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POLICY NUMBER:COMMERCIAL AUTO <br />CA 20 48 02 99 <br />THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. <br />DESIGNATED INSURED <br />This endorsement modifies insurance provided under the following: <br />BUSINESS AUTO COVERAGE FORM <br />GARAGE COVERAGE FORM <br />MOTOR CARRIER COVERAGE FORM <br />TRUCKERS COVERAGE FORM <br />With respect to coverage provided by this endorsement, the provisions of the Coverage Form apply unless <br />modified by this endorsement. <br />Provision of the Coverage Form. This endorsement does not alter coverage provided in the Coverage <br />Form. <br />This endorsement changes the policy effective on the inception date of the policy unless another date is <br />indicated below. <br />Endorsement Effective:Countersigned By: <br />Named Insured: <br />(Authorized Representative) <br />SCHEDULE <br />Name of Person(s) or Organization(s): <br />Any person or organization that the Named Insured is obligated to provide Insurance where required by a <br />written contract or agreementis an insured, but only with respect to legal responsibility for acts or <br />omissions of a person for whom Liability Coverage is afforded under this policy. <br />(If no entry appears above, information required to complete this endorsement will be shown in the <br />Declarations as applicable to the endorsement.) <br />Each person or organization shown in the Schedule i <br />contained in Section IIof the Coverage Form. <br />CA 20 48 02 99Copyright, Insurance Services Office, Inc., 1998Page1of1 <br /> <br />