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It is hereby understood and agreed that from noon of.
Warranties of this policy is amended to read as follows:

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(NEW ESTIMATED ANNUAL PREMIUM.)

It is further understood and agreed that the estimated annual premium under this policy beginning.. ) instead of as stated therein.

It is also understood and agreed that the annual minimum premium under the policy beginning...
will be.

Attached to and forming part of Policy No...
CASUALTY INSURANCE COMPANY. of NEW YORK CITY to

dated.

19

issued by the ATLANTIC

John Doe

Secretary.

No.

ENDORSEMENT

Schedule of Operations

(being a part of Item 3 of the Declarations)

CLASSIFICATION OF OPERATIONS
(NOTE: If more than one classification indicate each
other by (b), (c), (d) etc.

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1(a)

(x) President, any Vice-President, Secretary or
Treasurer of corporate Employer who per-
forms duties of Superintendent, Foreman or
Workman.

2(a) Clerical Office Employees

(b) Draughtsmen (engaged exclusively in the profession)-office duties only.

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3(a) Additions to, alterations and repairs of Employer's existing buildings or plants (not construction of new building nor maintenance of equipment covered as manufacturing operations) excluding the erection or demolition of structural steel or of any fabricated iron or steel products or structure, and the construction of sewers, tunnels, shafts or subways, excluding also all operations conducted or supervised by contractors operating either as principals or on a percentage basis (unless specifically classified and rated in Division 1) Stamping-(metal, if not included in 1) (b) Blasting (Additional Minimum Premium for this item $25.00.)

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JOHN DOE
Secretary.

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APPENDIX XVI

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In consideration of the rate at which this Policy is written, the Company will, when requested by the Assured, furnish
at its own cost and expense, through its own surgeon, such medical and surgical attendance as it may deem necessary to
the treatment of any injured employee covered hereby, but the Company shall not be responsible for the cost of hospital
provided by the Company's own surgeon.
or ambulance service, nor for the service of specialists, or any medical or surgical treatment except such as may be

Attached to and forming part of Policy No. E..

issued by the Atlantic Casualty Insurance Company, of New York City to
.19.

New York, N. Y,

dated.

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