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POLICYNUMBER: BAP 4886792-01 <br />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 modified by <br />this endorsement. <br />This endorsement identifies person(s) or organization(s) who are 'insureds" under the Who Is An Insured Provision of <br />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: Countersigned By: <br />Named Insured: <br />Authorized Representative) <br />SCHEDULE <br />Name of Person(s) or Organization(s): <br />CITY OF SANTA ANA ALONG WITH THEIR RESPECTIVE OFFICERS, DIRECTORS, <br />AGENTS AND EMPLOYEES ARE LISTED AS ADDITIONAL INSUREDS ON A PRIMARY <br />AND NON-CONTRIBU'T'ORY BASIS BUT SOLELY IN REGARDS TO WORK BEING <br />PERFORMED BY OR ON BEHALF OF THE NAMED INSURED AS REQUIRED BY THOSE <br />ENTITIES WITH WHOM THE NAMED INSURED EXECUTES A WRITTEN CONTRACT. <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 that <br />person or organization qualifies as an 'insured" under the Who Is An Insured Provision contained in Section 11 of the <br />Coverage Form. <br />CA 20 48 02 99 Copyright, Insurance Services Office, Inc., 1998 Page 1 of 1 ? <br />Insured Cepy