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4/26/2024 <br /> POLICY NUMBER: BAP557108811 COMMERCIAL AUTO <br /> CA 20 48 10 13 <br /> THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. <br /> DESIGNATED INSURED FOR <br /> COVERED AUTOS LIABILITY COVERAGE <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 this endorsement. <br /> This endorsement identifies person(s)or organization(s)who are "insureds"for Covered Autos Liability Coverage <br /> under the Who Is An Insured provision of the Coverage Form. This endorsement does not alter coverage <br /> provided in the Coverage Form. <br /> This endorsement changes the policy effective on the inception date of the policy unless another date is indicated <br /> below. <br /> Named Insured: All American Asphalt <br /> Endorsement Effective Date:08/01/2023 <br /> SCHEDULE <br /> Name Of Person(s)Or Organization(s): <br /> ANY PERSON OR ORGANIZATION TO WHOM OR WHICH YOU ARE REQUIRED TO <br /> PROVIDE ADDITIONAL INSURED STATUS ON A PRIMARY, NON-CONTRIBUTORY <br /> BASIS, IN A WRITTEN CONTRACT OR WRITTEN AGREEMENT EXECUTED PRIOR TO <br /> LOSS, EXCEPT WHERE SUCH CONTRACT OR AGREEMENT IS PROHIBITED BY LAW. <br /> Information required to complete this Schedule, if not shown above,will be shown in the Declarations. <br /> Each person or organization shown in the Schedule is <br /> an "insured" for Covered Autos Liability Coverage, but SCHEDULED: <br /> only to the extent that person or organization qualifies City of Santa Ana. <br /> as an "Insured" under the Who Is An Insured provision <br /> contained in Paragraph A.1. of Section II — Covered <br /> Autos Liability Coverage in the Business Auto and <br /> Motor Carrier Coverage Forms and Paragraph D.2. of <br /> Section I — Covered Autos Coverages of the Auto <br /> Dealers Coverage Form. <br /> CA 20 48 10 13 ©Insurance Services Office, Inc., 2011 (---) <br /> *,OR4� Risk�tDttis[on <br /> . . REVIEWED&APPROVED BY: <br /> ��, 1 <br /> Risk Management Specialist :/ \ <br /> 79714219 1 23 (01] Standard with $5mm XS 1 Lisseth Medina 1 4/26/2024 10.52:32 AM (PDT) 1 Page 9 of 11 <br />