HO 04 41 04 91

THIS ENDORSEMENT CHANGES THE POLICY . PLEASE READ IT CAREFULLY.

ADDITIONAL INSURED

RESIDENCE PREMISES

Name and Address of Person or Organization*

 

Interest*

 

The definition of "insured" in this policy includes the person or organization named above with respect to:

SECTION I

Coverage A - Dwelling and Coverage B - Other Structures; and

SECTION II

Coverage E - Personal Liability and Coverage F - Medical Payments to Others but only with respect to the employee's employment by the person or organization.

If we decide to cancel or not renew this policy, the party named above will be notified in writing.

*Entries may be left blank if shown elsewhere in this policy for this coverage.

All other provisions of this policy apply.

 

HO 04 41 04 91  Copyright, Insurance Services Office., 1990