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POLICY NUMBER: AS5-Z51-290099-034 COMIVERCIAL AUTO <br /> CIA 20 48 10 13 <br /> THIS ENDORSEMENT CHANGESTHE POLICY. PLEASE READ IT CAREFULLY. <br /> DESIGNATED INSURED FOR <br /> COVERED AUTOS LIABILITY COVERAGE <br /> This endorsement modes insurance provided under the fallowing: <br /> AUTO DEALERS COVERAGE FORM <br /> BUSINESS AUTO COVERAGE FORM <br /> MOTOR CARRIER COVERAGE FORM <br /> With respect to coverage provided by this endorsement, the provisions of the Coverage Form apply unless <br /> modified by the endorsement. <br /> This endorsement identifies person(s) or organization(s) who are "insureds" for Covered Autos Liability Coverage <br /> under the Who Is An Insured provision of the Coverage Form. This endorsement does not alter coverage <br /> provided in the Coverage Form. <br /> SCHEDULE <br /> Name Of Person(s)Or Organization(s): --- <br /> lAny person or organization whom you have agreed in writing to add as an additional insured, but only to <br /> coverage and minimum limas of insurance required by the written agreement, and in no event to exceed either <br /> the scope of coverage or the limits of insurance provided in this policy. <br /> ------------------ <br /> Information required to complete this Schedule, if not shown above, will be shown in the Declarations. <br /> Each person or organization shown in the Schedule is <br /> an "insured" for Covered Autos Liability Coverage, but <br /> only to the extent that person or organization qualifies <br /> as an "insured" under the Who Is An Insured provision <br /> contained in Paragraph A.I. of Section II - Covered <br /> Autos Liability Coverage in the Business Auto and <br /> Motor Carrier Coverage Forms and Paragraph D.2. of <br /> Section I - Covered Autos Coverages of the Auto <br /> Dealers Coverage Form. <br /> o�p"°Y..r.4e 141iiL�� <br /> REOEWED APPRovE]By. <br /> ' Risk Management specialist <br /> CA 20 48 10 13 0 Insurance Services Office, Inc.. 2011 F VP A 503 <br />