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. ;, <br />_w <br />THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. <br />DESIGNATED INSURED CA 20 48 07 97 <br />COMMERCIAL AUTO <br />POLICY NUMBER: BAA (08) 53536382 <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 modified by this <br />endorsement. <br />This endorsement identifies person(s) or organization(s) who are "insureds" under the Who Is An Insured provision of the <br />Coverage Form. This endorsement does not alter coverage provided in the Coverage Form. <br />This endorsement changes the policy effective on the inception date of the policy unless another date is indicated below. <br />Endorsement Effective: Countersigned By: <br />Named Insured: <br />H & J Construction, Inc (Authorized Representative) <br />SCHEDULE <br />Name of Person(s) Or Organization(s): <br />The City of Eugene, its officials, employees, servants <br />and agents <br />RE: Contract 2009-0005/ Job 44544 Tonawanda Pump Station Capacity <br />r.____~ s <br />(If no entry appears above, information required to complete this endorsement will be shown in the Declarations or above <br />Schedule as applicable to the endorsement.) <br />Each person or organization indicated above is an "insured" for Liability Coverage, but only to the extent that person or <br />organization qualifies as an "insured" under the Who Is An Insured provision contained in Section II of the Coverage Form. <br />Copyright, Insurance Services Office, Inc., 1996 Page 1 of 1 <br />