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POLICY NUMBER: MTK1565488A <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 Organization(s): <br />Effective Date: 11/04/2021 12:01 AM <br />THE CITY OF SANTA ANA, OFFICERS, AGENTS, EMPLOYEES AND VOLUNTEERS <br />RISK MANAGEMENT DIVISION <br />20 CIVIC CENTER PLAZA <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 />BP 04 48 01 06 © ISO Properties, Inc., 2004 w.k�oM�� <br />rRREVIEWED6 APPY <br />�E�: <br />R��O��V//®�B� <br />LMWNW' r'1FhGi'�� P- VaiR/Vf(F4 <br />Risk Management Anatyst <br />