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<br />Oc/OI/~004 10:J4 FAX 714 538 4054 <br /> <br />Banh~$ter & A$se", Ins, <br /> <br />Il!l 00"'00" <br /> <br />Iii <br />! I I I <br /> <br />I <br /> <br />THIS ENDORS~ ..!NT CHANGES THE POLICY. PLbr.SE READ IT OAREFULL Y. <br />CG ~o 10 03 517 <br />AODITIONAL.INSURED-OWNERSj LESSEES OR CONT~CTOR$- <br />SCHEDULED PERSON OR ORGANIZATION' <br /> <br />! 'HI,' <br />I I'r <br />I I l ~ <br />I I.~ " <br /> <br />ThiS ~ndorHmenl rnQ~lfl"'ljllnsur!ll1ce prtlvld.d undsrth. followin~: <br />QOMMJ;RCJA~ GENI!RAL LIABILITY COVERAGS PART <br />Thls endOTlll!ment changes the PIIIII;iY effective on l/1e InlleP~O" dllle Qf the policy unless llMther dtll$ ~ Indhlllled <br />below. <br />endorsement effective <br /> <br />NBmed Insur,.d Wcters <br /> <br />Policy No, 3341 2" <br />12:01 A.M. standard time PPS 3 ..1 <br />8. F~ubel COU"~rKrSlnllld by <br /> <br />--1""""'rlud Regresenlan"'l <br /> <br />scHEDULE. <br /> <br />Neme of P"rsllln or QfSllnlzath:ln: <br />City of Santa Ana, its officers, ~qents, re~resentat1ve5, <br />volnteere: <br />(Iflj\!( erlWipp"kM'?tlov?:"ffiFmJl6ft reqU~di\6\?Omlete Ihle elldlltsemenl WIll be sheWn in the t'llilolandlonf as <br />.ppli=blv tIIthls endQrSem80t.) <br /> <br />WHO Is AN INSUReO (SecHon II) Is emeMdlillllO Inc:lUdl IS In In'urea Il1Iil pBtSOl1 or lll'gMizaUOI1llhownIn the <br />Schedul", but onl~ with respect to lIabUlly wing out of yaLJr ongDlngllporlltlonlll'srform9d?'or thai inllured. <br /> <br />i. ( <br />".1 <br />! I.~ It' <br />ill <br />,! <br />,Ii" ~'I <br /> <br />I ! <br /> <br />;% ;2;3 <br /> <br />,1\;1 <br /> <br /> <br />If <br /> <br />Cl. 8i7l30g1) <br />CGZ0100H7 <br /> <br />Co~gh~ 111I,""" SIt'riaeI DIIkll', In.... 1S8G <br /> <br />,.. un <br /> <br />I <br />I <br /> <br />e~;-~ ~OO/~OO'd 9!1-! <br /> <br />_WOJ~ wOIO: II ~OOI-II-AON <br />