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POLICY NUMBER: 1523011368497 COMMERCIAL AUTO <br />CA 20 4810 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 modified by this <br />endorsement. <br />This endorsement identifies person(s) or organization(s) who are "insureds" for Covered Autos Liability Coverage under the <br />Who Is An Insured provision of the Coverage Form . This endorsement does not alter coverage provided in the Coverage <br />Form . <br />This endorsement changes the policy effective on the inception date of the policy unless another date is indicated below. <br />Named Insured: American Asphalt Repair and Resurfacing Company, Inc. <br />Endorsement Effective Date: 12/31/2023 <br />SCHEDULE <br />Name Of Person(s) Or Organization(s): As required by written contract. <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 is an "insured" for Covered Autos Liability Coverage , but only to the <br />extent that person or organization qualifies as an "insured" under the Who Is An Insured provision contained in <br />ParagraphA.1. of Section II -Covered Autos Liability Coverage in the Business Auto and Motor Carrier Coverage Forms <br />and Paragraph 0.2. of Section I -Covered Autos Coverages of the Auto Dealers Coverage Form. <br />© Insurance Services Office , Inc. <br />DocuSign Envelope ID: E96A4C74-2FC7-4968-986D-B86E1F2596BA