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POLICY NUMBER: <br />SCHEDULE <br />COMMERCIAL AUTO <br />CA 76 01 06 15 <br />THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. <br />DESIGNATED INSURED - PRIMARY AND <br />NONCONTRIBUTORY - COVERED AUTOS <br />LIABILITY COVERAGE <br />This endorsement modifies insurance provided under the following: <br />BUSINESS AUTO COVERAGE FORM <br />MOTOR CARRIER COVERAGE FORM <br />AUTO DEALERS COVERAGE FORM <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. <br />This endorsement changes the policy effective on the inception date of the policy unless another date is <br />indicated. <br />Named Insured: Tree Sculpture Group A California Corporation <br />Name Of Person(s) Or Organization(s): <br />Any person or organization you are required to add as an <br />additional insured under a written contract or agreement <br />in effect prior to any accident, injury, loss or damage. <br />Information required to complete this Schedule, if not shown above, will be shown in the Declarations. <br />A.Each person or organization shown in the <br />Schedule is an "insured" for Covered Autos <br />Liability Coverage, but only to the extent that <br />person or organization qualifies as an "insured" <br />under the Who Is An Insured provision contained <br />in: <br />(1)Paragraph A.1. of Section II - Covered Autos <br />Liability Coverage in the Business Auto and <br />Motor Carrier Coverage Forms; or <br />(2)Paragraph D.2. of Section I - Covered Autos <br />Coverages of the Auto Dealers Coverage <br />Form. <br />B.Primary And Noncontributory Insurance <br />This insurance is primary to and will not seek <br />contribution from any other auto insurance issued <br />to the person or organization in the schedule <br />under your policy provided that: <br />(1)The person or organization is a Named Insured <br />under such other insurance; and <br />(2)Prior to the “accident” you have agreed in <br />writing in a contract or agreement that this <br />insurance would be primary and would not <br />seek contribution from any other insurance <br />available to the person or organization. <br />Includes copyrighted material of Insurance Services Office, Inc., <br />with its permission. <br />A0187554001 <br />CA 76 01 06 15 Page 1 of 1 <br />A0187554 <br />Middlesex Insurance Company <br />00001 0000000000 22047 0 N1 f63bc784-c411-407d-8d5e-67502efd8546f63bc784-c411-407d-8d5e-67502efd8546 <br />Docusign Envelope ID: 7C0E76E7-1031-45FB-8C1F-DF2FE0E6CF0B