CTR066268_-_AO_Endorsements.pdf

INSURED COPY

Pennsylvania Manufacturers’

Association Insurance Company

THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.

IL 12 01 11 85 Copyright, Insurance Services Office, Inc., 1983 Copyright, ISO Commercial Risk Services, Inc., 1983

Page

POLICY CHANGES

Policy Change Number

POLICY NUMBER POLICY

CHANGES

EFFECTIVE

COMPANY

NAMED INSURED AUTHORIZED REPRESENTATIVE

COVERAGE PARTS AFFECTED

CHANGES

Authorized Representative Signature

152375-14-89-67-3

09-30-23

ROSS INNOVATIVE EMPLOYMENT

THOMPSON FLANAGAN EXECUTIVE

LIABILITY GROUP LLC

626 W. JACKSON BLVD.

SUITE 500

CHICAGO IL 60661-0000

COMMERCIAL BUSINESS AUTO COVERAGE PART

NO CHARGE TO BE ADJUSTED AT AUDIT

THE FOLLOWING FORM(S) HAS BEEN ADDED:

CA 20 48 10-13 DESIGNATED INSURED

THE FOLLOWING FORM(S) HAS BEEN AMENDED:

CA 20 01 11-20 LESSOR-ADDL INSURED AND LOSS PAYEE

ALL OTHER TERMS AND CONDITIONS REMAIN THE SAME

INSURED COPY

POLICY NUMBER: COMMERCIAL AUTO

CA 20 48 10 13

THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.

CA 20 48 10 13 Insurance Services Office, Inc., 2011 Page 1 of 1

DESIGNATED INSURED FOR

COVERED AUTOS LIABILITY COVERAGE

This endorsement modifies insurance provided under the following:

AUTO DEALERS COVERAGE FORM

BUSINESS AUTO COVERAGE FORM

MOTOR CARRIER COVERAGE FORM

With respect to coverage provided by this endorsement, the provisions of the Coverage Form apply unless modified by this endorsement.

This endorsement identifies person(s) or organization(s) who are ‘‘insureds’’ for Covered Autos Liability Coverage under the Who Is An Insured provision of the Coverage Form. This endorsement does not alter coverage provided in the Coverage Form.

This endorsement changes the policy effective on the inception date of the policy unless another date is indicated below.

Named Insured:

Endorsement Effective Date:

SCHEDULE

Name Of Person(s) Or Organization(s):

Information required to complete this Schedule, if not shown above, will be shown in the Declarations.

Each person or organization shown in the Schedule is an ‘‘insured’’ for Covered Autos Liability Coverage, but only to the extent that person or organization qualifies as an ‘‘insured’’ under the Who Is An Insured provision contained in Paragraph A.1. of Section II ---- Covered Autos Liability Coverage in the Business Auto and Motor Carrier Coverage Forms and Paragraph D.2. of Section I ---- Covered Autos Coverages of the Auto Dealers Coverage Form.

152375-14-89-67-3

TO INCLUDE: THE STATE OF ARIZONA, AND ITS DEPARTMENTS, AGENCIES,

BOARD, COMMISSIONS, UNIVERSITIES, OFFICERS, OFFICIALS, AGENTS, AND

EMPLOYEES AS ADDITIONAL INSUREDS WITH RESPECT TO THE LIABILITY

ARISING OUT OF THE ACTIVITIES PERFORMED BY, OR ON BEHALF OF, THE

CONTRACTOR INVOLVING AUTOMOBILES, OWNED, HIRED AND/OR NON OWNED BY

THE CONTRACTOR