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POLICY M BA6708L755 <br />COMMERCIAL AUTO <br />CA 20 48 02 99 <br />THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. <br />X*lmU.1iM1ll\E4110=17 <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 ofthe Coverage Form apply unless modi- <br />fied by this endorsement. <br />This endorsement identifies person(s) or organization(s) who are "insureds" under the Who Is An Insured Provi- <br />sion of 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: 6/18/2015 <br />Countersigned By: <br />Named Insured: <br />John Kaliski Architects dba John Kaliski A <br />Authorized Representative) <br />SCHEDULE <br />Name of Person(s) or Organization(s): Re: on -call services, 0210 141125 <br />-- The City of Santa Ana, its officers, employees, <br />agents, volunteers and representatives <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 <br />that person or organization qualifies as an "insured" under the Who Is An Insured Provision contained in Section II <br />of the Coverage Form. <br />2& yo4 <br />CA 20 48 02 99 Copyright, Insurance Services Office, Inc., 1998 <br />