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POLICY NUMBER: <br />Named Insured: <br />Endorsement Effective Date: <br />SCHEDULE <br />Name Of Person(s) Or Organization(s): <br />© Insurance Services Office, Inc., 2011 <br />COMMERCIAL AUTO <br />CA 20 48 10 13 <br />THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. <br />DESIGNATED INSURED FOR <br />COVERED AUTOS LIABILITY COVERAGE <br />This endorsement modifies insurance provided under the following: <br />AUTO DEALERS COVERAGE FORM <br />BUSINESS AUTO COVERAGE FORM <br />MOTOR CARRIER 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"for Covered Autos Liability Coverage <br />under the Who Is An Insured provision of the Coverage Form.This endorsement does not alter coverage <br />provided in the Coverage Form. <br />This endorsement changes the policy effective on the inception date of the policy unless another date is <br />indicated below. <br />Information required to complete this Schedule, if not shown above, will be shown in the Declarations. <br />Each person or organization shown in the Schedule <br />is an "insured"for Covered Autos Liability Coverage, <br />but only to the extent that person or organization <br />qualifies as an "insured"under the Who Is An Insured <br />provision contained in Paragraph A.1.of Section II - <br />Covered Autos Liability Coverage in the Business <br />Auto and Motor Carrier Coverage Forms and <br />Paragraph D.2.of Section I -Covered Autos <br />Coverages of the Auto Dealers Coverage Form. <br />Page 1 of 1CA 20 48 10 13 <br />04/02/2024A0080216 <br />Middlesex Insurance Company <br />00001 0000000000 24093 0 N1 77288648-5d84-4893-b16d-224c8e33635977288648-5d84-4893-b16d-224c8e336359 <br />Docusign Envelope ID: CF064D56-F89A-8651-8229-D168AFF8B909