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CIV74 SOURCE AGR #k TBD <br />POLICY #k: SA4592L37 7 <br />REVIEWED 6Y. "e°ep,p EUNIGE f-1EREI�IA (GSC; 4 OF 5� <br />COMMERCIAL AUTO <br />CA 20 48 02 99 <br />THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. <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: 7/17/2018 <br />Countersigned By: <br />services <br />-- city of Santa Ana <br />Named Insured:+ <br />CivilSource, Inc. <br />. <br />empl.oyeea <br />Authorized Representative)_ <br />SCHEDULE <br />Name of Person Is) or Organization (a): Re: <br />City Engineering <br />services <br />-- city of Santa Ana <br />and <br />their officers, <br />agento and <br />empl.oyeea <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 />CA 20 48 02 99 Copyright, Insurance Services Office, Inc., 1998 <br />