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COMMERCIAL AUTO <br />POLICY NUMBER: BA-4X180280-24-42-G ISSUE DATE: 12-18-24 <br />DRIVER LISTING <br />The subsequent page(s) of this form includes those drivers whom you have indicated will be using your <br />automobiles insured through us. Please be sure this listing is complete and includes both full-time and occasional <br />drivers. If this information needs modification or when drivers are added or deleted, please complete both sides of <br />this form, as applicable, and send it to your agent in a secure manner, being mindful of the sensitive information it <br />could contain. <br />NEW/ADDED DRIVERS <br />LAST FIRST <br />DATE OF LICENSE STATE <br />BIRTH NUMBER LICENSED <br />CA Al 05 02 15 Page 1 of 2 <br />