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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 modi- <br /> fied by this endorsement. <br /> This endorsement identifies person(s)or organization(s) who are "insureds"under the Who Is An Insured Provi- <br /> sion of the Coverage Form. This endorsement does not alter coverage provided in the Coverage Form. <br /> SCHEDULE <br /> Name of Person(s)or Organization(s): <br /> Any person or organization whom you have agreed. in writing to add as an <br /> additional insured, but only to coverage and minimum limits of insurance <br /> required by the written agreement, and in no event to exceed either the scope of <br /> coverage or the limits of insurance provided in this policy. <br /> (If no entry appears above, information required to complete this endorsement will be shown in the Declarations <br /> as applicable to the endorsement,) <br /> Each person or organization shown in the Schedule is an "insured"for Liability Coverage, but only to the extent <br /> that person or organization qualifies as an "insured" under the Who Is An Insured Provision contained <br /> in Section II of the Coverage Form. <br /> Policy No: AS5-Z11-C3H77D-024 Issued By: r M Insurance Corporation <br /> Effective Date: 12/14/2024 <br /> Expiration Date: 121.14/2025 <br /> Sales Office: 0202 <br /> CA 20 48 02 99 Copyright, Insurance Services Office, Inc„ 1998 Page 1 of I � <br />