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POLICY NUMBER:GLA 3994747 -05 <br />COMMERCIAL AUTO <br />CA 04 03 06 04 <br />THIS ENDORSEMENT CHANGES THE POLICY, PLEASE READ IT CAREFULLY, <br />TEXAS ADDITIONAL 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 />Wth respect to coverage provided by this endorsement, the provisions of the Coverage Form apply unless modified <br />by the endorsement. <br />This endorsement changes the policy effective on the inception date of the policy unless another date is Indicated <br />below. <br />Endorsement Effective: 10 -01 -11 Countersigned By: <br />Named Insured: Raba — Kistner <br />Consultants Inc. Authorized Re resentative <br />SCHEDULE <br />Name and Address of Additional insured: <br />ANY PERSON OR ORGANIZATION WITH WHOM YOU HAVE AGREED, THROUGH WRITTEN <br />CONTRACT, AGREEMENT OR PERMIT, EXECUTED PRIOR TO THE LOSS, TO PROVIDE <br />ADDITIONAL INSURED COVERAGE. <br />(if no entry appears above, information required to complete this endorsement will be shown in the Declarations as <br />applicable to this endorsement.) <br />A Who Is An Insured (Section II) is amended to in- <br />clude as an 'insured" the person(s) or organiza- <br />tion(s) shown in the Schedule, but only with respect <br />to their legal liability for acts or omissions of a per- <br />son for whom Liability Coverage is afforded -under <br />this policy. <br />B. The additional insured named In the Schedule or <br />Declarations is not required to pay for any premiums <br />stated in the policy or earned from the policy. Any <br />return premium and any dividend, if applicable, de- <br />clared by us shall be paid to you. <br />C. You are authorized to act for the additional insured <br />named in the Schedule or Declarations in all matters <br />pertaining to this Insurance. <br />D. We will mail the additional insured named In the <br />Schedule or Declarations notice of any cancellation <br />of this policy. If we cancel, we will give 10 days no- <br />tice to the additional insured. <br />E. The additional insured named in the Schedule or <br />Declarations will retain any right of recovery as a <br />claimant under this policy. <br />CA 04 03 06 04 0 ISO Properties, Inc., 2003 Page 1 of 1 O <br />IpeM copy <br />