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06/14/2004 15:03 <br /> <br />2129864713 <br />POLICY NVMER: HDO G20591365 <br />COMMERCIAL GENERAL LIABILITY <br />THIS ENDORSEMENT CHANGES THE POLICY. PLEASE REAI) IT CAREFULLY. <br />ADDITIONAL INSURED - OWNERS, LESSEES <br />OR CONTRACTORS.(FORM B) <br />This endorsement modifies Insurance provided under the following: <br />COMMERCIAL GENERAL LIABILITY COVERAGE PART <br />SCHEDULE <br />1. Name of Person or Organization: , <br />THE CIT'Y' OF SANTA ANA, ITS OFFICERS, EMPLOYEES, VOLUNTEERS AND <br />REPRESENAMBS <br />(If no entry appears above, Information required to Complete this endorsement will be shown in the Declarations as <br />applicable to this endorsement.) <br />WHO IS AN INSURED (Section 11) is emended to Include as an Insured the person crorganitation shown In the <br />Schedule, but only with respect to liability arising out of "your work" for that insured by or for you. <br />i <br />APPZZOVLU i=O".Ii <br /> <br />LEGAL DEPT PAGE 03/05 <br />CG 20 10 11 85 Copyright, Insurance Services Office, Inc., 1964