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COMMERCIAL AUTO <br /> POLICY NUMBER: P-810-532D8375-IND-15 ISSUE DATE: 3/31/2015 <br /> THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. <br /> DESIGNATED INSURED <br /> This endorsement 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 /> fied by this endorsement. <br /> This endorsement identifies person(s) or 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 /> SCHEDULE <br /> Name of Person(s) or Organization(s): <br /> ANY PERSON OR ORGANIZATION THAT YOU <br /> ARE REQUIRED TO INCLUDE AS AN <br /> ADDITIONAL INSURED ON THIS COVERAGE FORM <br /> IN A WRITTEN CONTRACT OR AGREEMENT <br /> THAT IS SIGNED AND EXECUTED BY YOU <br /> BEFORE THE "BODILY INJURY' OR <br /> "PROPERTY DAMAGE " OCCURS AND THAT IS IN <br /> EFFECT DURING THE POLICY PERIOD. <br /> (If no entry appears above, information required to complete this endorsement will be shown in the Declarations <br /> as applicable to the endorsement.) <br /> Each person or organization shown in the Schedule is an "insured" for Liability Coverage, but only to the extent <br /> " that person or organization qualifies as an "insured" under the Who Is An Insured Provision contained in Section <br /> II of the Coverage Form. <br /> ,— <br /> 0= <br /> CA 20 48 02 99 Copyright, Insurance Services Office, Inc., 1998 Page 1 of 1 <br /> 000959 <br />