE HARTFORD INSURANCE -GROUP com pany designated therein, and takes effect as ot the effective date of said policy unless another effective date is stated herein.
Effective Date
Effective hour is the same as stated in the Declarations of the policy.
Endt. No.
THE HARTFORD
Named Insured and Address
It is agreed that the insurance does not apply with respect to any liability arising out of intentional or uninten tional violation of any provision of the Employee Retirement Income Security Act of 1974, Public Law 93-406 (commonly referred to as the Revision Reform Act of 1974), or any amendments to them.
Nothing herein contained shall be held to vary, waive, alter, or extend any of the terms, conditions, agreements or declarations of the policy, other than as herein stated.
This endorsement shall not be binding unless countersigned by a duly authorized agent of the company; provided that if
this endorsement takes effect as of the effective date of the policy and. at issue of said policy, forms a part thereof,
countersignature on the declarations page of said policy by a duly authorized agent of the company shall constitute valid
countersignature of this endorsement.
i
Form XL-224-0 Printed in U.S.A.
Countersigned by
GLD052050
0049-GLD-000052050
NEW YORK AMENDATORY ENDORSEMENT -- UMBRELLA LIABILITY
THE HARTFORD
Policy Number
10 HO HE t 700
This endorsement forms a part of the policy as numbered above, issued by THE HARTFORD INSURANCE GROUP company designated therein, and takes effect as of the effective date of said policy unless another effective date is stated herein.
Effective Date
Effective hour is the same as stated
__________ _______________in the Declarations of the policy.
Endt. No.I
Named Insured and Address
It is agreed that:
1. The definition of "personal injury" is amended to read:
"personal injury" means injury, other than adver tising injury, arising out of one or more of the following offenses committed during the policy pe riod in the conduct of the named insured's busi ness:
(1) the publication or utterance of a libel or slander or of other defamatory or disparaging material, or a publication or utterance in violation of an individual's right of privacy;
(2) false arrest, detention or imprisonment, or ma licious prosecution;
(3) wrongful entry or eviction or other invasion of an individual's right of privacy.
2. Exclusion L is amended to read:
L to personal injury sustained by any person:
(1) as the result of an offense directly or indirectly related to the employment of such person by the named insured, or
(2) on account of discrimination because of race, ` creed, color or national origin.
3. CONDITION 5, Action .^gainst Company, is
amended to read as follows:
No action shall lie against the company unless, as a condition precedent thereto, there shall have been full compliance with all of the terms of this policy, nor until the amount of the insured's obligation to pay shall have been finally determined either by judgment against the insured or by written agreement of the insured, the claimant, and the company.
Any person or organization or the legal representative thereof who has secured such judgment or written agreement shall thereafter be entitled to recover under this policy to the extent`of the insurance afforded by this policy. No person or organization shall have any right under this policy to join the company as a party to any action against the insured to determine the in sured's liability, nor shall the company be impleaded by the insured or his legal representative. Bankruptcy or insolvency of the insured or of the insured's estate shalf not relieve the company of any of its obligations hereunder.
Nothing herein contained shall be held to vary, waive, alter, or extend any of the terms, conditions, agreements or declarations of the policy, other than as herein stated.
This endorsement shall not be binding unless countersigned by a duly authorized agent of the company; provided that if this endorsement takes effect as of the effective date of the policy and, at issue of said policy, forms a part thereof, countersignature on the declarations page of said policy by a duly authorized agent of the company shall constitute valid countersignature of this endorsement.
Form XL-257-1 Printed in U.S.A.
Countersigned by..
Authorized Agent
GLD052051
0049-G LD-000052051
THE HARTFORD
Policy Number
Named Insured and Address
10 HU HE1700
This endorsement forms a part of the policy as numbered
above, issued by THE HARTFORD INSURANCE GROUP
company designated therein, and takes effect as of the
effective date of said policy unless another effective date
is stated herein.
......................
.................... --
Effective Date
Effective hour is the same as stated
in the Declarations of the policy.
IT IS AGREED THAT ITEM #1 NAMED INSURED SHALL READ:
NAMED INSURED
A) SCM CORPORATION, ALL SUBSIDIARIES AND SUBSIDIARIES OF THE
SUBSIDIARIES, SCM FOUNDATION, ANY OTHER
ASSUMES ACTIVE MANAGEMENT, ANY EMPLOYEE
OR CLUBS Q.F. THE. NAfjED INSURED. ____ -s/*? J<Ffcn Mara-vM.
