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OLD REPUBLIC GENERAL INS JRANCE CORPORATION ADDITIONAL INSURED -PRIMARY kND NON-CONTRIBUTORY THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. THIS ENDORSEMENT MODIFIES INSURANCE PROVIDED UNDER THE FOLLOWING: BUSINESS AUTO COVERAGE FORM With respect to coverage provided by this endorsement, the provisions of the Coverage Form apply unless modified by this endorsement. This endorsement identifies person(s) or organization(s) who are "insureds" under the Who Is An Insured Provision of the Coverage Form. This endorsement does not alter coverage provided in the Coverage Form. This endorsement changes the policy effective on the inception date of the policy unless another date is indicated below. SCHEDULE Name of Person(s) or Organization(s) : WHERE REQUIRED BY EXECUTED WRITTEN CONTRACT. (If no entry appears above, information required to complete this endorsement will be shown in the n__i...._1:--- -- -- .. _ ..•.•. � ••� �rN,,..- . rU I! IV aiiuursernenij Each person or organization shown in the Schedule is an "insured" for Liability Coverage, but only to the extent that person or organization qualifies as an "insured" under the Who Is An Insured Provision contained in Section II of the Coverage Form. If the person or organization shown in the schedule qualifies as an 'insured' for Liability Coverage, and they have coverage as a first named insured under another policy, this policy is primary to and non-contributory with that other insurance. All other terms, conditions, and exclusions apply. Named Insured T.E. Roberts, Inc. Policy Number A1CA13971801 Endorsement No. Ol Policy Period 9/01/2019 to 09/01/2020 Endorsement Effective Date: Producer's Name: 09/O1/2019 OHUB International Insurance Services. Inc. Producer Number: 27N12 IR DATE CA EN GN 0044 02 12 rH I `/��IPage 1 of 1