THIS ENDORSEMENT CHANGES THE POLICY

AUTO DEALERS – GARAGE SUPPLEMENTAL APPLICATION

(Required in addition to Acord 128 and 138)

For Internal or External Use

Describe any Yes answers

|Loc 1 |Loc 2 |Loc 3 |Loc 4 | Show # Class I and II in Loc boxes * |

| | | | |Note: Part Time employees (defined as those employees who work an average of ................
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