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BA7815084403 (Auto) <br />10/23/2012 <br />6/1/2012 6/1/2013 <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 <br />by this endorsement. <br />This endorsement identifies person(s) or organization(s) who are "insureds" under the Who Is An Insured Provision <br />of the Coverage Form. This endorsement does not alter coverage provided in the Coverage Form. <br />SCHEDULE <br />Name of Person(s) or Organization (s): <br />City of Santa Ana Community Development Agency <br />Refer to G- 56015 -B <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 II of the <br />Coverage Form. <br />Copyright, Insurance Services Office, Inc., 1998 <br />Lots 721 (3rd and Broadway) 201 W. Third Street, 722 (Fiesta Market) 300 E. Fifth Street, 723 (Third and Birch <br />310 N. Birch, 724 (Fifth and Main) 420 S. Main in Santa Ana, CA 92701 and #539 215 E. 3rd St. Santa Ana, C <br />92701 <br />CA 20 48 (02 -99) <br />CERT NO.: 14502022 CLIENT CODE: PARKC Isela Carrillo 10/23/2012 3:52:57 PM Page 5 of 6 <br />AS 'To eoo� <br />LISP E, SHOP �oCrev <br />PSS`S�an� GM <br />