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<br />POLICY NUMBER: <br /> <br />Everest Indemnity Insurance <br />51GL000501-051 <br /> <br />COMMERCIAL GENERAL LIABILITY <br />CG 20 10 1001 <br /> <br />THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. <br /> <br />ADDITIONAL INSURED - OWNERS, LESSEES OR <br />CONTRACTORS - SCHEDULED PERSON OR <br />ORGANIZATION <br /> <br />This endorsement modifies insurance provided under the following: <br /> <br />COMMERCIAL GENERAL LIABILITY COVERAGE PART <br /> <br />SCHEDULE <br /> <br />Name of Person or Organization: City of Santa Ana its officers, employees, agents, volunteers and <br />representatives <br /> <br />Is included as an additional insured when required by written contract. <br /> <br />(If no entry appears above, information required to complete this endorsement will be shown in the <br />Declarations as applicable to this endorsement.) <br /> <br />A. Section II - Who Is An Insured is amended to include as an insured the person or organization shown in <br />the Schedule, but only with respect to liability arising out of your ongoing <br />operations performed for that insured. <br /> <br />B. With respect to the insurance afforded to these additional insureds. the following exclusion is added: <br /> <br />2. Exclusions <br />This insurance does not apply to "bodily injury" or "property damage" occurring after: <br /> <br />(1) All work, including materials, parts or equipment furnished in connection with such work, on the <br />project (other than service, maintenance or repairs) to be performed by or on behalf of the additional <br />insured(s) at the site of the covered operations has been completed; or <br /> <br />(2) That portion of "your work" out of which the injury or damage arises has been put to its intended <br />use by any person or organization other than another contractor or subcontractor engaged in <br />performing operations for a principal as a part of the same project. <br /> <br />APPROVED AS 'ro . <br />, f~ORM <br />\ /Js.?o ; <br />~2~) </,(,/ <br />UiUla Sill! :')ht:cdy <br />ASsIStaUL CHy Al[ <br />orrwy <br /> <br />CG 20 10 10 01 <br /> <br />Copyright, ISO Properties, Inc., 2000 <br /> <br />Page 1 of 1 <br />