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<br />. 93.111/2003 14: 34 FAX <br />------- <br /> <br />. <br /> <br />GOLDEN EAGLE INSURANCE 4IIl <br /> <br />ADomONAlINSURISD - OWNERS, LESSEES <br />OR CONTRACTORS (FORM B) <br /> <br />Polley No: CBP9667121 <br /> <br />POlicy No: CBP9667121 <br /> <br />ADomONAL INSURED. OWNERS, LESSEES <br />OR CONTRACTORS (FORM B) <br />. THIS ENDORSEMENT Ct!AI'IGIE;;SYIi!,l'OLlCY, PLEASE READ IT CAREFULLY. <br /> <br />ThIs endoJSement modifies insulilnC$ provided under the following: <br /> <br />COMMERCIAL GI!NERAL L.IABIUTY COVERAGE PART <br /> <br />IiIJ 002 <br /> <br />WHO IS AN iNSURED (Seelio" 11) I. amended to include .... an Insured the pe""'rl or organization shown In the <br />S"hedul., bul only w1Ih respect 10 liability arising OUl of "your work" for that Insured by or for you. <br /> <br />Th. COverage afforded the additional Insured does nol apply 10 any project on whid> "yoUr work" waS completed <br />;;Yo;';;:":':': tl'":'l!:- :=ff;:~~""~ :;!~!: ~t.~!5 ~~t:'I"'Rml!nt. <br /> <br />~f"!:...~n111 ~ <br />City of Santa Ana, its officers and~employees <br /> <br />CG 20,a [""5) lo'Iodll\ed <br />GEeG eo, ('04.) <br />