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26n(11500011 <br />Policy Number:. AS2 -681- 004145 -726 <br />Issued by: Liberty Mutual Tire insurance Co. <br />THIS ENDORSElvENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY, <br />DESIGNATED INSURED. NONCONTRIaUTING <br />This endorsement modifies insurance provided under the following: <br />BUSINESS AUTO COVERAGE FORM <br />GARAGE COVERAGE FORM <br />MOTOR CARRIERS COVERAGE FORM <br />TRUCKERS COVERAGE FORM <br />With respect to coverage provided by dtl4 endorsement, the provisions of the Coverage Form apply unless <br />modified by this endorsement. <br />This endorsement Identifies, person(s) or organizalian(s) who are "insureds' under the Who Is An insured <br />Provision of the Coverage Farnt, This andorsoment does riot alter coverage provided in the Coverage Form_ <br />Schedule <br />Name of Perton(s) or t' yrganlZations(s)M <br />Any person or organization whom sou have agreed in writing to add, as an <br />additional insured, but only to coverage and minimum limits of insurance <br />required by the written agreement, and in no event to exgecd either the scope of <br />coverage or the limits of insurance provided in this policy. <br />Regarding Doslgnated Contractor Pr*cts <br />Each person or Organization shown In the Schedule of We endorsement is an "°insured" for Liability Goverago, but <br />only to the extent that person or orgai*ation qualMes as an "insured" under the Wh* Is An Insured provision <br />contained In Section p of the Coverage Form. <br />The fallowing is added to the Other Insurance Coftd€itton; <br />If you have agreed in a written agreement that this policy will be primary and without night of contribution <br />from any insurance In force for an Additional Insured for liability arising out of your operations, and tlto <br />agreement was executed pdar to the "badly hijurr" or "property damage ", then this insurance will he <br />primary and we will not seek contrbutionfrom such insurance, <br />AC 84 23 0811 C 2010, Liberty Mutual Group of Companies. All rights reserved, Page 1 of 1 <br />includes copyrighted matedai of Insurance Services Office, Inc., <br />with its permission. <br />