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<br />06/~/2004 16:03 FAX 4155417108 <br /> <br />ACORDIA OF CA <br /> <br />III 003 <br /> <br />POLICY NUMBER: Everest Indemnity Insurance <br />51 GL000501-041 <br /> <br />COMMERCIAL GENERAL LIABILITY <br />CG20101001 <br /> <br />THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. <br /> <br />ADDITIONAL INSURED - OWNERS, LESSEES OR <br />CONTRACTORS - SCHEDULED PERSON OR <br />ORGANIZA rlON <br /> <br />Thill endorsement modifies insurancllI provided unaer the following: <br /> <br />COMMERCIAL GENERAL LIABILITY COVERAGE PART <br />SCHEDULE <br /> <br />Name of Person or Organization: <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 11- Who hi An Insured is amended to Include as an insured the person or organization shown in <br />tha Schedule, but only with respect to liability arising out of your ongoing 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 ihe injury or damage arises has baen put to iis Iniended <br />use by any person or organization other than another contractor or subconiractor engaged in <br />performing operations for a principal as a part of the same project. <br /> <br />I ~ (..'w;; c';{; .2/3 <br />1/(:.:1'\" / - <br /> <br />CG 20 10 1001 <br /> <br />Copyright, ISO Properties, Inc., 2000 <br /> <br />Page 1 of 1 <br />