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<br />ADDITIONAL INSURED <br />THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ ITCAREFULL Y. <br /> <br />BUSINESS AUTO COVERAGE FORM <br /> <br />THE PROVISIONS AND EXCLUSIONS THAT APPLY TO LIABILITY COVERAGE ALSO APPLY <br />TO THIS ENDORSEMENT. <br /> <br />ANY PERSON OR ORGANIZATION THE NAMED INSURED IS OBLIGATED TO PROVIDE <br />INSURANCE WHERE REOUIRED BY A WRmEN CONTRACT OR AGREEMENT. <br /> <br />IS AN INSURED, BUT ONLY WITH RESPECT TO LEGAL RESPONSIBILITY FOR ACTS OR <br />OMISSIONS OF A PERSON FOR WHOM LIABILITY COVERAGE IS AFFORDED UNDER THIS <br />POLICY. <br /> <br />THE ADDmONAL INSURED IS NOT REQUIRED TO PAY FOR ANY PREMIUMS STATED IN <br />THE POLICY OR EARNED FROM THE POLICY. ANY RETURN PREMIUM AND ANY <br />DIVIDEND, IF APPLICABlE, DECLARED BY US SHAlL BE PAID TO YOU. <br /> <br />YOU ARE AUTHORIZED TO ACT FOR THE ADDITIONAL INSURED IN ALL MATTERS <br />PERTAINING TO THIS INSURANCE. <br /> <br />THE ADDmONAlINSUREO WILL RETAIN ANY RIGHT OF RECOVERY AS A CLAIMANT <br />UNDER THIS POLICY. <br /> <br />ADDITIONAL INSURED: <br /> <br />CITY OF SANTA ANA, ITS OFFICERS AND EMPLOYEES. <br />PB #11972 <br /> <br />This endorsement is part 0/ your policy and takes effect on the effectlve date of your policy, unless another effective <br />date is sI10Wn below. <br /> <br />Mus! Be Completed <br />ENOT. NO. POLICY NO. <br />1 BUA - 2077469066 <br /> <br />Complete Only When This Endorsement Is Not Prepared <br />With the pOlievor Is Not to be Effective With tIl.e Po..... <br />ISSUED TO: EFFECTIVE <br />PARSONS BRINCKERHOFF :lATE OF THIS <br />QUAOE & OOUGLAS, INC. ~NDORSEMENT <br />11/0112006 <br /> <br />e.~.---. <br /> <br />Counter SigmUure <br /> <br />,?")aA-~ Q /.-<:.-~ <br /> <br />Al1lhor~R:epresentatlve <br /> <br />tO~ <br />'to <br />~" 1'>.$ ____ <br />~it\?"J~~ . <br />tZJ;jJ:f'c~~O~~Olf>e'! <br />~tiro~ ~) <br />