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ENDORSEMENT <br />*POLICY NUMBER: 9003 c�a 1�7 <br />*INSURED COMPANY NAME: Vdq Pm��S ��� ftIliance- o� Co.l��. <br />THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. <br />ADDITIONAL INSURED - DESIGNATED PERSON or ORGANIZATION <br />This endorsement modifies insurance provided under the following: <br />COMMERCIAL GENERAL LIABILITY COVERAGE PART <br />SCHEDULE <br />',lame of Person or Organization: <br />City of Santa Ana and its Officers, Agents, Employees and Volunteers are <br />named as additional insured as respects their interest in connection with the <br />named insured. <br />(If no entry appears above, information required to complete this endorsement will be shown in the Declarations <br />as applicable to this endorsement.) <br />WHO IS AN INSURED (Section II) is amended to include as an insured the person or organization shown in the <br />Schedule, but only with respect to liability arising out of your operations or premises owned by or rented to you. <br />IT IS AGREED THAT ANY INSURANCE MAINTAINED BY THE CITY OF SANTA ANA SHALL <br />APPLY IN EXCESS OF, AND NOT CONTRIBUTE WITH, INSURANCE PROVIDED BY THIS <br />POLICY. <br />Agent's Signature: <br />INSURANCE ON FILE <br />WORK MAY PROCEED <br />UNTIII,, IN yRAN E EXPIRES <br />OI I )OC)V <br />-G 2010 I1 85 CLERK F CO NCIL <br />DATE: <br />218)C SAMPLE - Additional Insured with Primafy Non -Contributing language Added <br />A, iP'1' \i LD F,S I U 17( <br />tip P e� <br />I .aura Shccdy <br />DCputy Cii.y Atlorncy <br />