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POLICY NUMBER; BAP 5571088.01 <br />COt IJEFICIAL AUTO <br />CA 20 48 02 99 <br />THIS ENDORSEME14T CHANGES THE POLICY. PLEASE READ IT CAREFULLY, <br />DESIGNATED INSURED <br />This endorsement modules insurance provided undarthefo9owing: <br />BUSINESS AUTO COVERAGE FORM <br />GARAGE COVERAGE FORM <br />MOTOR CARRIERCOVERAGE FORM' <br />TRUCKERS COVERAGE FOAM <br />WRh respect to coverage provided by this endorsement„ the provislons of the Coverage Form, apply unless modified by <br />this endorsement. <br />This endorsement IdentffIse parson(s) or organizations) who are 'Ins under the Who Is An Insured Pravislon of <br />the Coverage Form. This endorsement does not agar coverage provided in the Coverege Form. <br />This endorsement changes the poficy effective on the Inception date of the poky unless another elate Is indicated <br />below. <br />Endorsement Eff active: 08/0 1/2013 <br />SCHEDULE <br />Namur of Person(s) or Organizatlain(s): <br />ANY PERSON OR ORGANIZATION TO WHOtd OR WHICH YOU ARE REQUIRED TO <br />PROtrIDE ADDITIONAL INSURER STATUS OR ADDITIONAL INSURED STATUS ON A <br />PRIMARY., NON—CONTRIBUTORY BASIS, INA WRITTEN CONTRACT OR WRITTEN <br />AGREEMENT EXECUTED PRIOR TO LOSS, EXCEPT WHERE SUCH CONTRACT OR <br />AGREEMENT IS PROHIBITED BY LAW. <br />Schedule Project <br />The City of Santa Ana, 20 Civic Center Plaza, Santa Ana, RE: City of Santa Ana - Project #14-6812; Local <br />California 92702; its officers, employees agents and Street Slurry Seal 2013-2014 <br />volunteers <br />jlf no entry appears above, Information required to complete this endorsement will be shown in the Declaratlons as <br />fppllcabta to th a endorsement.) <br />Each person or organization shown In the Sctioduleis an insured"far LoNfIty Coverage, but only to the tent that <br />person or organization qualifies as an "Ensured under the Who Is An Insured Provision contalned in Section II of the <br />Coverage Form, <br />GA 2p 4802 90 Copyright, Insurance Serves Office, Enc., ISM Page f of 1 I3 3684 <br />