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<br />~~3411/2003 14:34 FAX _ <br /> <br />. <br /> <br />GOLDEN EAGLE INSURANCE . <br /> <br />141002 <br /> <br />. <br /> <br />ADDmONAL INSURED - OWNERS, LESSEES <br />OR COtrrRACTORS (fORM B) <br /> <br />Policy No~ CBP9667121 <br /> <br />ADDmONAL INSURED. OWNERs, LESSEES <br />OR CONTRACTORS (FORM B) <br /> <br />. . THIS ENDORSEMENT CIlA/IIG_ES TH.E. POUCY. PLEASE READ IT CAREFULLY. <br /> <br />POlicy No: CBP9667121 <br /> <br />This endorsement modifies InsuranC$ provided under the following: <br /> <br />COMMERCIAL GENERAL LIABIUTY COVERAGE PART <br /> <br />WHO IS AN iNSURED (Section lQ is ;;men:lad to include as an Insured the parson or organizallon shown In the <br />Schedule, bulonly with respecllollability erlsing out of "your .00"'" for that Insured by or for you. <br /> <br />The coverage afforded the eddilionellnsured does not apply to ..ny proia'" on which "your .00"''' was completed <br />j;r;;. ~ ~~= ::'ffi:~~-.:~ ::!~~ ~~ t~~'! '!o!"!~t:'In;;p-ml!nt. <br /> <br />!C:r.:WFnlltW: <br />City of Santa Ana, its officers and~employees <br /> <br />co 20 10 (11.eS)lIodllled <br />c.co 801 (10-88) <br />