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POLICY NUMBER: BA4592L377 <br />COMMERCIAL AUTO <br />CA 20 48 10 13 <br />THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. <br />�s I I a 0 1 <br />19101TJ 21 W4 11HA111 061;21 • <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: CivilSource, Inc. <br />Endorsement Effective Date: 7 / 6 / 2 01.6 <br />SCHEDULE <br />Name Of Person(s) Or Organization(s): Re: A-2015-163 OnCall & A-2015-237 OnCall -- City <br />of Santa Ana and their officers, agents and <br />employees <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 />CA 20 48 10 13 © Insurance Services Office, Inc., 2011 Page 1 of 1 <br />C.@ Er VI VVE-6 Elk d EMU- HE RLCt A (P �ZCD ) <br />