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POLICY NUMBER: CX 1554764C <br />BUSINESSOWNERS <br />BP 04 48 01 06 <br />THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. <br />ADDITIONAL INSURED - DESIGNATED PERSON <br />OR ORGANIZATION <br />This endorsement modifies insurance provided under the following: <br />BUSINESSOWNERS COVERAGE FORM <br />SCHEDULE <br />Name of Additional Insured Person(s) Or Organ ization(s): <br />Effective Date: 09/26/2021 <br />CITY OF SANTA ANA ITS OFFICERS, EMPLOYEES, AGENTS, VOLUNTEERS AND REPRESENTATIVES <br />20 CIVIC CENTER PLAZA (M-30) <br />SANTA ANA, CA 92702 <br />Information required to complete this Schedule, if not shown above, will be shown in the Declarations. <br />The following is added to Paragraph C. Who is An <br />Insured in Section II - Liability: <br />3. Any person(s) or organization(s) shown in the <br />Schedule is also an additional insured, but only <br />with respect to liability for "bodily injury", <br />"property damage" or "personal and advertising <br />injury" caused, in whole or in part, by your acts or <br />omissions or the acts or omissions of those <br />acting on your behalf in the performance of your <br />ongoing operations or in connection with your <br />premises owned by or rented to you. <br />Aw F <br />Ride Management DMsian <br />Jy/ \'x REVIEWED & APPROVED BY.- <br />--� Risk janagement Analyst <br />