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<br />, <br /> <br />POLICY NUMBER: 2SMCC4CGLOO6304 <br />Empire Pipe Cleaning & Equipment Inc. <br /> <br />COMMERCIAL GENERAL LIABILITY <br /> <br />THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY <br /> <br />ADDITIONAL INSURED - OWNERS, LESSEES OR <br />CONTRACTORS (FORM B) <br /> <br />THIS ENDORSEMENT MODIFIES INSURANCE PROVIDED UNDER THE FOLLOWING: <br /> <br />COMMERCIAL LIABILITY COVERAGE PART. <br /> <br />SCHEDULE <br /> <br />NAME OF PERSON OR ORGANIZATION <br /> <br />Blanket As Required by Written Contract <br /> <br />(If uo entity appears above, infonnatiou required to complete this endorsement will be shown in the <br />Declarations as applicable to this endorsement.) <br /> <br />WHO IS AN INSURED (SECTION II) is amended to include as an insured the person or organizatiou <br />shown in the Schedule, but only with respect to liability arising out of "your work" for that insured by or <br />for you. <br /> <br />It is agreed that such insurance as is afforded by this policy for the benefit <br />of the additional insured shown shall be primary insurance, and any other <br />insurance maintained by the additional insured(s) shall be excess and <br />uon-contributory, but only as respects any claim, loss or liability arising out <br />of the operations if claim, loss or liability is determiued to be solely the <br />negligeuce or respousibility of the named insured." <br /> <br />L-3470 <br /> <br />COPYRIGHT, INSURANCE SERVICES OFF]CE, ]NC. ]984 <br /> <br />Page 1 of 1 <br /> <br />~~S/3 <br />