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Last modified
1/22/2024 4:26:25 PM
Creation date
8/27/2021 3:51:21 PM
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Template:
Contracts
Company Name
BRIAN PETERSON
Contract #
N-2021-67
Agency
Community Development
Expiration Date
12/31/2021
Insurance Exp Date
10/30/2021
Destruction Year
2026
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Policy No. 92 EYM168 1 CMP-4787 <br />Page 1 of 1 <br />THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY <br />CMP-4787 WAIVER OF TRANSFER OF RIGHTS OR RECOVERY AGAINST <br />OTHERS TO US <br />This endorsement modifies insurance provided under the following: <br />BUSINESSOWNERS COVERAGE FORM <br />SCHEDULE <br />Policy Number: 92 FYM168 1 <br />Named Insured: <br />BRIAN PETERSON ART INC <br />DBA FACES OF MANKIND <br />738 N SANTIAGO ST <br />SANTA ANA CA 92701-3951 <br />Name And Address Of Person Or Organization: <br />CITY OF SANTA ANA <br />RISK MANAGEMENT DIVISION <br />20 CIVIC CENTER PLAZA <br />SANTA ANA, CA 92702 <br />The following is added to Paragraph 10.b. of SECTION I AND SECTION II — COMMON POLICY <br />CONDITIONS: <br />We waive any right of recovery we may have against the person or organization shown in the Schedule <br />because of payments we make for injury or damage arising out of: <br />a. Your ongoing operations; or <br />b. "Your work' done under contract with that person or organization and included in the "products - <br />completed operations hazard". <br />This waiver applies only to the person or organization shown in the Schedule. <br />All other policy provisions apply. <br />CMP-4787 1006225 137715.1 11-19-2013 <br />©, Copyright, State Farm Mutual Automobile Insurance Company, 2008 <br />Includes copyrighted material of Insurance Services Office, Inc., with its permission. <br />„ """G WekMRnyganentAMelon <br />i 1� REVIEWED&APPROVEDRY. <br />8 t fl11 Fir-04,w P. V:FG�,.�fk <br />Risk management Analyst <br />
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