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THIS ENDORSEMENT CHANGES THE POLICE'. 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 aspect 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 />or <br />Any person or organi.,zation where the named insured has agreed by written <br />contract to include such person or organization as a designated insured. <br />(If no entry appears above, information required to complete this endorsement will be shown in the Declarations <br />as app€€cable to the endorsement.) <br />Each person or organization shown in the Schedule is an "insured" for l.3ability Coverage, but only to the extent <br />that person or organizations qualifies as an "insured" under the Who Is Ars Insured Provision contained <br />in Section 11 of the Coverage Form, <br />Policy No: AS7Z91462442027 Issued BY: Li.berty Instirance Corp. <br />Effective mate: 05101/2017 <br />Expiration bate: 05re1J2018 <br />Sales Office: 0237 <br />6j G��JU j��il j cC ['{�'DL 4 <br />Cly► 20 48 02 99 Copyright, Insurance Services Office, Inc., 1998 Rage 1 of 1 <br />