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DocuSign Envelope ID:42768609-3F6E-4668-8792-E66DBE7E5727 <br /> 30 <br /> Policy Number: AS7-621-094060-033 <br /> Issued by: Liberty Insurance Corp. <br /> THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. <br /> 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 <br /> modified by this endorsement. <br /> This endorsement identifies person(s) or organization(s) who are "insureds" under the Who Is An Insured <br /> Provision of 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 /> Any person or organization whom you have agreed in writing to add as an <br /> additional insured, but only to coverage and minimum limits of insurance <br /> required by the written agreement, and in no event to exceed either the scope of <br /> coverage or the limits of insurance provided in this policy. <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 <br /> only to the extent that person or organization qualifies as an "insured" under the Who Is An Insured Provision <br /> contained in 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 <br /> from any insurance in force for an Additional Insured for liability arising out of your operations, and the <br /> agreement was executed prior to the "bodily injury" or "property damage", then this insurance will be <br /> primary and we will 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 />