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THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY, <br />CA 20 48 02 99 <br />DESIGNATED INSURED ENDORSEMENT <br />The 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 of the Coverage Form apply unless <br />modified by the endorsement. <br />This endorsement identifies person(s) or organization(s) who are "insureds" under the WHO IS AN IN- <br />SURED provision of the Coverage Form. This endorsement does not alter coverage provided in the Cov- <br />erage Form. <br />This endorsement changes the policy effective on the inception date of the policy unless another date is <br />indicated below. <br />Endorsement Effective <br />Policy Number <br />11115/2016 <br />BAS56380327 <br />Named Insured <br />HDL Coren and Cone <br />T' <br />Counters/ ned b <br />(Authorized Representative) <br />SCHEDULE <br />Name of Person(s) or Organization(s) <br />The City of Santa Ana, its officers, employees and agents <br />20 Civic Center Plaza, Santa Ana, CA 92701 <br />(If no entry appears above, information required to complete this endorsement will be shown in the Declara- <br />tions as applicable to this endorsement.) <br />Each person or organization shown in the Schedule is an "insured" for LIABILITY COVERAGE, but only to <br />the extent that person or organization qualifies as an "insured" under the WHO IS AN INSURED provision <br />contained in SECTION II of the Coverage Form. <br />CA 20 48 02 99 1Copyright, Insurance Services Office, Inc., 1998 Page I of 1 <br />