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23320120014460006,5 <br />THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ 17 CAREFULLY, <br />BLANY+E'P ADDITIONAL INSURED <br />This endorsement modifies insurance provided under the following: <br />CWDIEiiCIAL GENER -\L LI, {BILITY COVERAGE FORM <br />SEC140N 11 -Wgh0 IS AN INSURED is amended to include as an insured any person or organization for whom you have <br />agreed in writing to provide finbility insurance, But: <br />The insurance provided by this amendment: <br />L Applies only to "bodily injury" or "property damage" ansueg out.of (a) "your work" or (l>) premises or other pmf"y owned <br />by or rev led to you; <br />2. Applies only to coverage and minimum limits of insurance required by the written agreement, but in no event exceeds either <br />the scope of coverage or die limits of insurance prodded by this policy, and <br />5. Does not apply to any person or orgarebation for whom you have procured separate liability btsurance while such insurance is <br />in effect, regardless of whether the scope of coverage or firms of insurance of this policy exceed those of such other insurance <br />or whether such other insurance is valid and collectible. <br />The following Provisions also apply: <br />1. 'Wiliere the applicable written agreement requires the instated to provide liability insurance on a primary, excess, contingent, or <br />any other basis, this policy will apply solely on the basis required by such wriucn ngtecmet and Item 4. Other Insurance of <br />SECTION 1V of this policy will not apply. <br />2. Where the applicabk written agreement does not specify on what basis the liability insurance will apply, the provisions of Item <br />4. Other Insurance of SECTION IV of this policy will govern. <br />3 This endorsemem shall not apply to any person or organl &anion for any "bodily Wray" or "property damage" if any other <br />additional insured endorsement on this policy applies to that person or organization with regard to the "bodily injury" or <br />"property damage ". <br />4. If any other additional insured endorsement applies to any person or organizaron and you are obligated under a written <br />Agreement to provide liability insurance on a primary, exeess,contingent, or any other basis for that additional insured, this <br />policy- will apply solely on the basis required by such written agreement and Item 4. Other Insurance of SECTION IV of this <br />Policy will not apply, regardless of whether the person ororgaru'ration has available other valid and collectible insurance, If <br />the applicable written agreemen7 does not specify on what basis the liability insurance will apply, the provisions of Item 4. <br />Other Insurance of SECTION IV of this policy will govern, <br />TKI the LIBERTY MUTUAL FIRE INSURANCE COMPANY <br />p mum $ <br />LFlartive Date Tvenintinn U¢¢ <br />Vnranaebmenr cn PAicy Nn, TB2 -631- 0 04 1 45 -7 1 3 <br />Audis Kmk <br />Issued To <br />I+sucJ <br />LN 20 0106 05 <br />r r to <br />Counienegmed by <br />,� haAn>S„N Yxnrncaanc <br />Silas Cebu, unJ Nu. <br />F, d. serial Nn. <br />