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<br />JAN 31 2005 2:13PM <br />,.,H, 31. 2005 934AM <br /> <br />HP LASERJET 3200 <br />AMERICA~ E&S-Sf 415-398-8730 <br /> <br />, . <br /> <br />NO. 3358 F. 4 <br /> <br />POUCYNUMBER: CLS104t666 <br /> <br />COMMERCIAL GeNERAl LIABILITY <br />0020100704 <br /> <br />THIS ENDORSEMENT CHANGES THE POLrCY. PLEASE READ IT CAREFUllY. <br /> <br />ADDITIONAL INSURED - OWNERS, LESSEES OR <br />CONTRACTORS - SCHEDULED PERSON OR <br />ORGANIZATION <br /> <br />This endorllement modllles Insurance provided uoder thlllollowlrIQ: <br /> <br />COMMERCIAL GENERAL UABIUlY COVERAG! PART <br /> <br />&CHEDULS <br /> <br /> <br />loc8tIon a of Coveted 0 0"" <br /> <br />CITY OF SANTA ANA <br />~o CIVIC CENTER PL~~A <br />SANT AN~, CA 92701 <br /> <br />Informlllon 1 <br /> <br /> <br />A. Bection II . Who Ie An Inaured is amended 10 In. <br />ctuc!e as an &ddkIOl1lIInsUllld lha person(a) or 01- <br />:'-'-'.~~fi') shown In lhe 5chadlle. but only with <br />IG~i13i,.i ~[J ,,.;Dlityfor "bodily 1nJur-! .nr!"!~!'!'o~ !'!!!~ <br />age" or 'periOnaI and advlllli&i"~ .. .,_., __cc.... <br />whole or In part by: <br /> <br />f. YnlJ'8Ctsorom@~'or <br /> <br />B. Wdh lupsct to 11I1 insurance aIIordecllO the" ad- <br />dkloflll ln8ureda, the tollOWing &ddnional elCl:lu- <br />slOns apply. <br /> <br />-prnpeny uamall8' occumng ener: <br />1. All work, InclUding materiala, pam or equlp- <br />man! tumished in connection with such work, <br />on 1M pr*~ ~_I..._- 6L....... ........1.... __1_- <br />n~n~ t)II'~'iiji;;..,.... ...... "'_................. "", .... VI'_- <br />"j(jillonallnsllrlld(sl 8l1he location <br /> <br />,,-, Thv uv~. vi v.ij~~f.6 ijJj ii'-~ iil!,,-iiiiV wit fWI <br />bMAI~ <br /> <br />'" HI9 ,",'O"IorIIl'ClI'''';;d(.\lY' """"~~";__:,,__,__,. . ..--- <br />tM eddlllonal In8 I) al lhe '~~"_"\_' ___.~ <br />natad above. <br /> <br />plerlld; 01' <br />2. Thel partlDn of "\'Our work" oUl of which the in- <br />lury 01' clamaga arises has bt6n put to Ira <br />Inlended use by 8"'1 peraon or ;;-r;;-=,Occ," <br />""!~~. ~~~ !~01her contractor or S1Jbcornt~J <br />.... i......_ ;jj ;:;elforrnlng OJ)f!!'e'~r\IZ. In!" .. r';~L <br />pel" 8 pe/1 of lhe _ pm!"",. <br /> <br />CG 20 100704 CllIlyrlgll. ISO Propet1las. Inc., 2004 <br />1NS1lR1iC <br />"U" uJ AS 'to 1"OttM <br /> <br />Pagel of' <br /> <br />~2/~ <br /> <br />'.aura Stitt Sheedy <br />'. ."J~tant City Attorney <br /> <br />p.2 <br />