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<br />.!-p'3.ill/2003 14: 34 FAX _ <br /> <br />. <br /> <br />GOLDEN EAGLE INSl~CE 4IIl <br /> <br />IilI 002 <br /> <br />" <br /> <br />ADDmONAL INSURED. OWNERS, LESSEES <br />OR COKfRACTORS (FORM B) <br /> <br />Policy No: CBP9667121 <br /> <br />ADDmONAL II\ISURED . OWNERS, LESSEES <br />OR CONTRACTORS (FORM B) <br /> <br />. . THISENDORSEMENLCtlANGES THE POUCY. PLEASE READ IT CAREFULLY. <br /> <br />POlicy No: CBP9667121 <br /> <br />This endorsement modifies insurilnctl provided under the foll....ing: <br /> <br />COMMERCIAL GENERAL LIABILITY COVERAGE PART <br /> <br />WHO IS AN iNSURiOD (Section II) i. ;mended to jnclude as an Insured the persorl or organization shown In the <br />Schedule, but only with respec! to liability arising out of "your work" for that I""u....d by or for you. <br /> <br />The coverage afforded the edditionallnsuRd does not apply to any project on wh~h "your work" waS completed <br />;;0.;;. ~ ;,;:= :?ff;:~~~!;: ....et!!! cl th!~ l!n~"n;;Ament <br /> <br />~r.:\.IFnll1-': <br />City of Santa Ana, its officers and~employees <br /> <br />Cll 20 10 (110115) I'odlned <br />GECG 801 (10088) <br />