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POLICY NUMBER: (25) 7351-79-04 COMMERCIAL AUTO <br /> CA 20 48 10 13 <br /> THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. <br /> DESIGNATED INSURED FOR <br /> COVERED AUTOS LIABILITY COVERAGE <br /> This endorsement modifies insurance provided under the following: <br /> AUTO DEALERS COVERAGE FORM <br /> BUSINESS AUTO COVERAGE FORM <br /> MOTOR CARRIER 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. 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 /> Named Insured: <br /> Endorsement Effective Date: <br /> SCHEDULE <br /> Name Of Person(s) Or Organization(s): <br /> PERSONS OR ORGANIZATIONS THAT YOU ARE OBLIGATED, PURSUANT TO WRITTEN <br /> CONTRACT OR AGREEMENT BETWEEN YOU AND SUCH PERSON OR ORGANIZATION, TO <br /> PROVIDE WITH SUCH INSURANCE AS IS AFFORDED BY THIS POLICY; BUT THEY AR <br /> INSUREDS ONLY IF AND TO THE MINIMUM EXTENT THAT SUCH CONTRACT OR <br /> AGREEMENT REQUIRES THE PERSON OR ORGANIZATION TO BE AFFORDED STATUS AS <br /> AN INSURED. <br /> Information required to complete this Schedule, if not shown above, will be shown in the Declarations. <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 Al. 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 /> CA 20 48 10 13 ©Insurance Services Office, Inc., 2011 Page 1 of 1 <br />