COMPANY OF WHICH IT SPONSORED ASSOCIATION
B) JOTUN-BALTIMORE COPPER PAINT COMPANY A JOINT VENTURE, HOWEVER, SUCH COVERAGE AS IS PROVIDED FOR THE INTEREST OF GLIODEN-DURKEE DIVISION OF SCM CORPORATION AND A.F. JOTUNGRUPPEN OF NORWAY IN THE JOINT VENTURE ABOVE IS RESTRICTED TO SUCH COVERAGE AS IS AVAILABLE TO THE INSURED UNDER THE PRIMARY INSURANCE STATED IN THE SCHEDULE OF UNDERLYING INSURANCES ATTACHED TO THIS POLICY.
C) SYLVACHEM CORPORATION, A JOINT VENTURE, HOWEVER, SUCH COVERAGE
AS IS PROVIDED FOR THE INTEREST OF GLIDDEN-DURKEE DIVISION OF SCM CORPORATION AND ST. REGIS PAPER CORPORATION IN THE JOINT VENTURE ABOVE IS RESTRICTED TO SUCH COVERAGE AS IS AVAILABLE TO THE INSURED UNDER PRIMARY INSURANCE STATED IN THE SCHEDULE OF UNDERLYING INSURANCES ATTACHED TO THIS POLICY.
HOWEVER COVERAGE SHALL NOT APPLY TO CANADIAN LIABILITY.-^
Nothing herein contained shall be held to vary, waive, alter, or extend any of the terms, conditions, agreements or declarations of the policy, other than as herein stated.
This endorsement shall not be binding unless countersigned by a duly authorized agent of the company; provided that if this endorsement takes effect as of the effective date of the policy jand, at issue of said policy, forms a part thereof, countersignature on the declarations page of said policy by a duly authorized agent of the company shall constitute valid countersignature of this endorsement.
Form G-22404 B Printed In U.S.A.
Countersigned by
Authorized Agent
GLD052052
0049-GLD-000052052
THE HARTFORD
Policy Number 10 HU HE 1700
Named Insured and Address
This endorsement forms a part of the policy as numbered above, issued by THE HARTFORD INSURANCE GROUP company desig nated therein, and takes effect as of the effective date of said policy unless another effective date is stated herein.
Effective Date
Effective hour js the same as stated in the Declarations oftrie policy.
Endt. No.
LIMITATION ENDORSEMENT UMBRELLA LIABILITY
IN CONSIDERATION OF THE PREMIUM CHARGED, IT IS AGREED THAT SUCH INDEMNIFICATION IS PROVIDED BY THE POLICY SHALL NOT APPLY TO:
AIRCRAFT LIABILITY""
UNLESS THERE IS VALID AND COLLECTIBLE UNDERLYING INSURANCE DESCRIBED IN THE SCHEDULE OF UNDERLYING INSURANCE, AND THEN ONLY FOR SUCH AIRCRAFT LIABILITY, IS AFFORDED UNDER SAID UNDERLYING INSURANCE.
Nothing herein contained shall be held to vary, waive, alter, or extend any of the terms, conditions, agreements or declarations of the policy, other than as herein stated.
This endorsement shall not be binding unless countersigned by a duly authorized agent of the company; provided that if
this endorsement takes effect as of the effective date of the policy and, at issue of said policy, forms a part thereof,
countersignature on the declarations page of said policy by a duly authorized agent of fhe company shall constitute
valid countersignature of this endorsement.
1
1.
Countersigned by.
Form G-2240-3 A Printed in U.S.A.
GLD052053
0049-GLD-000052053
THE HARTFORD
Policy Number
10 HU HE 1700
Named. Insured and Address
This endorsement forms a part of the policy as numbered above, issued by THE HARTFORD INSURANCE GROUP company desig nated therein, and takes effect as ol the effective date of said
policy unless another effective date is stated herein.
Effective Date
hour is the same as. stated in the eclarations of the policy.
i Endt. No.
r
"IT IS UNDERSTOOD AND AGREED THAT THIS POLICY EXCLUDES AUTOMOBILE LIABILITY COVERAGE FOR LEASED VEHICLES OR LEASED BACK VEHICLES WHEN BEING USED .FOR PERSONAL USE BY EMPLOYEES AND EMPLOYEES FAMILIES OR OTHERS DRIVING WITH THEIR PERMISSION."
Nothing herein contained shall be held to vary, waive, alter, or extend any of the terms, conditions, agreements or
declarations of the policy, other than as herein stated.
,
This endorsement shall not be binding unless countersigned by a duly authorized agent of the company; provided that if
this endorsement takes effect as of the effective date of the policy and. at issue of said policy, forms a part thereof, countersignature on the declarations page of said policy by a duly authorized agent of the company shall constitute valid countersignature of this endorsement.
