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16
City of Pleasanton
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CITY CLERK
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AGENDA PACKETS
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2017
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071817
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16
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7/12/2017 10:25:43 AM
Creation date
7/12/2017 8:33:19 AM
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CITY CLERK
CITY CLERK - TYPE
AGENDA REPORT
DOCUMENT DATE
7/18/2017
DESTRUCT DATE
15Y
DOCUMENT NO
16
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POLICY NUMBER: ACA-2624-3 COMMERCIAL AUTO <br /> CA 20 48 02 99 <br /> THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. <br /> DESIGNATE', 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 <br /> modified by this endorsement. <br /> This endorsement identifies person(s) or organization(s)vvtio are Insureds" under the Who Is An Insured Provi- <br /> sion of 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 indi- <br /> cated below. <br /> Endorsement Effective: 05/01/16 Countersigned By <br /> .✓I rat1,10/allot,, <br /> Named Insured:Stommel, Inc dba: Lehr Auto Electric/ <br /> Auto Additions (Authorized Representative) <br /> SCHEDULE <br /> Name of Person(s)or Organization(s); <br /> (If no entry appears above, information required to complete This endorsement will be shown in the Declarations <br /> as applicable to the endorsement.) <br /> Each person or organization shown in the Schedule is an °insured°for Liability Coverage, but only to the extent <br /> that person or organization qualifies as an "insured° under the Who Is An Insured Provision contained <br /> in Section II of the Coverage Form. <br /> CA 20 48 02 99 Copyright, Insurance Services Office, Inc., 1998 Page 1 of 1 ❑ <br />
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