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POLICY NUMBER: P63050OD409203 COMMERCIAL GENERAL LIABILITY <br />THIS ENDORSEMENT 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 />SCHEDULE <br />Name of Person or Organ!zaticn: <br />City of Santa Ana <br />Public Works Agency,Att: Zed Kekula <br />20 Civic Center Plaza <br />Mail Station 43 <br />Santa Ana, CA 92701 <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 work' for that insured by or for you. <br />Additional Insured Continued: And its officers and employees <br />PRIMARY INSURANCE: <br />IT IS UNDERSTOOD AND AGREED THAT THIS INSURANCE IS PRIMARY <br />AND ANY OTHER INSURANCE MAINTAINED BY THE ADDITIONAL INSURED <br />SHALL BE EXCESS ONLY AND NOT CONTRIBUTING WITH THIS <br />INSURANCE. <br />Ai r iaO�VQE�DLCJAs 10 1 ,Ayl <br />City AAt-�rnev <br />CG 20 10 11 85 <br />