Form G-2240-3 A Printed in U.S.A.
Countersigned by
' AuthdrtzecT Agent"
GLD052054
0049-GLD-000052054
THE HARTFORD
Policy Number
10 HU HE 1700
This endorsement forms a part of the policy as numbered above, issued by THE HARTFORD INSURANCE GROUP company desig nated therein, and takes effect as of the effective date of said
policy unless another effective date is stated herein.
Effective Date
Effective hour is the same as stated in the Declarations of the policy.
Endt. No.
Named Insured and Address
NOTICE OP CANCELLATION ENDORSEMENT. IT IS AGREED THAT IN THE EVENT OF CANCELLATION OF/OR NON-RENEWAL
OF THE ABOVE POLICY 90 DAYS PRIOR WRITTEN NOTICE WILL BE GIVEN TO
THE NAMED INSURED EXCEPT FOR NON-PAYMENT OF PREMIUM.
Nothing herein contained shall be held to vary, waive, alter, or extend any of the terms, conditions, agreements or declarations of the policy, other than as herein stated.
This endorsement shall not be binding unless countersigned by a duly authorized agent qf the company; provided that if this endorsement takes effect as of the effective date of the policy and, al issue of said policy, forms a part thereof, countersignature on the declarations page of said policy by a duly authorized agent of the company shall constitute valid countersignature of this endorsement.
Form G-2240-3 A Printed in U.S.A.
Countersigned by
Autfidrized' Agent'
/
GLD052055
0049-GLD-000052055
Policy Number 10 HU HE 1700
1
THE HARTFORD
Named Insured and Address
This endorsement torms a part of the policy as numbered above, issued by THE HARTFORD INSURANCE GROUP company designated therein, and takes effect as of the effective date of said policy unless another effective date
is stated herein. Effective Date
Effective hour is the same as stated in the Declarations of the policy.
Endl No.
r
*
JOINT VENTURE ENDORSEMENT (NMA 1687)
VJ* I
I. IT IS AGREE0 THAT THIS POLICY COVERS ANY LIABILITY WHICH IS INSURED ANO WHICH ARISES IN ANY MANNER WHATSOEVER OUT OF THE OPERATIONS OR EXISTENCE OF ANY JOINT VENTURE, CO-VENTURE, JOINT LEASE, JOINT OPERATING AGREEMENT OR PARTNERSHIP (HEREINAFTER CALLED "JOINT VENTURE") IN WHICH THE INSURED HAS AN INTEREST.
IN SUCH CLAIMS, LIA8ILITY UNDER THISPOLICY SHALL BE LIMITED TO THE PRODUCT OF (A) THE PERCENTAGE INTEREST OF THE INSURED IN THE JOINT VENTURE ANO (b ) THE TOTAL LIMIT OF LIABILITY INSURANCE
AFFORDED THE INSURED BY THIS POLICY. WHERE THE PERCENTAGE INTEREST OF THE INSURED IN THE JOINT VENTURE IS NOT SET FORTH IN WRITING, THE PERCENTAGE TO BE APPLIED SHALL BE THAT WHICH WOULD BE IMPOSED BY LAW AT THE INCEPTION OF THE JOINT VENTURE,. SUCH PERCENTAGE SHALL NOT BE INCREASED BY THE INSOLVENCY OF OTHERS INTERESTED IN THE SAID JOINT VENTURE.
II,
IT IS FURTHER AGREED THAT, WHERE ANY UNDERLYING INSURANCE(s) HAS BEEN REDUCED BY A CLAUSE HAVING THE SAME EFFECT AS PARAGRAPH (l),
THE LIABILITY OF UNDERWRITERS UNDER THIS POLICY, AS LIMITED BY PARAGRAPH (l), SHALL BE EXCESS OF THE SUM OF (A) SUCH REDUCED LIMITS OF ANY UNDERLYING INSURANCE(S) ANO (b )-THE LIMITS OF ANY UNDERLYING INSURANCE(S> NOT SO REDUCED.
Nothing herein contained shall be held to vary, waive, alter, or extend any of the terms, conditions, agreements or declarations ot the policy, other than as herein stated.
This endorsement shall not be binding unless countersigned by a duly authorized agent of the company: provided that if this endorsement takes effect as of the effective date of the policy and, at issue of said policy, forms a part thereof, countersignature on the declarations page of said policy by a duly authorized agent of the company shall constitute valid countersignature of this endorsement.
rent) 0-2240-3 B Printed In USA.
Countersigned by
Authorized Agent
GLD052056
0049-GLD-000052056