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POLICY NUMBER: CAP2650691 COMMERCIAL AUTO <br /> CA 20 48 02 99 <br /> THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. <br /> DESIGNATED INSURED <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 of the 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 /> below. <br /> Endorsement Effective: 1l16/2026 <br /> Countersigned By: <br /> Named Insured:Super Birthday Inc <br /> Authorized Representative) <br /> SCHEDULE <br /> Name.of Person(s)or Organization(s):City of Santa Ana,its City Council, its officers,officials, <br /> employees,agents,and volunteers <br /> 20 Civic Center Plaza,M-42 Santa Ana,CA 92701 <br /> (If no entry appears above, information required to complete this endorsement will be shown in the Declarations as <br /> applicable to the endorsement.) <br /> Each person or organization shown in the Schedule is an "insured" for Liability Coverage, but only to the extent <br /> that person or organization qualifies as an "insured" under the Who Is An Insured Provision contained <br /> in Section II of the Coverage Form. <br /> CA 20 48 02 99 Copyright, Insurance Services Office, Inc„ 1998 Rage 1 of 1 0 <br />