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POLICY NUMBER CAP 3758662 COMVERCIALAWTO <br /> CA20481013 <br /> THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. <br /> GNAMD INSURED FOR <br /> COVERED AUTOS UABI UTY COVERAGE <br /> This endorsement modifies insurance provided under the following: <br /> AUTO DEALERS COVERAGE FORM <br /> BUSINESS AUTO COVERAGE FORM <br /> MOTOR CARRI ER COVERAGE FORM <br /> With respect to coverage provided by this endorsement, the provisions of the Coverage Form apply unless modified by <br /> this endorsement. <br /> This endorsement identifies person(s) or organization(s) who are"insureds"for Covered Autos Liability Coverage under <br /> the Who Is An Insured provision of the Coverage Form. This endorsement does not alter coverage provided in the <br /> Coverage Form. <br /> This endorsement changes the policy effective on the inception date of the policy unless another date is indicated <br /> below. <br /> Nand h1SUF8d: PALP INC. DBA EXCEL PAVING COMPANY <br /> Endorsement Effective Date: P 6/01./2 0 2 <br /> SCHEDULE <br /> Name Of Pors*s)Or Organlxation(s): <br /> Any person or organization for whom the named insured has agreed by written "insured <br /> contract" to designate as an additional insured subject to all the provisions and <br /> 1 i mi tati ons of this policy. <br /> Information required to axTplete this Schedule, if not shown above,will be shown in the Declarations. <br /> Each person or organization shown in the Schedule is an <br /> "Insured" for Covered Autos Liability Coverage, but only <br /> to the extent that person or organization qualifies as an <br /> "insured" under the Who Is An Insured provision <br /> contained in Paragraph Al. of Section II - Covered <br /> Autos Liability Coverage in the Business Auto and Motor <br /> Carrier Coverage Forms and Paragraph 110:2 of Section <br /> - Covered Autos Coverages of the Auto Dealers <br /> Coverage Form. <br /> CA 20 48 10 13 0 Insurance Services Office, Inc.,2011 Page 1 of 1 <br />