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THIS FORM APPLIES IN STATES WHICH USE:CA 00 01 (10.13) <br /> IL 10 (12/06) OLD REPUBLIC INSURANCE COMPANY <br /> THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. <br /> ADDITIONAL INSURED <br /> This endorsement modifies Insurance provided under the following: <br /> BUSINESS AUTO COVERAGE FORM <br /> MOTOR CARRIER COVERAGE FORM <br /> SCHEDULE <br /> Name of Person(s)or Organizatlon(s): <br /> All persona or organizations as required by contract or agreement <br /> With respect to COVERED AUTOS LIABILITY COVERAGE, Who Is An Insured Is changed with the <br /> addition of the following: <br /> Each person or organization shown In the Schedule for whom you are doing work la an "insured". But <br /> only for "bodily injury" or "property damage" that results from the ownership, maintenance or use of a <br /> covered"auto"by: <br /> 1. You; <br /> 2. an"employee" of yours;or <br /> 3. anyone Who drives a covered "auto"with your permission or with the permission of one of your <br /> "employees". <br /> However, the Insurance afforded to the person or organization shown In the Schedule shall not exceed <br /> the scope of ooverage and/or limns of this policy, Not withstanding the foregoing sentence, In no event <br /> shall the insurance provided by this policy exceed the scope of coverage and/or limits required by the <br /> contract or agreement. <br /> PCA 001 10 13 <br /> MWTB 21543 Relryloua and Chaftable Risk Pooling Trust 00/16/2017.06/18/2018 <br />