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NOTICE: THESE POLICY FORMS AND THE APPLICABLE RATES ARE <br />EXEMPT FROM THE FILING REQUIREMENTS OF THE NEW YORK <br />INSURANCE LAW AND REGULATIONS. HOWEVER, THE FORMS AND RATES <br />MUST MEET THE MINIMUM STANDARDS OF THE NEW YORK INSURANCE <br />LAW AND REGULATIONS. <br />ADDITIONAL INSURED — STATE OR POLITICAL SUBDIVISIONS — PERMITS OR <br />AUTHORIZATIONS <br />Named Insured <br />Comcast Corporation <br />Endorsem ant Number <br />Policy Symbol <br />Policy Number <br />Pollcy Period <br />Effective Date of Endorsem ent <br />XSL <br />G71209313 <br />12/01/2018 to 12/01/2019 <br />09/04/2019 <br />Issued By (Name of Insurance Company) <br />ACE American Insurance <br />Company <br />11—1111 IN V1J111 y IlwlI i llpl, IIItl I WI IINI 1Pull, 1 1l1 I I IC II 11Vt IT I AllUI I I RP Utl 4iLlllljl I Ql Wl! [/Illy W11C111111b Oil L UMVIIIW III Ib Ib911AWN bUIJbVLIIJ Will 1V I I IC OlIf[JW l 11I I V11 L11111W r1V116y. <br />THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. <br />This Endorsement modifies insurance provided under the following: <br />EXCESS COMMERCIAL GENERAL LIABILITY POLICY <br />SCHEDULE <br />State Or Political Subdivision: <br />The City of Santa Ana, Risk Management, it's officers, employees, agents, representatives, and volunteers <br />(If no entry appears above, information required to complete this endorsement will be shown in the Declarations <br />as applicable to this endorsement.) <br />A. Section II — Who Is An Insured is amended to include as an additional insured any state or governmental <br />agency or subdivision or political subdivision shown in the Schedule, subject to the following provisions: <br />1. This insurance applies only with respect to operations performed by you or on your behalf for which the <br />state or governmental agency or subdivision or political subdivision has issued a permit or authorization. <br />However: <br />a. The insurance afforded to such additional insured only applies to the extent permitted by law; and <br />b. If coverage provided to the additional insured is required by a contract or agreement, the insurance <br />afforded to such additional insured will not be broader than that which you are required by the contract <br />or agreement to provide for such additional insured. <br />2. This insurance does not apply to: <br />a. "Bodily injury", "property damage" or "personal and advertising injury" arising out of operations per- <br />formed for the federal government, state or municipality; or <br />b. "Bodily injury" or roperty damage" included within the "products -completed operations hazard". <br />XS-21167b (04/13) Inc es copyrighted material of Insurance Services Office, Inc. with its permission. Page 1 of 2 <br />Class Code 2-14057 9 <br />9 <br />