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COMMERCIAL AUTO <br /> POLICY NUMBER: BA-0428R636-13-GRP ISSUE DATE: 09-17-13 <br /> THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. <br /> ADDITIONAL INSURED <br /> This endorsement modifies insurance provided under the following: <br /> BUSINESS AUTO COVERAGE FORM <br /> MOTOR CARRIER COVERAGE FORM <br /> TRUCKERS COVERAGE FORM <br /> Paragraph o. of the WHO IS AN INSURED provision 1. No liability is assumed by that person or organi- <br /> includes the person or organization indicated below, zation for the payment of any premiums stated in <br /> but only for his, her or its liability because of acts or the policy or earned under the policy. <br /> omissions of an"insured"under paragraphs a.or b.of 2. In the event of cancellation of the policy, written <br /> that provision, subject to the following additional pro- notice of cancellation will be mailed by us to that <br /> visions: <br /> person or organization. <br /> Person or Organization Address <br /> ORANGE COUNTY 200 SOUTH CAMERON ST <br /> HILLSBOROUGH NC 27278 <br /> o <br /> e <br /> o <br /> o <br /> o <br /> o� <br /> o. <br /> m=^ <br /> s <br /> CA T3 01 02 99 Page t of 1 <br /> oosieo <br />