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POLICY NUMBER: BA67081-755 <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 <br />by this endorsement. <br />This endorsement Identifies persons) or organizations) 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 <br />12/19/2018 <br />Named Insured <br />Countersigned by <br />John Kellald Architects dba Urban studio <br />SCHEDULE <br />Name of Persons) or Organization(s): <br />(Authorized Representative) <br />*Person or organization completed to read: City of Santa Ana, Its officers, employees, agents, volunteers and representatives -- Re: Pre -Design <br />AS for Bristol St Prop, Washington Ave & 17th St <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 />CA 20 48 02 99 Copyright, Insurance Services Office, Inc., 1998 Page 1 of f <br />