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FROM <br />Prof Insurers & Assoc <br />FROM <br />FAX No. : 3018687719 <br />FAX No. :714- 647 -6549 <br />-.b. 09 2004 01:04PM P2 <br />Feb. % 20%44 04:0SPM P2 <br />hVUrance Company Sm n <br />X[lr. T TSiik+n <br />TWO end"ment mudi &es such ingh e relatilgto t�j4g o rde by the Amvisi"oos of polic y <br />y 1pP <br />off l' "eCityofSettta <br />' °t l°Yees, agents, voles �� Centermaab, Santa Ana, C x`91701; its <br />a �) °sn+ed by or tb b ropm to � o o slues arising the MBIWW <br />chalfofthe insured. gperatiorks <br />2. withrgapent c <br />behattof the named bleared, o �s °�8 out of the operatioau and uses <br />tmnoth ee 49ls afforded by this perfary and by or t on <br />additions tom butiAg with say txhor asurance carried r f�Y is P benefit snit is not <br />by or for the benefit �the <br />soft is 3. this msura°ce [iea soparatet to each <br />y a8ainat whom claim ado or <br />_ mitred <br />would havee ae on if d arid] T� inclusion of MAY <br />if t 0 30 included. person or orggni� -tioh <br />tt� tth respect to the additiGnA insureds, this <br />Biven to the City O ia Santa � 20 � c "t after thirty (30 ys written shall <br />T notice has been or <br />Plum Ana, Cslii'omla 92701. <br />(Completion of the followlno' ineludnug eounters4naftm, is required to make this endorsement <br />eMove.) <br />Effective DECEM$1 R 1 Ana — <br />Policy # '~ 3— — �. tbi3 endorsement form as a part of <br />Issuedto clunrsr� °-- <br />CoentersiSned by — �,r. ✓I r.Gl <br />Authorized Represcrdatl�— <br />ah- <br />to <br />. . A <br />