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Policy No. 90 E3K874 5 0332—FAC7 CMP-4787 <br />Page 1 of 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: 90 E3K874 5 <br />Named Insured: <br />MELGOZA, JORGE B <br />6867 GOLFCREST DR APT 51 <br />SAN DIEGO CA 92119 2444 <br />Name And Address Of Person Or Organization: <br />CITY OF SANTA ANA ITS OFFICERS OFFICIALS EMPLOYEES & VOLUNTEERS <br />20 CIVIC CENTER PLZ <br />SANTA ANA CA 92701 4058 <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 />O, Copyright, State Farm Mutual Automobile Insurance Company, 2008 <br />Includes copyrighted material of Insurance Services Office, Inc., with its permission. <br />Rl8rMWw9dn%dDMsIun <br />g�y=R REVIEWED&p�AjPPPIR.OV/ DBr.. <br />' F�1l.s.tM1 h. V:l <br />®'. <br />Risk Management Matys[ <br />