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POLICY NUMBER: BAP 0112780-02 <br />COMMERCIAL AUTO <br />CA 20 48 10 13 <br />THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. <br />Mki DIVIXU '*. F.11 rWK01111. <br />This endorsement modifies insurance provided under the following: <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 this endorsement, <br />This endorsement identifies person(s) or organizations) 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 />This endorsement changes the policy effective on the inception date of the policy unless another date is indicated <br />below. <br />Named Insured: Stearns, Conrad and Schmidt, Consulting Engineers, Inc. <br />Endorsement Effective Date: 04/01/2017 <br />SCHEDULE <br />Name Of Person(s) Or Organization(s): <br />Any person or organization to whom or which you are required to provide additional insured status or additional <br />insured status on a primary, non-contributory basis, in a written contract or written agreement executed prior to <br />loss, except where such contract or agreement is prohibited by law. <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 <br />provision contained in Paragraph A.1. of Section II — <br />Covered Autos Liability Coverage in the Business <br />Auto and Motor Carrier Coverage Forms and <br />Paragraph D.2. of Section I — Covered Autos <br />Coverages of the Auto Dealers Coverage Form. <br />CA 20 48 10 13 © Insurance Services Office, Inc., 2011 Page 1 of 1 <br />Wolters Kluwer Financial Services I Uniform Formsrm <br />� REVIEWED BY. E,.UNii h I IY.R DIA (P OF � <br />