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Last modified
1/6/2022 3:15:59 PM
Creation date
1/6/2022 3:15:04 PM
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Template:
Contracts
Company Name
BRIAN PETERSON
Contract #
N-2021-167-01
Agency
Community Development
Expiration Date
6/30/2022
Insurance Exp Date
10/30/2022
Destruction Year
2027
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Policy No. 92 EYM168 1 CM7 e 1 8 <br />9 1 <br />THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY <br />CMP4787 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 EYM168 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 p, Copyright, State Farm Mutual Automobile Insurance Company, 2008 1006225 137715.1 11-19-2013 <br />Includes copyrighted material of Insurance Services Office, Inc., with its permission. <br />Rid MvYge llM <br />(� RenE6%MVRwm ar. <br />nWFn <br />All. aO Y JON <br />Rukhtaraage�em�Omc�l Aide <br />
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