GENERAL32724

• Permit No: C1989074
• IBM Index Class Name: General Documents
• Doc Date: 9/17/2004
• Doc Name: Certificate of Insurance
• From: Acord
• Permit Index Doc Type: Insurance
• Media Type: D
• Archive: No

POLICY NUMBER: 71 PKG36O4300 COMMERCIAL AUTO
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
DESIGNATED INSURED ENDORSEMENT
This endorsement modifies insurance provided under the following:
BUSINESS AUTO COVERAGE FORM
GARAGE COVERAGE FORM
With respect to coverage provided by this endorsement, the provisions of the
Coverage Form apply unless modified by the endorsement.
This endorsement changes the policy effective on the inception date of the policy
unless another date is indicated below:
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
EFFECTIVE DATE: 07/01/04 NAMED INSURED: AMERICAN CIVIL
CONSTRUCTORS, INC.
NAME OF PERSON(S~ OR ORGANIZATION(S)
Any Person or Organizations as required by written Contract.
Each person or organization indicated above is an "Insured" for LIABILITY
COVERAGE, but only to the extent that person or organization qualifies as an
"Insured" under the WHO IS AN INSURED provision contained in Section II of
the Coverage Form.