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POLICrNUMBFR: <br />THIS . 8 THE PoLlCy. <br />COMMERCIAL AUTO <br />CA 204.80797 <br />PLEASE READ 17`CAREFULI Y <br />UESIGNATED- INSURED <br />5 endorsement <br />MOdIfilts insurance Provided Underthe fowing.- <br />BUSINESS AUTO toVERAGE FORM <br />GARAGE COVERAGE FORM <br />'MOTOR CARRIER COVERAGE FORM <br />TRUCKER' S:.O-GVERA,GE FORM� <br />With, respect toz coverage PTO . 'Aded W� this end <br />ifitd by this endors*e-m- brsernen t. provisions <br />h of the: <br />-en ti e:rage* Form.: ap*��.uhles�§ mod_ <br />tries_ Pem'on(s)Qr PT9-Bhltat16hN)-, who e-� <br />Slomor th.e::COV rm: *-Ffti endorsement d .n-5ur&d§ .under th Who IS s red proVi- <br />e�idbr . Provided - " ..a An., Iti-14 <br />This endorsement: changes the policy effect provided inthe,.cOvera�ePor..rn <br />below, tva- On'the Inc on date. <br />of the po.11cy unless �aq.ofhet date is, indicated <br />Endorsement Effective: 121,311.2 <br />COVnterSlgned.ii3y: <br />Named lrm-tired: - Brown E3r.Cther.s-PlUrnb1r1g <br />Name of or b <br />9 #} <br />Any or A11:0. rm�101' h <br />,erson: - n <br />(s) Qrlio�ganjzato (s) as required by Wflftqnla�ei UtW r <br />Ca <br />rolina, onfra.G�. fot jobs. In the state of North <br />(If no entry appears abovej information required to M <br />or above: - 1 00 Plate this endorsement <br />Schedule at applicable to. the endorsemerlt} t-Mll 'be Shown. in the Declarations <br />Each person br-orgarjjzat' <br />Person"pr 0'** !on i1101680d above . is an InSuredq f6T Llabo y c()VOrage, but only to the , extent t� <br />TgEltilk6tion qualifies �as.an "1ns0r9dn.: under t WbollsAril a ,at, <br />of the;Coiverage Fprm, <br />he: insured provit10nl Contained in SE7C <br />TION,ji <br />-CA tb 49:07 917 <br />-Otbht, 111-5iirance Services Off1ce,.lnc,,,, 1996. <br />Pago I of <br />