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POLICY NUMBER: 680.4 1'1 5-A <br />COMMERCIAL GENERAL LIABILITY <br />THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. <br />ADDITIONAL INSURED ---- DESIGNATED PERSON OR <br />ORGANIZATION <br />This endorsement modifies insurance provided under the following: <br />COMMERCIAL GENERAL LIABILITY COVERAGE PART. <br />SCHEDULE <br />Name of Person or Organization: <br />CITY OF SANTA ANA, M-25 <br />COMMUNITY DEVELOPMENT AGENCY <br />PO BOX 2988 M-25 <br />SANTA ANA, CA 92702 <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 as an insured but only with respect to liability arising out of your operations or premises owned by or <br />rented to you. <br />CITY OF SANTA ANA, ITS OFFICERS, AGENTS, EMPLOYEES AND VOLUNTEERS ARE NAMED AS <br />ADDITIONAL INSURED AS RESPECTS THEIR INTEREST IN CONNECTION WITH THE NAMED INSURED. <br />At', -ROVED AS <br />TO FORM <br />L ura Sheedy <br />Deputy City Attorney <br />Copyright, Insurance Services Office, Inc. 1984 <br />