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POLICYNUMSEf: SAP 8044405 17 COMMERCIAL AUTO <br />CA 20 48 02 99 <br />THIS ENDORSEMENT CHANGES THE POLICY. PLEASE REAL? IT CAREFULLY. <br />DESIGNATED INSURED p! <br />This endorsement modifies Insurance provided under the following: <br />13USINESS AUTO COVERAGE FORM i <br />GARAGE COVF_RAGFc FORM <br />MOTOR CARRIER COVERAGE FORM f <br />TRUCKERS COVERAGE FORM � <br />Wfth respect to coverage provided by this endorsement. theprovisionsof the Coverage Form apply unless modified by <br />this endorsement. <br />This endorsarrient identifies persons) or organizations) who are "Insureds" under the Who Is An Insured Provision of <br />the Coverage Form. This endorsement does not niter coverage provided in the. Coverage Form. <br />This andorsament changes the policy effective on the inception data of the policy unless another dale Is Indicatuci <br />below. <br />Endorsement Effective; Countersigned By_ <br />Vanned Insured: <br />orbmd rAsantalivis <br />SCHEDULE <br />Name of Persons) or Organlzatlon(s)- <br />ANY PERSON OR ORGANI2AT202'T WITH WHOM YOU HAVE ^GREED, THROUGH WRITTEN <br />,'ONTR.&CT, AGRESM]ENT OR PERMIT, EXECUTED PRIOR TO ANY TtDSS. <br />(if no entry appears above, information required to complete this endorsement will be shown in the Dectarations as <br />applicable to the and orserneru.) <br />Each person or organization shown in the Schad ule is an 'insured' for Liability Coverage, but Only to the axtcnt that <br />person or organization qualifies as an Insured" tinder the VHho Is An Insured Provision contained in Section U of the <br />Coverage Form. <br />CA 20 48 02 99 Copyright, Insurance Services Office, Inc., 199E Page 1 of 1 p <br />— C— <br />