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POLICY NUMBER: BA3C999002 <br />COMMERCIAL AUTO <br />CA 20 48 02 99 <br />1 , <br />This 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 modified <br />by this endorsement. <br />This endorsement identifies person(s) or organization(s) who are "insureds" under the Who Is An Insured Provision of <br />the Coverage Form. This endorsement does not alter coverage provided in the Coverage Form. <br />This endorsement changes the policy effective on the inception date of the policy unless another date is indicated <br />below. <br />Endorsement effective <br />04/01/2016 <br />Named Insured <br />Countersigned by /��U/� <br />Larry Walker Associates, Inc. <br />,[�� <br />� �"" — —"' <br />SCHEDULE <br />Name of Persons) or Organization(s): <br />(,vutnorized Kepresentative) <br />NAME OF PERSON OR ORGANIZATION CONTINUATION:The City of Santa Ana, its officers, employees, agents, and representatives <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 person or organization shown in the Schedule is an "insured" for Liability Coverage, but only to the extent that <br />person or organization qualifies as an "insured" under the Who Is An Insured Provision contained in Section II of the <br />Coverage Form. <br />CA 20 48 02 99 Copyright, Insurance Services Offi96, Inc., ),998 Page 1 of 1 <br />Rl VII-w1/UED BY: i'' �. .Mr � � I[:. Nk C;E @ I REf.Y A (l:r(Y (t ..-.)._. <br />