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Front: Mod Dow At: Advanced Insurance FaxID: To: Qty of Santa Ana <br />• <br />INSURED: Casa Teresa <br />POLICY NUMBER: 200301408NPO <br />EFFECTIVE DATE: 01/09;03 <br />Data: giW003 04:04 PM Page: 3 of 3 <br />THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY <br />ADDITIONAL INSURED—DESIGNATED PERSON OR ORGANIZATION <br />This endorsement modifies insurance provided tinder the following: <br />COMMERCIAL GENERAL LIABILITY COVERAGE PART. <br />SCHEDULE <br />Name of Person or Organization: <br />City of Santa Ana and it's officers, agents & employees and volunteers <br />RE: Grant for Pre -Natal Healthcare & Education program <br />(If no entry appears above, information required to complete this endorsement will be shown in <br />the Declarations as applicable to this endorsement.) <br />WHO IS AN INSURED (Section 11) is amended to include as an insured the person or <br />organization shown in the Schedule as an insured but only with respect to liability arising out of <br />your operations or premises owned by or rented to you. <br />The insurance afforded by this policy to the person or organization listed above is <br />primary insurance and any other insurance available to such a person or organization is <br />Non -Contributory. <br />Ai, t,t:OVf'D AS TO FORM <br />ura .'beedy <br />Deputy City Attorney <br />CG 20 26 1185 <br />