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Page 4 of 13 <br /> 39 <br /> ADDITIONAL INSURED — <br /> DESIGNATED PERSONS OR ORGANIZATIONS <br /> Nan•ea Insured Endorsemen:Number <br /> Republic Services, Inc. 4 <br /> Pnllry Syrnbdl P©Iicy Murnb�r Policy Period Effotrtive oat,OF Erlddme?rnt?rlt <br /> ISA H11370950 06130/2026 to 06f3012027 <br /> Issued By{Name of Insurance companyF <br /> AGE American Insurance Company <br /> Insert the policy number.The remainder of the information is to DC completed only when this endorsement is issued sibsoauant to the preparation or the policy. <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 /> 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 <br /> insured under written contract or agreement which include permits and licenses requiring DA911-174b <br /> (0614), provided such contract or agreement was executed prior to the date of loss. <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 /> Authorized Representative <br /> ®A-9J74b J06114) Page 1 of 1 <br />