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THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. <br />DESIGNATED INSURED <br />This endorsement modified 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 <br />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 after coverage provided in the Coverage Form, <br />SCHEDULE <br />Name of Person(s) or <br />Organization(s): Any person or organization whom you have agreed in writing to add as an additional <br />insured, but only to coverage and minirnim hirruts of insurance required by the written <br />a;:eer Pent <br />and in no event to exceed either the scope of c:ovelsge or the linuts of <br />insurance provided in this polity. <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 contained <br />in Section II of the Coverage Form. <br />Policy Igo: AS2 -64 - 0k 097-0351 I", ued Fay: Lbe t f v'u :a Firer lnsur nc e (a):nranp <br />Eff ective Date: 01/01/2011 <br />Expiration Date: 01/01/2012 <br />Sales Office: 0465 <br />CA 20 48 02 99 Copyright, Insurance Services Office, Inc., 1998 Page 1 of 1 <br />