Laserfiche WebLink
POLICYNUMBER BAP5571088-03 COMMERC14L AUTO <br />CA 2D 48 02 99 <br />THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. <br />DESIGNATED INSURED <br />This endorsenait modifies Insurance provided under the following: <br />BUSINESS AUTO COVERAGE FORM <br />GARAGE COVERAGE FOWst <br />MOTOR CARRIER COVERAGE FORM <br />TRUCKERS COVERAGE FOM <br />VWh respect to coverage provided by this endorsement, the provisions of the Coverage Fonn 8" unless modified by <br />this endorsement. <br />This endorsement identifies person(s) or organization(s) who are 'insureds" under the Miw Is An Insured Provision of <br />the Coverage Farm. This endorsement does not alter coverage provided M the Coverage Form. <br />This endorsemant changes the policy effective on the Inception date of the policy unless another date is indicated <br />below. <br />Endorsement Effec9ve: 8/1/15 <br />Countersigned By: <br />Authorized esertative <br />Named Insured: All American Asphalt <br />K-101a01IJA <br />Name of Pelson(s) or Organissllon(s): <br />ANY PERSON OR ORGANIZATION TO WHOM OR WHICH YOU ARE REQUIRED TO <br />PROVIDE ADDITIONAL INSURED STATUS OR ADDITIONAL INSURED STATUS ON A <br />PRIMARY, NON-CONTRIBUTORY BASIS, IN A WRITTEN CONTRACT OR WRITTEN <br />AGREEMENT EXECUTED PRIOR TO LOSS, EXCEPT WHERE SUCH CONTRACT OR <br />AGREEMENT IS PROHIBITED BY LAW. <br />Schedule <br />Project <br />City of Santa Ana, its officers, employees, agents, volunteers Project #15-6839 /RE: Local Street Slurry Seal 2014 - <br />and representatives 15 <br />(if no entry appears above, intonoatidn 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 edent that <br />person or organization qualities as an 'insured" under the Ydno Is An Insured Provision contained In Section It of the <br />Coverage Form. <br />CA 2048 02 99 Copyright, Insurance Services Off cs, Inc., 1998 Page 1 d 1 13 3910 <br />