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OLD REPUBLIC GENERAL INSURANCE- CORPORATION <br />ADDITIONAL INSURED -PRIMARY AND NON-CONTRIBUTORY <br />THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. <br />THIS ENDORSEMENT MODIFIES INSURANCE PROVIDED UNDER THE FOLLOWING: <br />BUSINESS AUTO 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 />cruFni u c <br />Name of Persons) or Organization(s) <br />WHERE REQUIRED BY EXECUTED WRITTEN CONTRACT. <br />(If no entry appears above, Information required to complete this endorsement will be shown in the <br />Declarations as aDDlicable to tha i <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 <br />contained in Section II of the Coverage Form. <br />If the person or organization shown in the schedule qualifies as an 'insured' for Liability Coverage, and they <br />have coverage as a first named insured under another policy, this policy is primary to and non-contributory <br />with that other insurance. <br />All other terms, conditions, and exclusions apply. <br />Roberts, Inc.umber <br />ndorsement No.A1CA13971801 <br />FNamejdInsuredT.E. <br />eriod <br />O1 <br />9/01/2019 to09/01/2020 Endorsement Effective Date: <br />r's Name: <br />09/01/2019 <br />OHUB International Insurance Services. Inc. <br />cer Number: <br />27N12 <br />DATE <br />CA EN GN 0044 02 12 Page 1 of 1 <br />