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HISCOX <br />Policy Number: <br />Named Insured: <br />Endorsement Number: <br />Endorsement Effective: <br />UDC-4856692-CGL-21 <br />Department of Civic Things <br />20 <br />October 22, 2021 <br />Hiscox Insurance Company Inc. <br />THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. <br />ADDITIONAL INSURED - DESIGNATED <br />PERSON OR ORGANIZATION <br />This endorsement modifies insurance provided under the following: <br />COMMERCIAL GENERAL LIABILITY COVERAGE PART <br />SCHEDULE <br />Name Of Additional Insured Persons Or Organization(s) <br />City of Santa Ana, Risk Management <br />20 Civic Center Plaza <br />Santa Ana, CA 92701 <br />Information required to complete this Schedule, if not shown above, will be shown in the Declarations. <br />Section II — Who Is An Insured is amended to in- <br />clude as an additional insured the person(s) or organi- <br />zation(s) shown in the Schedule, but only with respect <br />to liability for "bodily injury", "property damage" or <br />"personal and advertising injury" caused, in whole or <br />in part, by your acts or omissions or the acts or omis- <br />sions of those acting on your behalf: <br />A. In the performance of your ongoing operations; or <br />B. In connection with your premises owned by or <br />rented to you. <br />0 Re/ m6,MaRo rB <br />�® Rnk Management SupmBor <br />Of <br />CG 20 26 07 04 © ISO Properties, Inc., 2004 Page 1 of 1 <br />