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INSURED: Wiseplace, a Ca Corp <br />POLICY NUMBER: PUPK068383 <br />EFFECTIVE DATE: l/l/04 <br />THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY <br />ADDITIONAL INSURED —DESIGNATED PERSON OR ORGANIZATION <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, its officers, agents, employees, and volunteers <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 H) is amended to include as an insured the person or <br />organization shown in the Schedule as an insured but only with respect to liability arising out of <br />your operations or premises owned by or rented to you. <br />APPROVED AS TO FORM <br />Laura S[i t Sheerly <br />Assistant City Attorney <br />CG 20 26 1185 <br />