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POLICY NUMBER: GL 2057247647 A/S COMMERCIAL GENERAL LIABILITY <br />'THIS ENDORSEbfENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY <br />,ADDITIONAL INSURED - OWNERS, LESSEES OR <br />CONTRACTORS (FORM B) <br />This endorsement modifies insurance provided under the following: <br />COMMERCIAL GENERAL LIABILITY COVERAGE PART <br />SCHEDDLE <br />Vame of Person or Organization: <br />CITY OF SANTA ANA, ITS OFFICERS AND EMPLOYEES <br />(if no entry appears above, information required to complete thi:~ <br />=_ndorsement will be shown in the Declarations as applicable to this <br />andorsement.) <br />'AHO IS AN INSURED (Section II) is amended to include as an insured <br />the person or organization shown in the Schedule, but only with <br />respect to liability arising out of "your work" for that insured by <br />~r for you. <br />'?8 #11972 <br />CG 20 10 11 85 Copyright, Insurance Services Office, Inc., 1989 <br />aerial #: 506062 F>age 2 <br />