CIVIL SOURCE, INC. (3) - 2015 - Laserfiche WebLink

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POLICY NUMBER: BA4592L377 COMMERCIAL AUTO CA 20 48 10 13 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. �s I I a 0 1 19101TJ 21 W4 11HA111 061;21 • This endorsement modifies insurance provided under the following: AUTO DEALERS COVERAGE FORM BUSINESS AUTO COVERAGE FORM MOTOR CARRIER COVERAGE FORM With respect to coverage provided by this endorsement, the provisions of the Coverage Form apply unless modified by this endorsement. This endorsement identifies person(s) or organization(s) who are "insureds" for Covered Autos Liability Coverage under the Who Is An Insured provision of the Coverage Form. This endorsement does not alter coverage provided in the Coverage Form. This endorsement changes the policy effective on the inception date of the policy unless another date is indicated below. Named Insured: CivilSource, Inc. Endorsement Effective Date: 7 / 6 / 2 01.6 SCHEDULE Name Of Person(s) Or Organization(s): Re: A-2015-163 OnCall & A-2015-237 OnCall -- City of Santa Ana and their officers, agents and employees Information required to complete this Schedule, if not shown above, will be shown in the Declarations. Each person or organization shown in the Schedule is an "insured" for Covered Autos Liability Coverage, but only to the extent that person or organization qualifies as an "insured" under the Who Is An Insured provision contained in Paragraph A.I. of Section II - Covered Autos Liability Coverage in the Business Auto and Motor Carrier Coverage Forms and Paragraph D.2. of Section I - Covered Autos Coverages of the Auto Dealers Coverage Form, CA 20 48 10 13 © Insurance Services Office, Inc., 2011 Page 1 of 1 C.@ Er VI VVE-6 Elk d EMU- HE RLCt A (P �ZCD )