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Policy Number: <br />Issued by: <br />THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT <br />CAREFULLY. DESIGNATED INSURED - NONCONTRIBUTING <br />This endorsement modifies insurance provided under the following: <br />BUSINESS AUTO COVERAGE FORM <br />GARAGE COVERAGE FORM <br />MOTOR CARRIERS 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 <br />this endorsement. <br />This endorsement identifies person(s) or organization(s) who are "insureds" under the Who Is An Insured Provision of <br />the Coverage Form. This endorsement does not alter coverage provided in the Coverage form. <br />Schedule <br />Name of Person(s) or Organizations(s): <br />Regarding Designated Contract or Project: <br />Each person or organization shown in the Schedule of this endorsement is an "insured" for Liability Coverage, but only <br />to the extent that person or organization qualifies as an "insured" under the Who Is An Insured Provision contained in <br />Section II of the Coverage Form. <br />The following is added to the Other Insurance Condition: <br />If you have agreed in a written agreement that this policy will be primary and without right of contribution from <br />any insurance in force for an Additional Insured for liability arising out of your operations, and the agreement <br />was executed prior to the "bodily injury" or "property damage", then this insurance will be primary and we will <br />not seek contribution from such insurance. <br />AC 84 23 08 11 © 2010, Liberty Mutual Group of Companies. All rights reserved.Page 1 of 1 <br />Includes copyrighted material of Insurance Services Office, Inc., <br />with its permission. <br />AS2-691-467423-011 <br />Liberty Mutual Fire Insurance Co. <br />Attachment Code: D580421 Certificate ID: 16927711 <br />DocuSign Envelope ID: E737BD71-2898-4C23-ADC2-40E10C31F966