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KPD Insurance, Inc. <br />POLICY NUMBER. <br />COMMERCIAL AUTO <br />CA 20 48 02 99 <br />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 Provi- <br />sion of the 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 indi- <br />cated below <br />Endorsement Effective <br />Countersigned By <br />Authorized Representative <br />Named Insured. <br />SCHEDULE <br />Name of Person(s) or Organization(s): <br />Per AL.-ached Certificate <br />(If no entry appears above, information required to complete this endorsement will be shown in the Declarations <br />as 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 II of the Coverage Form. <br />Nov. 15 -2010 09:34:09 Pg. 004 <br />CA 20 48 02 99 Copyright, Insurance Services Office, Inc , 1998 - Page 1 of 1 ❑ <br />