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11-iis endorsernent 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 unless modi- <br />fiedbythieendomemenL <br />This endorsement identifies organization(s) who are "insureds" under the Who Is An Insured Provi- <br />sion of the Coverage Form. This endorsement does not alter coverage provided in the Coverage Form. <br />rovi-sionmf1heCo*anogeFonn.Thieendnnaemantdoeenota|terooverogepnovidedinUheCovenageFonn. <br />mmu��� <br />Name of Person(s) or Organization(s): <br />Any person or organization where the named iosorad has anzeed uy written <br />contract to incli.1de s�jch person or organization as a desiqna�ed insured. <br />(If no entry appears above, information required to complete this endorsement will be shown in the Declarations <br />asapplicable tothe endorsemenL) <br />Each person or organization shown in the Schedule is an "insured" for Liability Coveraga, but only to the extent <br />that person or organization qualifies as an "insured" under, the Who Is An Insured Provision contained <br />in Section 11 of the Coverage Form. <br />Policy No: xs7Ze1462442027 Issued By: Liberty Insurance Corp. <br />Effective Date: 05m1o017 <br />Expiration Date: nsm/am1n <br />SalesOffice: 0237 <br />CA 2048 02 99 Copyright, Insurance Services Office, km 1998 Page 1of1 <br />