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<br />~~Ul1/2003 14:34 FAX _ <br /> <br />. <br /> <br />GOLDEN EAGLE INSURANCE . <br /> <br />IgJ002 <br /> <br />ADomONAL INSURED - OWNERS, LESSEES <br />OR CONTRACTORS (FORM B) <br /> <br />PollcyNo~ CBP9667121 <br /> <br />ADDmONA,L INSURED. OWNERS, LESSEES <br />OR CONTRACTORS (FORM B) <br />. . THIS ENDORSEMENTCIfAll!c;ES TilE ~OUCY. PLEASE READ IT CAREFULLY. <br /> <br />POlicy No: CBP9667121 <br /> <br />This ..ndors..ment modifies insurance provided under the following: <br /> <br />COMMERCIAL GENERAL LIABIUTY COVERAGE PART <br /> <br />WHO IS AN INSURED (Section ;q is .amended to include g an Insured the person Dr organization sho\Yl1 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 edditionallnsured does not apply to any project on whid> "your wo"''' waS completed <br />;;;.h;;:;- ~ ~:.= ~~~~'".::;:: ~.....~ cl!..~!!' ~tj"n;:f!m@nt. <br /> <br />~r:""'Fnlll 1= <br />City of Santa Ana, its officers and~employees <br /> <br />CC 20 1a [11-85) I/Iocllfted <br />CECG M1 (10.aB) <br />