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APR -29 -2005 11:06 THE CPMBODIAN FAMILY <br />POLICYNUMBER: PHPKIJD443 <br />714 571 1974 <br />COMMERCIAL GENERAL LIABILITY <br />THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. <br />ADDITIONAL INSURED - DESIGNATED PERSON OR <br />ORGANIZATION <br />This andorsement modifies insurance provided under the following: <br />COMMERCIAL GENERAL LIABILITY COVERAGE PART. <br />SCHEDULE <br />Name of Person or Organlzdlon: <br />CITY OF SANTA ANA, ITS OFFICERS, ITS <br />AGENTS A EMPLOYERS CDGB M•34 <br />(If no entry appears above, information required to complete this endorsement will be shown in the Declarations <br />as applicable to this endorsement) <br />WHO IS AN INSURED (Section ll) is amended to include as an insured the person or organization shown in the <br />Schedule as an insured but only with respect to liability arising out of your operations or premises owned by or <br />rented to you. <br />APPROVED AS TO FORM <br />.-- & 21 <br />Laura Stitt Speedy <br />Assistant City Attorney <br />P. i=t ..'L 14 <br />CG 20 26 11 85 Copyright, Insurance Services Office, Inc., 1984 Page 1 of 1 ❑ <br />