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<br />APR-29-2005 11:06 <br />, <br /> <br />THE CPMBODIAN FAMILY <br /> <br />714 571 1974 <br /> <br />F'.OJ'D4 <br /> <br />POLICY NUMBER: PHPK110443 <br /> <br />COMMERCIAL GENERAL LIABILITY <br /> <br />THIS ENDORSEMENT CHANGES THE POUCY. PLEASE READ IT CAREFUllY. <br /> <br />ADDITIONAL INSURED - DeSIGNATED PERSON OR <br />ORGANIZATION <br /> <br />Thi. endorsement madlfiec insurance provided undllr lIle folowlng: <br /> <br />COMMERCIAL GENERAL LIABILITY COVERAGE PART. <br />SCHEDULE <br /> <br />Harrllt of Person or OrgenlZllllon: <br />CITY OF SANTA ANA, ITS OFFICERS, ITS <br />AGENTS &. EMPLOYERS CDGB M.34 <br /> <br />(If no enll)' appears lIbo.,., information required to complet. this endorsement will be shown in the Oeclaratio"s <br />a. appNClIbIe to lIlis endorsement) <br /> <br />WHO IS AN INSURED (Section II) is amended to Include as an insured the person or organization shown in the <br />Schedule as an ins\.nd but only with respect \0 6abilily arlslng oul of your operations or premises owned by or <br />rented \0 you. <br /> <br />APPROVED AS TO FORM <br /> <br />:/53 z/j, <br /> <br />Laura Stitt Sheedy <br />Assistant City Attorney <br /> <br />CG202tl,,85 <br /> <br />Copyright, Insunt"ce Services Office, Inc., '984 <br /> <br />Page 1 of , <br /> <br />o <br />