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<br />H P r '2 " eO 1 U 1: ~ 2 PM' H ~ L H ~ E ~ J t:. I f fI X <br /> <br />S16-6"11-15~U <br /> <br />p.e <br /> <br />-, ' <br /> <br />MELCASEY <br />DPA550037702 <br /> <br />nus ENDORSEMENT CHANGES lltE POUCY. PLEASE READ IT CAREFULL V. ' <br />ADDITIONAL INSURED - DESIGNATED PERSON OR ORGANIZATION <br /> <br />This endoreement modifies lnlurance provided under the folloWing: <br /> <br />BUSINESS AUTO COVERAGE FORM <br />GARAGE COVERAGE FORM <br />MOTOR CARRIER COVERAGE FORM <br />TRUCKERS COVERAGE FORM <br /> <br />With respect to coverage provided by this endorsement. the provisions of the Coverage Form apply . <br />Unless m~)(nfled by the endorsement. <br /> <br />SCHEDULE <br /> <br />Name of Pe...on or Organl~atlon: . <br />THE em OF REDWOOD OIlY, ITS COUNCIL MEMBERS. OFFICERS, BOARDS, COMMISSIONS. EMPLOYEES & <br />AGENTS <br />Descrlptlon of Operatlonsl8ervlces: <br />JOB: SANITARY SEWER PUMP STATION #12 IMPROVEMENTS PROJECT <br />Location: <br />ENGINEERING & CONSTRUCTION <br />PO BOX 391 REDWOOD el1:v. CA 94064 <br /> <br />Description of Covered · ALltol' <br /> <br />SUCH INSURANCE AS IS AFFORDED BY 11IIS POUCY SHAlL BB PRD4ARY <br />INSURANCE. AND A}ri INSURANCB 01. SBLF-INSURANCB MAINrAINBD BY <br />THE ABOVB ADDmONAL INSURBD SHALL BB BXCBSS Of THB INSURANCB <br />AFFORDED TO TUB NAMED mSURBD AND SHAlL NOr CONTJUBU'I'B 10 rr. <br /> <br />Pet tehedule on ftJe with company <br /> <br />If no entry appears above. Information reQuired to complete this endorsement will be shown In the <br />Declarations sa applicable to this endorsement.) . . <br /> <br />The WHO 18 AN JNSURED provision under LIABILITY COVERAGE Is changed to Include 88 an -Insured" <br />The person or organization shown In the Schedule. but only with respect to lIabll ity arising out of: <br />1. Your operations or services performed for that person or organization at the locatiOn shown In the <br />Schedule;, or <br />2. The ownership. maintenance or use afthe covered -autos" described In the Schedule. <br /> <br />A person's or organization's status as an addltlonellnsured under this endorsement ends when: <br />1. Your operations or services perfonned for that person or org8fllzstion are completed; or <br />2. That person's or organIzation's Interest In the descrlbed "auto- ends. . . <br /> <br />Include. copyrighted materia1 of Inaunmce Gervtees Ofllco. Inc.. with ita permission. <br />Copyright. Insurance Services Ortice,lnc.. 1984, 1996 <br /> <br />SACA0122 (12-(6) <br /> <br />ADDITIONAL INSURED . <br />