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POLICY NUMBER: CAH740901701 COMMERCIAL AUTO <br />CA 20 48 02 99 <br />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 <br />unless modified by this endorsement. <br />This endorsement identifies person(s) or organization(s) who are "insureds" under the Who Is An Insured <br />Provision of the Coverage Form. This endorsement does not alter coverage provided in the Coverage <br />Form. <br />This endorsement changes the policy effective on the inception date of the policy unless another date is <br />indicated below. <br />Endorsement Effective Countersigned By: <br />4/1/2012 <br />Named Insured: <br />(Authorized Representative) <br />Atkins North America, Inc. <br />SCHEDULE <br />Name of Person(s) or Organization(s): <br />Any person or organization with whom you have agreed, through written contract, agreement or permit <br />executed prior to the loss, to provide primary additional insured verbiage. <br />(If no entry appears above, information required to complete this endorsement will be shown in the <br />ueclaratlons as appllcaDle to the endorsement.) <br />Each person or organization shown in the Schedule is an "insured" for Liability Coverage, but only to the <br />extent that person or organization qualifies as an "insured" under the Who Is An Insured Provision <br />contained in Section II of the Coverage Form. <br />CA 20 48 02 99 Copyright, Insurance Services Office Inc. 1998 Page 1 of 1 <br />