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07/01/21 to 07/01/22 #EPK135992 CRUM &FORSTER <br />THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. <br />ADDITIONAL INSURED - OWNERS, LESSEES OR <br />CONTRACTORS <br />This endorsement modifies insurance provided under the following: <br />COMMERCIAL GENERAL LIABILITY COVERAGE PART <br />CONTRACTORS POLLUTION LIABILITY COVERAGE PART <br />SCHEDULE <br />Name Of Additional Insured Person(s) or organization(s) <br />of Santa Ana (its officers, employees, agents, and representatives) <br />i Civic Center Plaza <br />nta Ana, CA 92701 <br />SECTION III — WHO IS AN INSURED within the Common Provisions is amended to include as an additional <br />insured the person(s) or organization(s) indicated in the Schedule shown above, but only with respect to <br />liability caused, in whole or in part, by "your work" for that insured which is performed by you or by those acting <br />on your behalf. <br />EN0111-0211 <br />ALL OTHER TERMS AND CONDITIONS OF THE POLICY REMAIN UNCHANGED. <br />��oRaN <br />} z <br />a <br />wsknmWmertoMsiat <br />REVIEWED & APPROVED BY.- <br />p R. vj&wd <br />Risk Management Analyst <br />