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POLICY NUMBER: AS5-621-095327-044 <br />COMMERCIAL AUTO <br />CA 20 4810 13 <br />THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. <br />DESIGNATED INSURED FOR <br />COVERED AUTOS LIABILITY COVERAGE <br />This endorsement modifies insurance provided under the following: <br />AUTO DEALERS COVERAGE FORM <br />BUSINESS AUTO COVERAGE FORM <br />MOTOR CARRIER COVERAGE FORM <br />With respect to coverage provided by this endorsement, the provisions of the Coverage Form apply unless <br />modified by the endorsement. <br />This endorsement identifies person(s) or organization(s) who are "insureds" for Covered Autos Liability Coverage <br />under the Who Is An Insured provision of the Coverage Form. This endorsement does not alter coverage <br />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 additional insured, but only to <br />coverage and minimum limits of insurance required by the written agreement, and in no event to exceed <br />either the scope of coverage or the limits of insurance provided in this policy. <br />Information required to complete this Schedule, if not shown above, will be shown in the Declarations. <br />Each person or organization shown in the Schedule is <br />an "insured" for Covered Autos Liability Coverage, but <br />only to the extent that person or organization qualifies <br />as an "insured" under the Who Is An Insured provision <br />contained in Paragraph A.I. of Section If - Covered <br />Autos Liability Coverage in the Business Auto and <br />Motor Carrier Coverage Forms and Paragraph D.2. of <br />Section I - Covered Autos Coverages of the Auto <br />Dealers Coverage Form. <br />CA 20 48 10 13 © Insurance Services Office, Inc., 2011 <br />°mac <br />„ <br />g , <br />NekMwagxmWD[Pi = <br />RE EwED 6 APPRov®By: <br />4ju Aaa*w6 <br />.: <br />. <br />�� <br />RMManage mSpea*st <br />