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SIEMENS INDUSTRY, INC
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Last modified
6/23/2020 4:17:42 PM
Creation date
6/23/2020 8:58:24 AM
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Contracts
Company Name
SIEMENS INDUSTRY, INC
Contract #
A-2020-114
Agency
PUBLIC WORKS
Council Approval Date
6/2/2020
Expiration Date
6/30/2023
Insurance Exp Date
10/1/2020
Destruction Year
2028
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POLICY NUMBER: TC2J-CAP-7440L34A-TIL-19 <br />COMMERCIAL AUTO <br />ISSUE DATE: 08-23-19 <br />THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. <br />DESIGNATED INSURED FOR <br />COVERED AUTOS LIABILITY COVERAGE <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 modi- <br />fied by this endorsement. <br />This endorsement identifies person(s) or organization(s) who are "insureds" for Covered Autos Liability Coverage <br />under the Who Is An Insured provision of the Coverage Form. This endorsement does not after coverage pro- <br />vided in the Coverage Form. <br />SCHEDULE <br />Name Of Person(s) Or Organization(s): <br />ANY PERSON OR ORGANIZATION WHOM YOU RAVE <br />AGREED TO ADD AS ADDITIONAL INSURED, BUT <br />ONLY TO COVERAGE AND MINIMUM LIMITS <br />REQUIRED IN A WRITTEN CONTRACT <br />Information required to complete this Schedule, if not shown above, will be shown in the Declarations. <br />Each person or organization shown in the Schedule is <br />an "insured" for Covered Autos Liability Coverage, but <br />only to the extent that person or organization qualifies <br />as an "insured" under the Who Is An Insured provi- <br />sion contained in Paragraph A.I. of Section II — Cov- <br />CA 20 48 10 13 <br />ered Autos Liability Coverage in the Business Auto <br />and Motor Carrier Coverage Forms and Paragraph <br />D.2. of Section I — Covered Autos Coverages of the <br />Auto Dealers Coverage Form <br />& APPROVED <br />tGEMENT DIVISION <br />Inc., 2011 <br />Page 1 of 1 <br />M. LAMBERT <br />
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