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POLICY NUMBER: AS2-631-510805-015 COMMERCIAL AUTO <br /> CA20481013 <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 modified <br /> 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 provided <br /> in the Coverage Form. <br /> SCHEDULE <br /> Name Of Person(s)Or Organization(s): <br /> The City of Santa Ana, its City Council, officers, officials, employees, agents and volunteers are covered as <br /> additional insured with respect to liabiity arising out of work or operations performed by or on behalf of the <br /> Permittee including materials, parts orequipment furnished in connection with such work or operations <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 <br /> only to the extent that person or organization qualifies <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 /> ZOUP INTERQA12ff J*63s and partners who r@dd3arWm.Services Office, Inc., 2011 Page 1 of 1 <br />