Laserfiche WebLink
POLICY NUMBER: PSA0001069 <br />COMMERCIAL AUTO <br />CA 20 48 10 13 <br />THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. <br />DESIGNATED INSURED FOR <br />COVERED AUTOS LIABILITY COVERAGE <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 unless <br />modified by this endorsement. <br />This endorsement identifies person(s) or organization(s) who are "insureds" for Covered Autos Liability Coverage <br />under the Who Is An Insured provision of the Coverage Form. This endorsement does not alter coverage <br />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 />Named Insured: Joseph C. Truxaw and Associates, Inc. <br />Endorsement Effective Date: 10/31/2013 <br />SCHEDULE <br />Name Of Person(s) Or Organization(s): <br />City of Santa Ana <br />Information required to complete this Schedule, if not shown above, will be shown in the Declarations. <br />Each person or organization shown in 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.I. of Section II — <br />Covered Autos Liability Coverage in the Business <br />Auto and Motor Carrier Coverage Forms and <br />Paragraph D,2. of Section I - Covered Autos <br />Coverages of the Auto Dealers Coverage Form. <br />APPROV�D AS TO FORM <br />----^ L 5 E. STORCK__. <br />Assistant City Attorney <br />CA 20 48 10 13 © Insurance Services Office, Inc., 2011 1 Page 1 of 1 <br />CERT NO.: 201496S4 IAVC) Belly Ttan 5/12/2014 10:49:39 AN (MV) Pe9e 3 of 5 f Yom' <br />