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<br />Policy Number: BK01565160 <br /> <br />Owners;..Lessees or Contractors (Form B) <br />ADDITluNAL INSURED <br /> <br />Change(s) Effective: 12/28/04 <br /> <br />THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT <br />CAREFULLY. This endorsement modifies insurance policy under the following: <br /> <br />LIABILITY COVERAGE PART: <br /> <br />Schedule <br /> <br />Name of Person or Organization: <br /> <br />City of Santa <br />Attn: vincent <br />P.O. Box 1988 <br />Santa Ana, CA <br /> <br />Ana <br />Fergoso <br /> <br />92702 <br /> <br />SECTION II - WHO IS AN INSURED is amended to include as an insured the <br />person or organization shown in the Schedule, but only with respect to liability <br />arising out of "your work" for that insured by or for you. <br /> <br />City of Santa Ana, its officers, employees, agents, volunteers and <br />representatives are named as an additional insureds as respects <br />general liability for claims arising from the operations of the named <br />insured. <br /> <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 /> <br />SEVERABILITY OF INTEREST: <br />IT IS AGREED THAT EXCEPT WITH RESPECT TO THE LIMIT OF INSURANCE, THIS <br />COVERAGE SHALL APPLY AS IF EACH ADDITIONAL INSURED WERE THE ONLY INSURED <br />AND SEPARATELY TO EACH INSURED AGAINST WHOM CLAIM IS MADE OR SUIT IS <br />BROUGHT. <br /> <br />APPROVED AS TO FORM <br /> <br />~ 2./"2- <br />[/ Laura Stitt Sheedy <br />,'\~::;istant City Attornc\' <br /> <br />CUBF 22 40 03 95 <br /> <br />