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POLICY NUMBER: COMMERCIAL AUTO <br /> CA 20 48 10 13 <br /> <br />THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. <br /> <br />CA 20 48 10 13 Insurance Services Office, Inc., 2011 Page 1 of 1 <br /> <br />DESIGNATED INSURED FOR <br />COVERED AUTOS LIABILITY COVERAGE <br /> <br />This endorsement modifies insurance provided under the following: <br /> <br />AUTO DEALERS COVERAGE FORM <br />BUSINESS AUTO COVERAGE FORM <br />MOTOR CARRIER COVERAGE FORM <br /> <br />With respect to coverage provided by this endorsement, the provisions of the Coverage Form apply unless <br />modified by this endorsement. <br />This endorsement identifies person(s) or organization(s) who are ‘‘insureds’’ for Covered Autos Liability Coverage <br />under the Who Is An Insured provision of the Coverage Form. This endorsement does not alter coverage <br />provided in the Coverage Form. <br />This endorsement changes the policy effective on the inception date of the policy unless another date is indicated <br />below. <br /> <br />Named Insured: <br />Endorsement Effective Date: <br /> <br />SCHEDULE <br /> <br />Name Of Person(s) Or Organization(s): <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br />Information required to complete this Schedule, if not shown above, will be shown in the Declarations. <br /> <br />Each person or organization shown in the Schedule is <br />an ‘‘insured’’ for Covered Autos Liability Coverage, but <br />only to the extent that person or organization qualifies <br />as an ‘‘insured’’ under the Who Is An Insured <br />provision contained in Paragraph A.1. of Section II ---- <br />Covered Autos Liability Coverage in the Business <br />Auto and Motor Carrier Coverage Forms and <br />Paragraph D.2. of Section I ---- Covered Autos <br />Coverages of the Auto Dealers Coverage Form. <br />(25)7364-82-69 <br />AS PER SCHEDULE ON FILE WITH COMPANY <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br />Docusign Envelope ID: 0AE19FB4-94DC-42D8-9154-6DA4F0413C5E