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POLICY NUMBER: GL 382 9190 COMMERCIAL GENERAL LIABILITY <br />DATE: <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 organization: <br />City of Santa Ana <br />20 Civic Center Plaza <br />P.O. Box 1988 <br />Santa Ana, Ca 92702 <br />(If no entry appears above, information required to complete this endorsement will be shown in <br />the Declarations as applicable to this endorsement.) <br />WHO IS AN INSURED (Section 11) is amended to included as an insured the person or <br />organization shown in the Schedule, but only with respect to liability arising out of"your <br />work" for that insured by or for you. <br />It is further agreed that such insurance as is afforded by this policy for the benefit of the <br />additional insureds shown above shall be primary insurance, but only as respects to any <br />claims, loss or liability arising out of the named insured operations, and any insurance <br />maintained by the additional insured shall be non-contributing. <br />APPROV LD AS 1'0 I ORM <br />Laura SLti ShccJy <br />CG 2010 1185 Copyright, Insurance Services Office, Inc., 1984 Page 1 of 1 <br />