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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 alter 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 /> • <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-023 Issued By: LM Insurance Corporation <br /> Effective Date: 01/30/2024 <br /> Expiration Date: 12/14/2024 Riek Management Division <br /> Sales Office: 0202 �. �.`��.` REVIEWED&APPROVED BY: <br /> 711I AG4'44 <br /> Risk taxi cigernent Specialist <br /> CA 20 48 02 99 Copyright, Insurance Services Office, Inc., 1998 Page 1 of 1 <br />