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INSURED: Teen Challenge of So. Ca. Inc. <br />POLICY NUMBER: PHPK130052 <br />EFFECTIVE DATE: 07/19/05 <br />THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY <br />ADDITIONAL INSURED -DESIGNATED PERSON OR ORGANIZATION <br />This endorsement modifies insurance provided under the following: <br />COMMERCIAL GENERAL LIABILITY COVERAGE PART. <br />SCHEDULE <br />Name of Person or Organization: <br />CITY OF SANTA ANA CDBG M-25 <br />COMMUNITY DEVELOPMENT AGENCY <br />PO BOX 1988 M-25, SANTA ANA, CA 92702 <br />RE: FiiNDING <br />(If no entry appears- above, information required to complete this endorsement will be shown in <br />the Declarations as applicable to this endorsement.) <br />WHO IS AN INSURED (Section II) is amended to include as an insured the person or <br />organization shown in the Schedule as an insured but only with respect to liability arising out of <br />your operations or premises owned by or rented to you. <br />APPROVED AS TO FORM <br />Laura Stitt Sheedy <br />Assistant City Attoimw� <br />CG 20 26 11 85 <br />