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United Storm Water
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Entry Properties
Last modified
7/15/2015 3:04:05 PM
Creation date
6/23/2005 9:43:13 AM
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Contracts
Company Name
United Storm Water, Inc
Contract #
A-2005-124
Agency
Public Works
Council Approval Date
6/6/2005
Expiration Date
5/31/2006
Insurance Exp Date
11/16/2005
Destruction Year
2011
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<br />POLICY NUMBER: BAP :J258433-02 <br /> <br />COMMERCIAL AUTO <br />CA 20 01 1001 <br /> <br />THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. <br /> <br />LESSOR - ADDITIONAL INSURED AND LOSS PAYEE <br /> <br />This endorsement modifies insurance provided under the following: <br /> <br />BUSINESS AUTO COVERAGE FORM <br />BUSINESS AUTO PHYSICAL DAMAGE COVERAGE FORM <br />GARAGE COVERAGE FORM <br />MOTOR CARRIER COVERAGE FORM <br />TRUCKERS COVERAGE FORM <br /> <br />With respect to coverage provided by this endorsement, the provisions of the Coverage Form apply unless modi- <br />fied by the endorsement. <br />This endorsement changes the policy effective on the inception date of the policy unless another date is indicated <br />below. <br /> <br />Endorsement Effective: <br /> <br />Countersigned By: <br /> <br />Named Insured: <br /> <br />(Authorized Representative) <br /> <br />SCHEDULE <br /> <br />Insurance Company ZURICH AMERICAN INSURANCE COMPANY <br />Policy Number BAP 5258433-02 <br />Effective Date 11-16-04 <br />Expiration Date 11-16-05 <br />Named Insured UNITED SruIDRMWATER, INC. <br />Address 14000 EAST VALLEY BOULEVARD <br />CITY OF INDUSTRY CA 91746 <br />Additional Insured AS REQUIRED BY THOSE ENTITIES WITH <br />(Lessor) WHOM THE NAMED INSURED EXECUTES A <br />Address WRITTEN CONTRACT. <br /> CITY OF INDUSTRY,CA 91746 <br />Designation or ANY LEASED VEHICLE <br />Description <br />of "Leased Autos. <br /> <br />CoveraQes Limit Of Insurance <br />Liabilitv 1 000,000 Each .Accident" <br />personallnlury <br />Protection or equivalent <br />no-fault coveraaeY <br />Comprehensive ACTUAL CASH VALUE OR COST OF REPAIR WHICHEVER IS LESS; <br /> MINUS: 3,000 For Each Covered "Leased Auto. <br />Collision ACTUAL CASH VALUE OR COST OF REPAIR WHICHEVER IS LESS; <br /> MINUS: 3.000 For Each Covered "Leased Auto. <br />Specified Causes of Loss ACTUAL CASH VALUE OR COST OF REPAIR WHICHEVER IS LESS; <br /> MINUS: For Each Covered "Leased Auto. <br /> <br />(If no entry appears above, information required to complete this endorsement will be shown in the Declarations <br />as applicable to this endorsement.) <br /> <br />APPROVED i\S i'O j"UJ~.\j <br /> <br />>,:~,/ <br /> <br />/ "} <br />i .~-~ <br /> <br />Laura SUtr ~..;t-~::,(>J.'I <br /> <br />CA 20 01 1001 <br /> <br />As,istall! Citv'\iicr',@ ISO Properties, Inc., 2000 <br /> <br />Page 1 of 2 <br /> <br />AtENT copy <br /> <br />
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