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POLICY NUMBER: <br />J ~ <br />810-504D7504 <br />THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. <br />ADDITIONAL INSURED <br />This endorsement modifies insurance provided under the following: <br />COMMERCIAL AUTO <br />ISSUE DATE: 4/14/04 <br />BUSINESS AUTO COVERAGE FORM <br />MOTOR CARRIER COVERAGE FORM <br />TRUCKERS COVERAGE FORM <br />Paragraph c. of the <br />includes the person <br />below, but only for <br />because of acts or <br />under paragraphs a. <br />subject to the folly <br />WHO IS AN INSURED provision <br />or organization indicated <br />his, her or its liability <br />omissions of an "insured" <br />or b. of that provision, <br />swing additional provisions: <br />1. No liability is assumed by that <br />person or organization for the <br />payment of any premiums stated <br />in the policy or earned under <br />the policy. <br />Person or Organization <br />CITY OF EUGENE <br />2. In the event of cancellation of <br />the policy, written notice of <br />cancellation will be mailed by <br />us to that person or organiza- <br />tion. <br />Address <br />244 EAST BROADWAY <br />EUGENE OR 97401 <br />CA T3 O1 02 99 Page 1 of 1 <br />