HomeMy WebLinkAboutSTACY BATES TRUCKING - INSURANCE CERTIFICATEPOLICY NUMBER: BA2491 532 57 02 COMMERCIAL AUTO
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WILSHIRE INSURANCE COMPANY
P.O. Box 7006, Lancaster, California 93539-7006
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
ADDITIONAL INSURED - DESIGNATED PERSON OR
ORGANIZATION
This endorsement modifies insurance provided under the following:
COMMERCIAL AUTOMOBILE COVERAGE PART
This endorsement changes the policy effective on the inception date of the policy unless another date is indicated
below.
Named Insured: STACY BATES
Effective Date: 03/09/201 7
(If no entry appears above, information required to complete this endorsement will be shown in the Declarations as
applicable to this endorsement.
Who Is An Insured (Section II, Part 1) of the policy is amended to include as an insured the person or organization
shown in the schedule as an insured but only with respect to liability arising out of the operation of "covered
autos" owned by the Named Insured and shown in the schedule forming a part of the policy.
Schedule of person(s) or organization(s):
CITY OF FORT COLLINS
PO BOX 582
FORT COLLINS CO 80522
COVERAGE
Commercial Automobile Liability I Bodily Injury/Property Damage I Combined Single Limit $
This endorsement shall take effect at 12:01 o'clock A.M., standard time at insured's address and shall terminate
simultaneously with this policy.
Nothing herein contained shall be held to vary, waive, alter, or extend any of the terms, conditions, agreements or
declarations of the undermentioned Policy other than as above stated.
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