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POLICY NUMBER: PSA0001069 <br />COMMERCIAL AUTO <br />CA 20 48 10 13 <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 />VVfth respect to coverage provided by this endoroement, the provisions of the Coverage Form apply unless <br />modified by this endorsement. <br />This endorsement identifies person(s) ororQan|zabnn(s) who are °immunedm" 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 Fornm, <br />This endorsement changes the policy effective on the inception date of the policy unless another date is indicated <br />Named Insured: Joseph u.Truxaw and Associates, Inc. <br />Endorsement Effective Date: 10/31/2014 <br />SCHEDULE <br />Nonna Of Person(s) OrOqJanizatkzn(m): <br />City of Santa 4mm <br />its officers and employees <br />Information requi d to complete this Schedule, if not shown above, will be h in <br />Each person or organization shown in the Schedule ia <br />an "inaured" for Covered Autos Liability CuwaneQe, but <br />only 10 the extent that person or organization qualifies <br />as an "insured" under the Who Is An Insured <br />provision contained in Paragraph A.1. of Section U - <br />Covered Autos LimbiNty Coverage in the Business <br />Auto and Motor Carrier Coverage Forma and <br />Paragraph U.2. of Section | - CVmonad Autos <br />Coverages uf the Auto Dealers Coverage Form, <br />JOSEPH C.TRU AGREEMENT #A-2D14-100 <br />REVIEWED BY: ^���_ �� , EUW|CE HERE0A (pg� 3 of 5) <br />CA20401U13 Insurance Services Office, |no,2811 Page 1of1 <br />c��21'mn. 22237971 (AV , oEw rran 11/6/2014 71sz.36 um (PSn oag" ` ^^ � <br />