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t ' FEB 23, 2005 <br />FIR: ESTHER MYERS <br />#53562 PAGE: <br />POLICY NUMBER: NC382364 <br />NAUTILUS INSURANCE COMPANY <br />LIABILITY ENDORSEMENT <br />THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. <br />ADDITIONAL INSURED ENDORSEMENT <br />This endorsement modifies insurance provided under the following: <br />COMMERCIAL GENERAL LIABILITY COVERAGE PART <br />SCHEDULE <br />Name of Person or Organization: Premium $ 250 <br />City of Santa Ana Community Development <br />P.O. Box 1988 <br />Santa Ana, CA 92702-1988 <br />WHO IS AN INSURED (Section 11) is amended to include as an insured the person or organization shown in <br />the Schedule and only for liability arising out of your negligence and only for occurrences or coverages not <br />otherwise excluded in the policy to which this endorsement applies. <br />Your policy is primary in the event of an occurrence caused by your sole negligence as respects the job <br />described below: (MUST BE COMPLETED) <br />Job Description: <br />Comedy Productions <br />AN other Terms and Conditions of this Insurance remain unchanged. <br />APPROVED AS TO FORM <br />z/ <br />Laura Stitt She�:dy <br />--- <br />Assistant City Attorney <br />S 114 (04/97) <br />