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CA 29 48 (0290) <br />THIS ENDORSEMENT CHANGES THE POLICY, PLEASE READ IT CAREFULLY, <br />DESIGNATED INSURED <br />This endorsement modifies insurance provided under the tDltawing: <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 modified <br />by this endorsement <br />This endorsement identiffes person(s) or crganlzation(s) who are "Insureds' under the Who Is An Insured Proviolon <br />of the Coverage Form. This endorsement does not alter coverage provided in the Coverage Farm, <br />SCHEDULE <br />Name of Persons) or Organbatlon(s): <br />CITY OF SANTA ANA <br />PUBLIC WORKS AGENCY M36 <br />(If no entry appears above, information required to complete this endorsement will be shown in the Declarations as <br />applicable to the endorsement.) <br />Each porson-ol ofganizatlon shown. in the'Sohadule is an 'Insured" for Liabilityy Coverage, but oni to the extent that <br />person or organizallon qualified as an "Insured" under the Who Is An Insured Provision ocntalnad in &option 11 of the <br />Coverage Form. <br />Copyright, Insurance Services OfOos, Inc., 1989 <br />CA 20 48 (02-99) <br />ACP BAP025-3-H04078 <br />LYNO <br />14121 <br />AaaNr COPY <br />CA2448020900 4240 <br />n seesaw <br />