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THIS ENDORSEMENT CHANGES THE POLICY. 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 respect 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 after coverage provided in the Coverage Form. <br />SCHEDULE <br />Name of Person(s) or Organization(s): <br />Any person or organization whom you have agreed in writing to add as an <br />additional insured, but only to coverage and minimum limits of insurance <br />required by the written agreement, and in no event to exceed either the scope of <br />coverage or the limits of insurance provided in this policy. <br />(If no entry appears above, information required to complete this endorsement will be shown in the Declarations <br />as applicable to the endorsement.) <br />Each person or organization shown in the Schedule is an "insured" for Liability Coverage, but only to the extent <br />that person or organization qualifies as an "insured" under the Who Is An Insured Provision contained <br />in Section II of the Coverage Form. <br />Policy No: AS5-Z11-C3H77D-024 Issued By: LM Insurance Corporation <br />Effective Date: 12/14/2024 <br />Expiration Date: 12/14/2025 <br />Sales Office: 0202 <br />CA 20 48 02 99 Copyright, Insurance Services Office, Inc., 1998 Page 1 of 1 <br />