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Policy Number: BKO1565160 <br />Owners Lessees or Contractors (Form B) <br />ADDITIbNAL INSURED <br />Change(s) Effective: 12/28/04 <br />THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT <br />CAREFULLY. This endorsement modifies insurance policy under the following: <br />LIABILITY COVERAGE PART: <br />Schedule <br />Name of Person or Organization: <br />City of Santa Ana <br />Attn: Vincent Fergoso <br />P.O. Box 1988 <br />Santa Ana, CA 92702 <br />SECTION II - WHO IS AN INSURED is amended to include as an insured the <br />person or organization shown in the Schedule, but only with respect to liability <br />arising out of "your work" for that insured by or for you. <br />City of Santa Ana, its officers, employees, agents, volunteers and <br />representatives are named as an additional insureds as respects <br />general liability for claims arising from the operations of the named <br />insured. <br />PRIMARY INSURANCE: <br />IT IS UNDERSTOOD AND AGREED THAT THIS INSURANCE IS PRIMARY <br />AND ANY OTHER INSURANCE MAINTAINED BY THE ADDITIONAL INSURED <br />SHALL BE EXCESS ONLY AND NOT CONTRIBUTING WITH THIS <br />INSURANCE. <br />SEVERABILITY OF INTEREST: <br />IT IS AGREED THAT EXCEPT WITH RESPECT TO THE LIMIT OF INSURANCE, THIS <br />COVERAGE SHALL APPLY AS IF EACH ADDITIONAL INSURED WERE THE ONLY INSURED <br />AND SEPARATELY TO EACH INSURED AGAINST WHOM CLAIM IS MADE OR SUIT IS <br />BROUGHT. <br />APPROVED AS TO FORM <br />— a Sh d <br />Assistant City Attornc>' <br />CL/BF 22 40 03 95 <br />