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11 tfm <br />HISCOX <br />Policy Number: <br />Named Insured: <br />Endorsement Number: <br />Endorsement Effective: <br />UDC-2163525-CG L-21 <br />MICHAEL RANESES <br />19 <br />October 11, 2021 <br />Hiscox Insurance Company Inc. <br />III IR24ki11101*14IT, l4ki111111111191:/_10M4:1IN1:1aell1WM"A_1RIA0:F_111111 111111a_1N41111111111M <br />ADDITIONAL INSURED - DESIGNATED <br />PERSON OR ORGANIZATION <br />This endorsement modifies insurance provided under the following: <br />COMMERCIAL GENERAL LIABILITY COVERAGE PART <br />SCHEDULE <br />Name Of Additional Insured Persons Or Organization(s) <br />The City of Santa Ana Risk Management Division <br />20 Civic Center Plaza <br />Santa Ana,CA 92702 <br />Information required to complete this Schedule, if not shown above, will be shown in the Declarations. <br />Section II — Who Is An Insured is amended to in- <br />clude as an additional insured the person(s) or organi- <br />zation(s) shown in the Schedule, but only with respect <br />to liability for "bodily injury", "property damage" or <br />"personal and advertising injury" caused, in whole or <br />in part, by your acts or omissions or the acts or omis- <br />sions of those acting on your behalf: <br />A. In the performance of your ongoing operations; or <br />B. In connection with your premises owned by or <br />rented to you. <br />CG 20 26 07 04 © ISO Properties, Inc., 2004 <br />�oRaN <br />} z <br />RAMwaganadDMsiun <br />REVIEWED & APPROVED BY.- <br />f R. V;&wd <br />Risk Management Analyst <br />