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i <br /> AM-H516177-05 <br /> I <br /> THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. <br /> DESIGNA`I•ED 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 /> This endorsement identifies person(s) or organization(s) who are "Insureds" under the Who Is An Insured <br /> Provision of the Coverage Form. This endorsement does not alter coverage provided In the Coverage Form. <br /> This endorsement changes the policy effective on the inception date of the policy unless another date Is <br /> Indicated below. { <br /> i <br /> Endorsement Effective: Countersigned By, <br /> Named Insured: <br /> (Authorized Representative) <br /> SCHEDULE <br /> Name of Person(s) or Organization(s): <br /> "BLANKET AS REQUIRED BY <br /> WRITTEN CONTRACT, AGREEMENT ' <br /> OR PERMIT " <br /> Gf no entry appears above, Information required to complete this endorsement will be shown in the Dec[a- <br /> rations as applicable to the endorsement.) <br /> Each person or organization shown in the Schedule is an "insured" for Liability Coverage, but only to the <br /> extent that person or organization qualifies as an "insured" under the Who Is An Insured Provision con- <br /> tained in Section II of the Coverage Form. <br /> i <br /> I <br /> CA 20 48 02 99 Copyright, Insurance Services Office, Inc., 1998 Page 1 of 1 <br />