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CA 20 01 <br />(Ed. 03 06) <br />THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. <br />ADDITIONAL INSURED <br />This endorsement modifies insurance provided under the following: <br />BUSINESS AUTO COVERAGE FORM <br />BUSINESS AUTO PHYSICAL DAMAGE 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 <br />modified by the endorsement. <br />Schedule <br />Insurance Company: Great American Insurance Group <br />Policy Number: CAP 4614129 Effective Date: 2/11/2015 Expiration Date: 2/11/2016 <br />Named Insured: Boys & Girls Club of Santa AnaBoys & Girls Club of Santa Ana Foundation <br />Address: 250 N. Golden Circle, Suite 104, Santa Ana, CA 92705 <br />Additional Insured ( Lessor): Any person or organization when required by a written contract or agreement <br />Address: <br />Designation or Description <br />Any person or organization when required by a written contract or agreement. <br />Coverages <br />Limit of Insurance <br />Liability <br />$ 1,000,000 Each "Accident"� <br />Comprehensive <br />Actual Cash Value or Cost of Repair whichever is less; MINUS <br />$ 1,000 Deductible for Each Covered "Leased Auto" <br />Collision <br />Actual Cash Value or Cost of Repair whichever Is less; MINUS <br />$ 1,000 Deductible for Each Covered "Leased Auto" <br />Specified <br />Causes of Loss <br />Actual Cash Value or Cost of Repair whichever Is less; MINUS <br />$ 1,000 Deductible for Each Covered "Leased Auto" <br />nformation required to complete this Schedule, if not shown above, will be shown in the Declarations. <br />Copyright, ISO Properties, Inc., 2005 <br />CA 20 01 (Ed. 03/06) PRO (Page 1 of 2) <br />