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UNITED STATES LIABILITY INSURANCE GROUP <br />WAYNE, PENNSYLVANIA <br />This endorsement modifies insurance provided under the following: <br />BUSINESSOWNERS COVERAGE FORM <br />Primary And Non -Contributory - Written Contract <br />Schedule: <br />Effective Date: 09/26/2021 <br />Name of Person or Organization: <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 />(If no entry appears above, the information required to complete this endorsement will be shown in the Declarations as <br />applicable to this endorsement) <br />SECTION III - COMMON POLICY CONDITIONS, Paragraph H. OTHER INSURANCE, is <br />amended with the addition of the following: <br />The coverage afforded by this policy to the person(s) or organization(s) listed above is primary and non- <br />contributory i£ <br />1. This insurance is required to be primary or non-contributory under a written contract: and <br />2. The loss to be covered occurs on or after the effective date of the written contract; and <br />3. The loss to be covered resulted solely and exclusively from your ongoing acts or omissions or the <br />ongoing acts or omissions of those acting on your behalf in performing "your work" under a written <br />contract referred to above. <br />4. The person(s) or organization(s) listed above is an additional insured under this policy. <br />All other terms and conditions of this policy remain unchanged. This endorsement is a part of your <br />policy and takes effect on the effective date of your policy unless another effective date is shown. <br />BP 172 (07-12) <br />ew cF RAMwagementDMsian <br />Jy/ 1'x REVIEWED & APPROVED BY: <br />V"° <br />--� Risk janagement Analyst <br />