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POLICY NUMBER: BAP2018652-12 <br />COMMERCIAL AUTO <br />CA 20 0110 13 <br />THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. <br />LESSOR - ADDITIONAL INSURED AND LOSS PAYEE <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 the endorsement. <br />This endorsement changes the policy effective on the Inception date of the policy unless another date is <br />Indicated below. <br />Named Insured: Ocean Blue Environmental Services, Inc. <br />Endorsement Effective Date: 07/01/2018 <br />SCHEDULE <br />_...._ <br />Insurance Company: <br />...................... <br />Great Divide Insurance Company <br />Policy Number- BAP2018652-12 <br />Effective Date: 07/01/2018 <br />Expiration Date: <br />07/01/2019 <br />Named Insured: <br />Ocean Blue Environmental Services, Inca <br />Address: <br />925 West Esther Street, Long Beach, CA 90813 <br />Additional Insured (Lessor): <br />As required by those entities with whom the Named Insured executes a written <br />contract for a "leased auto" and on file with the underwriter submitted at binding on <br />a Business Auto Acord application or on an Acord Business Auto Policy Change <br />Request form prior to loss. <br />Address: <br />Designation Or Description Of "Leased Autos": <br />CA 20 01 10 13 © Insurance Services Office, Inc.,2011 Pago 1 of 2 <br />REVIEWED BY. UNICE HEREDIA {PStF� ( ) <br />