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i <br />POLICY NUMBER: <br />AA.8932429 <br />COMMERCIAL AUTO <br />CA 20 48 02 99 <br />THIS ENDORSEMENT CHANGES THE POLICY, PLEASE READ IT CAREFULLY. <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 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 />ndorsement effective <br />�oxlt3 <br />amed Insured <br />F <br />Countersigned by <br />EYSER MARSTON ASSOCIATES, INC. <br />SCHEDULE <br />Name of Person(s) or Organizatlon(s): <br />City of Santa Ana, City of Santa <br />Ana Acting as successor Agency and <br />or Housing Authority of the City of. <br />Santa Ana et a1 <br />(Authorized Representative) <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 qualities as an 'Insured" under the Who Is An Insured Provision contained In Section II of the <br />Coverage Form, <br />APPROVED AS fro r-OVINT <br />Assista; t City At <br />CA 20 48 02 99 Copyright, Insurance Services Office, Inc., 1998 Page 1 of 1 <br />