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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 <br />modified by this endorsement. <br />This endorsement Identifies person(s) or organization(s) who are "insureds" under the Who is An Insured Provision <br />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 organizatlon whom you have agreed in writing to add as an additional Insured, but only to <br />coverage and minimum limits of Insurance required by the written agreement, and in no event to exceed either <br />the scope of coverage or the limits of insurance provided in this policy. <br />(if no entry appears above, information required to complete this endorsement will be shown in the Declarations as <br />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 <br />In Section 11 of the Coverage Form. <br />Policy No: AS6 -641- 439037 -024 Issued By: The First Liberty Insurance Corp. <br />Effective Date: 11/05/2014 <br />Expiration Date: 1110512015 <br />Sales Office: 0001 <br />CA20 48 02 99 Copyright, Insurance Services Office, Inc., 1998 Page 1 of 1 <br />