FETTERS, PAUL 1 - Laserfiche WebLink

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06/03/2004 15:59 8585190822 FITNESS AND WELLNESS PAGE 03/03 D,ATI .: June 3, 2004 POLI ;Y NUMBER: EOL9012328-00 INSU ZED NAME: Paul H. Fetters TH] S ENDORSEMENT CHANGES THE ]POLICY. PLEASE READ IT CAREFULLY 1 CG 20 10 11. 85 A )DITIONAL INSURED --OWNERS, LESSEES OR CONTRACTORS (FORM B) This ei 3orsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Name � f Person or Organization: City of Santa Ana 20 Civic Center Plaza Santa. Ana, CA 92701 (If no E atry appears above, information required to complete this endorsement will be shown in the Declarations as applicr -ilc to this endorsement,) WHO 3 AN INSURED (Section II) is amended to include as an insured the person or organization shown in the Schede le, but only with respect to liability arising out of "your work" for that insured by or for you. Primas • Insurance it is agreed that such insurance as is afforded by this policy for the benefit of the additional insure( shown shall be primary insurance, and any other insurance maintained by the additional insured(s) shall be excess and non-contributory, but only as respects any claim, loss or liability arising out of the operations of the named nsured(s) or its subcontractors, and only if such claim, loss or liability is determined to be soley the negli.gE -.ice or responsibility of the named insured. Notice )f Cancellation or Non -renewal it is agreed that the company will provide the additional insured shown below lith 30 days notice of cancellation of this policy in the evert of cancellation due to company election only. Hold F arnticss Clause it is agreed that such insurance as is a.ffo.rded by this policy for the benefit of the additional insures shown below shall indemnify and hold harmless the additional insured, but only as respects any claim, loss or liab: ity arising out of the operations of named insured(s) or its sub -contractors. Severa iility of Interest as is afforded by this policy for the benefit of the additional insured shown below shall apply separai ,ly to each additional insured against whom a claim is made or suit is brought, except with respects to the limits ; f insurance under this policy. WAIVER OF SUBROGATION It is agreed that we waive any right of recovery we may have against the person or organization shown in the schedule because of payment we make for injury or damage arising out of "your work" done under a contract with that person or organization. The waiver applies only to the person or organization shown in. the schedule. SCHEDULE NAME OF PERSON OR ORGANIZATION