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Policy Number <br />Issued by Liberty Mutual Fire Insurance Co. <br /> THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. <br />OTHER INSURANCE AMENDMENT – SCHEDULED ADDITIONAL INSURED <br /> This endorsement modifies insurance provided under the following: <br />COMMERCIAL GENERAL LIABILITY COVERAGE PART <br />PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART <br />LIQUOR LIABILITY COVERAGE PART <br />If you are obligated under a written agreement to provide liability insurance on a primary, excess, contingent, or any <br />other basis for any person(s) or organization(s) shown in the Schedule of this endorsement that qualifies as an <br />additional insured on this Policy, this Policy will apply solely on the basis required by such written agreement and <br />Paragraph 4. Other Insurance of Section IV – Conditions will not apply. Where the applicable written agreement <br />does not specify on what basis the liability insurance will apply, the provisions of Paragraph 4. Other Insurance of <br />Section IV – Conditions will apply. However, this insurance is excess over any other insurance available to the <br />additional insured for which it is also covered as an additional insured for the same "occurrence", claim or "suit". <br />Schedule <br />Name of Person(s) or Organization(s): <br />Any person(s) or organization(s) that qualifies as an additional insured as required under written agreement. <br />Page of <br />© 2018 Liberty Mutual Insurance <br />Includes copyrighted material of Insurance Services Office, Inc., with its permission. <br /> 1 1LC 24 20 11 18 <br />TB2Z91472257023 <br />Docusign Envelope ID: 06528EA8-C8FB-4176-8C2E-D53F24B897F0