Laserfiche WebLink
<br />ENDORSEMENT <br /> <br />THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. <br /> <br />NON-OWNED AUTO LIABILITY <br /> <br />This endorseme"t, erreetive 0" 10/01103 forms a part of <br />(11:01 A.M. St8Hari n.e) <br /> <br />Policy Number: 3CJ8801 <br /> <br />Certificate Number: SSA02-0017 <br /> <br />Issued To: Da"iel Juan <br /> <br />By: <br /> <br />Essex Insurance Company <br /> <br />This eudorsement modifies insurance provided under the following: <br /> <br />COMMERCIAL GENERAL LIABILITY COVERAGE PART <br /> <br />SCHEDULE <br /> <br />COVERAGE <br /> <br />ADDITIONAL PREMIUM <br /> <br />Non-Owned Auto Liability <br /> <br />$ 250.00 <br /> <br />Coverage applies only to City ef Sa.ta ABa <br />as limited by the specific worlc <br />performed under this certificate. No coverage <br />affixded to certific>te bold« <br /> <br />NON-OWNED AUTO LIABILITY <br /> <br />The insurance provided under COVERAGE A (Section 1) applies to "bodily injury" or "property damage" arising <br />out ofthe Use ofany "non-owood auto" in your business by any person other than you. <br /> <br />With respeet to the iusuranee provided by this e"dorsement: <br /> <br />The exclusions, under COVERAGE A (Section I), other than exclusions a, b, d, fand i are deleted and the <br />following exclusions are added: <br /> <br />I. <br /> <br />"Bodily injury" <br /> <br />(a) To an "employee" of the insured arising out of and in the course of employment by the insured; or <br /> <br />(b) To the spouse, child, parent, brother or sister of that "employee" as a consequence ofpan¡graph (a) <br />above. <br /> <br />This exclusion applies: <br /> <br />(a) Whether the insured may be liable as an employer or in any other capacity; and <br /> <br />(b) To any obligation to share damages with or repay someone else who must pay damages because of the <br />injury. <br /> <br />Page lof2 <br /> <br />APPROVED AS TO FORM <br /> <br />~OÅ~ <br />Lau eedy <br />Deputy City Attorney <br />