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TATSUM|&PARTNERS, INC A-2OO9-Q22REVIEWED 8Y <br />POLICY #: Ba4669uo23 <br />/�, i , <br />^ EUN|CEHERE0A(PG J0FO) <br />COMMERCIAL AUTO <br />CA 20 48 02 99 <br />THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. <br />This endorsement modifies insurance provided under the following: <br />BUSINESS AUTO COVERAGE FORM <br />GARAGE COVERAGE FORM <br />MOTOR CARRIER COVERAGE FORM <br />TRUCKERS COVERAGE FORM <br />With respect to coverage provided by this endorsement, the provisions ofthe Coverage Form apply unless modi- <br />fied by this endorsement. <br />This endorsement identifies person(s) or organization(s) who are "insureds" under the Who Is An Insured Provi- <br />sion of the Coverage Form. This endorsement does not alter coverage provided in the Coverage Form. <br />This endorsement changes the policy effective on the inception date of the policy unless another date is indicated <br />Endorsement Effective: 6/26/2015 <br />Countersigned By: <br />Named Insured: <br />Tatsumi and Partners Inc <br />(Authorized Representgye) <br />SCHEDULE <br />Name of Person(s) or Organ ization(s): city of Santa Ana <br />20 Civic Center Plaza (M-29), P 0 Box 1988 <br />Santa Ana CA 92702-1988 <br />(If no entry appears above, information required to complete this endorsement will beshown inthe Declarations as <br />applicable hothe andorsemenL) <br />EachperoonororganizationahowninthoSohedu|eisan^ineured^fo/Uabi|ityCoverage.buton|ytodhaexbant <br />tkatpermznororganizadonqua|ifiouaaan^inoured^undertheVVho|oAo|nauredProvoionoontsinedinSectionU <br />of the Coverage Form. <br />CA 20480299 Copyright, Insurance Services Office, |no, 1998 <br />