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<br />-,---E.3./1l/2003 14:34 FAX _ <br /> <br />. <br /> <br />GOLDEN EAGLE INSURANCE 4IIf <br /> <br />Ii!I 002 <br /> <br />. <br /> <br />ADomoNAL INSURED - OWNERS, LESSJ;:ES <br />OR CONTRACTORS (FORM B) <br /> <br />POlicy No: CBP9667121 <br /> <br />ADomONAL INSURED. OWNERS, LESSEES <br />OR CONTRACTORS (FORM B) <br />_ . THIS ENDORSEMENLCt!AIIIG~l;.S THE POUCY. PLEASE READ IT CAREFULLY. <br /> <br />POlicy No: CBP9667121 <br /> <br />This endorsement modilles insurance provided under the following: <br /> <br />COMMERCIAL GENERAL LIABIUTY COVt:RAGE PART <br /> <br />WHO IS AN iNSURED (Section II) is amended to include as an Insured the person or organization shown In the <br />Schedule, bul only with respect 10 liability arising out of "your work" for that Il15ured by or for you. <br /> <br />The coverage afforded the edditional Insu..... does not apply 10 any project on which "your work" was completed <br />;;.;.;::. ~ ~:-a ~'ffi:~:a.,..~ ":"-!~ cl't.i'!!5 ~~~n::Ament. <br /> <br />';~I-IFntn1= <br />City of Santa Ana, its officers and~employees <br /> <br />co 20 10 (110115) IIodllled <br />Geca 801 (10088) <br />