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POLICY NUMBER: aA2G560575 <br />COMMERCIAL AUTO <br />CA 20 48 02 99 <br />THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. <br />DESIGNATED INSURED <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 />09/0112015 <br />Named Insured <br />Countersigned by �v1� <br />NelsonlNygaard Consulting <br />N'F' <br />SCHEDULE <br />Name of Person(s) or Organization(s): <br />(Authorized Representative) <br />NAME OF ADDITIONAL INSURI =D PERSONS) OR ORGANIZATION(S) CONTINUED: City of Santa Ana, its officers, employees, agents, <br />volunteers 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, <br />REVIEWED FAY: VZ–L fj(/,�/ '— - EUNICE FIEREDIA (PG �'/OF CA <br />