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POLICY NUMBER: BA -5D394305 -16 -GRP COMMERCIAL AUTO ISSUE DATE: 08-30-16 DESIGNATED INSURED FOR COVERED AUTOS LIABILITY COVERAGE This endorsement modifies insurance provided under the following: AUTO DEALERS COVERAGE FORM BUSINESS AUTO COVERAGE FORM MOTOR CARRIER COVERAGE FORM With respect to coverage provided by this endorsement, the provisions of the Coverage Form apply unless modi- fied by this endorsement, This endorsement identifies person(s) or organization(s) who are "insureds" for Covered Autos Liability Coverage under the Who Is An Insured provision of the Coverage Form, This endorsement does not alter coverage pro- vided in the Coverage Form. SCHEDULE Name Of Person(s) Or Organization(s). ANY PERSON OR ORGANIZATION THAT YOU ARE REQUIRED TO INCLUDE AS AN ADDITIONAL INSURED ON THIS COVERAGE FORM IN A WRITTEN CONTRACT OR AGREEMENT THAT 19 SIGNED AND EXECUTED BY YOU BEFORE THE "BODILY INJURYK OR 9PROPERTY DAMAGE" OCCURS AND THAI' IS IN 'EFFECT DURING THE POLICY PERIOD. Information required to complete this Schedule, if not shown above, will be shown in the Declarations. Each person or organization shown in the Schedule is an "insured" for Covered Autos Liability Coverage, but only to the extent that person or organization qualifies as an "insured" under the Who Is An insured provi- sion contained in Paragraph A.1. of Section 11 — Cov- CA 20 48 10 t 3 ered Autos Liability Coverage in the Business Auto and Motor Carrier Coverage Forms and Paragraph D.2. of Section I — Covered Autos Coverages of the Auto Dealers Coverage Form, 0 Insurance Services Office, Inc., 2011 Page I of 1 ------------ REVIEW ED BY:DSNI CE i IEREDA (PG5 OF—/ I . ... ..... .... . __.. ------ F--]