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POLICY NUMBER: 648737720 <br />COMMERCIAL AUTO <br />CA 20 461013 <br />THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. <br />DESIGNATED INSURED FOR <br />COVERED AUTOS LIABILITY COVERAGE <br />This endorsement modifies insurance provided under the following: <br />AUTO DEALERS COVERAGE FORM <br />BUSINESS AUTO COVERAGE FORM <br />MOTOR CARRIER COVERAGE FORM <br />Mh 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) who are Insureds" for Coverer( Autos Liability Coverage <br />under the Who Is An Insured provision of the Coverage Form This endorsement does not atter coverage <br />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 />�avw. / <br />Named Insrxed: ANTHONY GROCE <br />Endorsemerd Effective Date: 11-30-2015 <br />SCHEDULE <br />Name Of Person(s) Or <br />�s): <br />CIT`: OF SARI L ANDRO <br />835 E 14TH ST <br />SAN LEANDRO, CA USA 445773767 <br />Information required to complete this Schedule, if not shown above, will be shown in the Declarations. <br />Each person or organ'¢ation shown in the Schedule is <br />an Insured' for Covered Autos Liability Coverage, but <br />only to the extent that person or organization qualifies <br />as an insured" under the Who Is An Insured <br />provision contained in Paragraph A.I. of Section II — <br />Covered Autos Liability Coverage in the Business <br />Auto and Motor Carry Coverage Forms and <br />Paragraph D.Z. of Section I — Covered Autos <br />Coverages of the Auto Dealers Coverage Form. <br />CA 20 48 10 13 ® Insurance Services Office, Inc., 2011 Page 1 of 1 <br />PdCiaml h—d Cavy <br />