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POLICY NUMBER: BAP2018652-12 <br />COMMERCIAL AUTO <br />CA 20 0110 13 <br />THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. <br />LESSOR -ADDITIONAL INSURED AND LOSS PAYEE <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 />modl0ed by the endorsement. <br />This endorsement changes the policy effective on the Inception date of the policy unless another date Is <br />Indicated below. <br />Insured: Ocean Blue Environmental Services, Inc. <br />SCHEDULE <br />Insurance Company: <br />Great Dlvide Insurance Company__ _... <br />Polloy Number: SAP2018652-12 Effective Date: 07/0111016 <br />Expiration Data: <br />07/01/2019 <br />Named Insured: <br />Ocean Blue Environmental Services, Inc, <br />Address: <br />925 West Esther Street, Long Beach, CA 90813 <br />Additional insured (Lessor): <br />As required by those entities with whom the Named Insured executes a written <br />contract fora "leased auto" and on Cie with the underwriter submitted at binding on <br />a Bualness Auto Acord application or on an Acord Business Auto Policy Change <br />Request form prior to loss. <br />AI ddrass: <br />Design®tion Or pascrl)ttlon Of <br />"Leased Autos": <br />CA 20 01 10 13 0Insurance Services Office, Inc„2011 Page 1 of 2 <br />CREVIEWED BY EUNICE NFREDIA PG or <br />_. <br />