Laserfiche WebLink
4OT"13 <br />39 <br />ADDITIONAL INSURED — <br />DESIGNATED PERSONS OR ORGANIZATIONS <br />Named Insured <br />Endorsement Number <br />Republic Services, Inc. <br />4 <br />Policy Symbol <br />Policy Number <br />Policy Period <br />Etfectbre Data of Endorsement <br />ISA <br />H1137119A <br />06130f2025 to 96l3912D26 <br />Issued By (Nam& of Insurance Company) <br />ACE American Insurance Company <br />Insert the pdicy number_ The remainder of the information is to be completed only when this endorsement is issued subsequent to the preparation of the palicyf- <br />TIT ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. <br />This endorsement modifies insurance provided under the following: <br />BUSINESS AUTO COVERAGE FORM <br />AUTO DEALERS COVERAGE FORM <br />MOTOR CARRIER COVERAGE FORM <br />EXCESS BUSINESS AUTO COVERAGE FORM <br />EXCESS TRUCKERS COVERAGE FORM <br />Additional Insured(s): Any person or organization whom you have agreed to include as an additional insured <br />underwritten contract or agreement which include permits and licenses requiring DA91J74b (0614), provided such <br />contract or agreement was executed prior to the date of Voss. <br />A. For a covered "auto," Who Is Insured is amended to include as an "insured," the persons or organizations <br />named in this endorsement. However, these persons or organizations are an "insured" only for "bodily <br />injury" or "property damage" resulting from acts or omissions of: <br />1. You. <br />2. Any of your "employees" or agents. <br />3. Any person operating a covered "auto" with permission from you, any of your "employees" or agents. <br />B. The persons or organizations named in this endorsement are not liable for payment of your premium. <br />DA-9IJ74b (06114) <br />Page 1 of 1 <br />