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POLICY NUMBER: PHPKO[ J7 <br />FEEDBACK FOUNDATION <br />COMMERCIAL GENERAL LIABILITY <br /> <br /> THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. <br /> <br /> ADDITIONAL INSURED --- DESIGNATED PERSON OR <br /> ORGANIZATION <br /> <br />'rh'= endorsement modifies insurance provided under the following: <br /> <br /> COMMERCIAL GENERAL LIABILITY COVERAGE PART. <br /> <br /> SCHEDULE <br /> <br />Name o[ Per~on or Organization: <br /> <br />CITY OF ,SANTA ANA <br />COMMUNITY DEVELOPMENT AGENCy M-25 <br /> <br />ATTN: CARLA THOMPKINS <br /> <br />P.O. BOX 19~8 <br /> <br />SANTA AN& GA 92702 <br /> <br />RE: Additional insured with re~3e~ to ~ams a~tng out of the operations and use~ pen'om~d by or on behalf ~ the named <br />In~ured, suoh Insurance as is afforded by thl~ poiloy is prima;y and is no{ ed~rlttonal to or ~onffibu~ng with err/~her insurance <br />canisd by or for the bens~t of the acldWona~ ir~ured's, with the e~:ep~on of sole neg~genee or wilful misconduot by the City of <br /> <br />Of no enby appears above, Informalton required to cemlflete this endomement will be shown In the Declarations es <br />al:~plic, able to this endorsement.) <br /> <br />WHO I$ AN INSURED (Beckon II) is amended to include as an insured the pemon or organiza~on shm~n in the <br />S~hedule es an Insured but only with respect to lial~ arising out of your opera,ohs or pmmlses owned by or <br />rented to you. <br /> <br />CO 2026 11 85 <br /> <br />~ht, Insurance.~.ewices Office, Inc.. 1984 <br /> <br /> APPROVED AS ~lO bORM <br /> <br /> <br />