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POLICYNUMBER: WS443240 <br />COMMERCIAL GENERAL LIABILITY <br />CG 20 12 05 09 <br />THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. <br />ADDITIONAL INSURED - STATE OR GOVERNMENTAL <br />AGENCY OR SUBDIVISION OR POLITICAL <br />SUBDIVISION - PERMITS OR AUTHORIZATIONS <br />This endorsement modifies insurance provided under the following: <br />COMMERCIAL GENERAL LIABILITY COVERAGE PART <br />SCHEDULE <br />State Or Governmental Agency or Subdivision or Political Subdivision: <br />City of Santa Ana Risk Management Division, 4th Floor, 20 Civic Center <br />Plaza, Santa Ana, CA 92702 <br />Information required to complete this Schedule, if not shown above, will be shown in the Declarations. <br />Section 11 - Who Is An Insured is amended to Include as <br />an insured any state or governmental agency or <br />subdivision or political subdivision shown in the Schedule, <br />subject to the following provisions: <br />1. This insurance applies only with respect to operations <br />performed by you or on your behalf for which the state <br />or governmental agency or subdivision or political <br />subdivision has issued a permit or authorization. <br />2. This Insurance does not apply to: <br />a. 'Bodily injury", "property damage" or "personal and <br />advertising injury" arising out of operations <br />performed for the federal government, state or <br />municipality; or <br />b. 'Bodily injury" or "property damage" included within <br />the "products -completed operations hazard". <br />CG 20 12 05 09 Copyright, Insurance services Office, Inc., 2008 <br />111" RlskManagem`mfDMsIm <br />IVA k7P REVIEWED &rVAPPROVED BY-. <br />R„ <br />i Risk Management Analyst <br />