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Agmt13 Infrastructure Engineering Corporation
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Agmt13 Infrastructure Engineering Corporation
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Last modified
11/1/2013 11:13:16 AM
Creation date
10/31/2013 4:38:24 PM
Metadata
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Template:
Agreement
Contractor Name
Infrastructure Engineering Corporation
PROJECT NAME
City Corporation Yard and Winslow Parking Lot
RMP File Number
304.5
Date
10/23/2013
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i <br /> POLICY#: BA8643M522 COMMERCIAL AUTO <br /> CA 20 48 02 99 <br /> THIS END�RSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY, <br /> �ESIGNATED 1NSURED <br /> This endorsemer►t modfies insurance provided under the following: <br /> BUSINESS AUTO COVERAGE FORM <br /> OARAGE COVERAGE FORM <br /> MOTOR CARRIER COVERAGE FORM <br /> TRUCKERS COVERAGE FORM <br /> W9th respect to coverage provided by this endorsement,the provisions of tfie Coverage Form apply unless modi- <br /> fied by this andorsement. <br /> 7his endorsement IdeMifies person(s) or organizat�on(s)who are"insureds" under the Who Is M tnsured Provi- <br /> sion o#the Coverage farm. This endorsement does not after coverage provided in the Coverage Fortn. <br /> This endorsemerrt changes the policy effective on the inceptian date of the policy unless another date is indicated <br /> below. <br /> Endorsement Effective:z/la/aa�a Cour�e�signed By: <br /> Named Insured: � <br /> Tnfrastructure &ngineering Corporation <br /> 142?1 Danielson 3treet Dorothy Qon <br /> Powa CA 92D64 UYlited S dtes U IlOf128C�R8 �8S8f1t�IV@ <br /> SCHEDUI.E <br /> Name of Person(s)or Organlzatlon{s): <br /> 1IH8EtE R6QUYAED BX HRI'ITRN fiONTRACr <br /> {If no entry appears above, information required to complete this endorsement will be shown in the Declaratans as <br /> epplicable to ihe endorsement.) <br /> Each person or orgenization shown in the Schedule is an 'insured'for Liab�iry Coverage, but only to the extent <br /> that person or organization qual�es as an°insured'under the Who Is M Insured Provision contained in Section Il <br /> of the Caverage Form. <br /> CA 20 48 02 9S Copyright, Insurance Senrices Office, Inc., 1998 <br /> ATTY/AGR/2013.205/INFASTRUCTURE ENGINEERING CORP <br /> REV: 10-17-13 VR <br /> Page 16 of 18 <br /> Paga 3 0 <br />
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