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<br />02~~::3,0~!..r'!'-~.:::;.~. FAX 714+565 4020 CITY OF SANTA ANA ~~~ CITY ATTORNEY <br />. . <br /> <br />I4J 002/002 <br /> <br />OCI.I""... <br /> <br />01/28/Z005 08:51 F&I <br />3&" 29 05 09;34~ <br /> <br />Tlt"Cl <br /> <br />fill 001/001 <br />~. 1 <br /> <br />ç\.L. <br />~". <br />9."""'..11... <br />;", <br /> <br />. . <br />THIS SHEET MUST BE COMPLeTED AND ACCOMPANY <br />THE CER, """.LCATe OF INSU~NCE <br /> <br />T'd <br /> <br /> <br />ADDmONAL INSURED ENDORSEMENT <br /> <br />InsuliIl1œc:ompany .AMERlCAN SAFETY RRS c/o THO/1CO <br /> <br />This endo.-semenl moc!ifj~ suct'l insuranc:e as b illforded Þy the .:¡rOYlsions of <br />POlicy NO.PC0041769t2!1l3 Rllatingla the following: . <br /> <br />,. <br /> <br />Tno city "" SilO'Ita Ana, 20 Civic Center Plam, Santa Ana, California 82701. Its <br />OlflCØlS, employees, agenl!l, and repJe58ntBllvli!s are nemli!d as additIonal <br />insureds ("additional il1l5urøds") wi1h resaid 10 Jiabilit)l anCl dot.nero 01 sullS arising <br />lrom the operations and usee performed by or on ~NI" of the mimed inllUm, <br /> <br />Wi'" respect to claims artslng oul at - Dp8lil!lonS and uses pertormed by or an <br />bend of the named Insured. such Insurance as Is afforded by this poliCY 1$ <br />primary and i$ not additional to Dr conUlbuling with Bny other insurance canied <br />by or tor the benefit of ,he ßClClIUonal insurecfS. <br /> <br />2. <br /> <br />3. <br /> <br />11\15 Insurance ~lie5 separlllely to eaGh in.....red against \'\/horn claim is made or <br />suit is brought except with r85 )ðCII to the company's limits of lIaÞillty. Thll <br />inclusion 01 sny person or arganlJ!8tlon M ar1 insul'Ðd shall not aliect any right <br />whioll such person or organiZ3tion would have U a dalman! if not SO included. <br /> <br />4. <br /> <br />W"h resp8Ctto 11'\8 aad"otig,..1 insureds. "I¡II Irmurance shall nat bil cancelled or . <br />materlølly redl1ecd in cowr. or Mmhs exc:epl alter Ihirty (30) days written not~e <br />. I'Ia& been given to the City of San1a Ana, 2Q Civic Center PIaU. Sa:n,- Ana. <br />. CaliltJrnia 92701. <br /> <br />.. <br /> <br />(Compl"tion gf Ihe !ollowlng, including countersignature, is required to malw this <br />D"dorsemertt IIffecd"...) <br /> <br />eff9cù"" -... ~ANUARY 26. 2005 <br />poncy No. PCOO41769~ 2~13 <br /> <br />. this endorsemoO'lt torrn is a part of <br /> <br />Issued 10 <br /> <br />~RANk II Plnr^.~~TF~M'NðTjUr- TNr <br />NameCllnsured <br /> <br />.~ <br /> <br /> <br />w.:øa:n:;CMinO~.r"'''''''''lòe'''lIi~ ''I~11I <br /> <br />APPROVED AS TO FORM <br /> <br />)z:8?'f;/ / 2- <br />.Y Laura Stitt Sheedy <br />Assistant City Attornev <br />R~O~~O ~O ttQ~~ <br /> <br /># <br /> <br />r <br />~ <br /> <br />!HIE:DLÞB~9S <br /> <br />SUI tt""PT":;¡ <br />