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<br />~ --p'3ill/2003 14: 34 FAX _ <br /> <br />. <br /> <br />GOLDEN EAGLE INSURANCE 4IIl <br /> <br />IilJ 002 <br /> <br />. <br /> <br />ADDmONAL INSURED - OWNERS, LESSJ;:ES <br />OR CONTRACTORS (FORM B) <br /> <br />PollcyNo~ CBP9667121 <br /> <br />ADDmONAL INSURED. OWNERS, LESSEES <br />OR CONTRACTORS (FORM B) <br /> <br />. THISENDORSEMENTCIfAJ\IGES JHEPOLICY. PLEAS!! READ IT CAREfUU Y. <br /> <br />POlicy No: CBP9667121 <br /> <br />ThIs endorsement modilles Il'lsuranC$ provided under the following: <br /> <br />COMMERCIAL GENERAL LIABJUTY COVERAGE PART <br /> <br />WHO IS AN INSUiU:D (Section ;~ i. ;amended to include ~ an Insured the person or organization shown In the <br />Schedule, but only wlth respect to liability arising out of "your work" for that Insured by or for you. <br /> <br />The coverage afforded the edditionellnsuRd does not apply to any project on whic/l "your wo","' was completed <br />p;r;;. ~ ;;;: ;ffi;~~-.:::: ~~e ~! th!l! i!!'?:~t:'In;;p-m@nl <br /> <br />~1'!:"'Fnlllt= <br />City of Santa Ana, its officers and~employees <br /> <br />CG 20 10 [11-115) lo'Iodlfted <br />GECG 601 (10-88) <br />