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POLICY NUMBER: PSA0001078 <br />COMMERCIAL AUTO <br />THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. <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 un|aaa <br />modified by this endorsement. <br />This endorsement identifies ( rganization(n)who are "inoureda"for Covered Autos Liability Coverage <br />under the Who Is An Insured provision of the Coverage Form. This endorsement does not o|bar coverage <br />provided inthe Coverage Form. <br />This endorsement changes the policy effective on the inception date of the policy unless another date is indicated <br />Named Insured: Joxnnnn-Fmrma^omociama Inc. <br />Endorsement Effective Date: 12/11/2016 <br />SCHEDULE <br />Name OfPersOr Oizmbon <br />City of Santa Ana, its officers and employees <br />Information required to complete this Schedule, if not shown above, will be shown in the Declarations. <br />Each or organizationshown i 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 <br />provision contained in Paragraph A.1of Section U <br />Covered Autos Liability Coverage in the Business <br />Auto and Motor Comer Coverage ,onnn and <br />Paragraph D.2. of Section | — Covered Autos <br />Coverages o[the Auto Dealers Coverage Form, <br />CA2O481013 @ Insurance Services Office, |nn,2O11 Page 1vf1 <br />