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POLICY NUMBER: BAP2018652-13 COMMERCIAL AUTO <br />CA 20 01 10 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 />modified 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 />Named Insured: Ocean Blue Environmental Services, Inc. <br />Endorsement Effective Date: 07/01/2019 <br />SCHEDULE <br />Insurance Company: Great Divide Insurance Company <br />Policy Number: BAP2018652-13 <br />Effective Date: 07/01/2019 <br />Expiration Date: 07/01/2020 <br />Named Insured: Ocean Blue Environmental Services, Inc. <br />Address: 925 West Esther Street Long Beach, CA 90813 <br />Additional Insured (Lessor): As required by those entities with whom the Named Insured executes a written <br />contract for a "leased auto" and on file with the underwriter submitted at binding <br />on a Business Auto Acord application or on an Acord Business Auto Policy <br />Change Request form prior to loss. <br />Address• <br />-Designation or Description of "Leased Autos": <br />CA 20 01 10 13 © Insurance Services Office, Inc., 2011 <br />Page 1 of 2 <br />