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<br />.____ 03/20/2005 14: 38 <br /> <br />3235504231 <br /> <br />i-1UM4t'i R!::5CJd~CES <br /> <br />PAGE 04 <br /> <br />POLICY NUMBER PHPK104336 <br /> <br />COMMERCIAL GENERAL LIABILITY <br /> <br />THIS ENDORSEMENT CHANGES THE POLICY. PLEASe ~EAD IT CAREFULLY. <br /> <br />ADDITIONAL INSURED - DESIGNATED PERSON OR <br />ORGANIZA liON <br /> <br />This endorsement modifies insuranee provided under 1M 101l0w1ng <br /> <br />COMMERCIAL GENERAL LIABILITY COVERAGE "'ART <br /> <br />Name of P....on or Organiution: <br />City of Santa Ana <br /> <br />ScheClula: <br /> <br />PO Sol( 1'188 <br />Sant. Ana. Clio 92702 <br />(If no entry appears above, inlormabon required to oomple!e this "naorsemen! will be shown In the <br />Deelarallons III. applicable to thia endorsement) <br /> <br />WHO IS AN INSURED (Section II) is amended to include as an 'n!;ured the pe!1lon or organization ahown <br />il'1 the Schedule as an,nsured but only with respect (0 the liability ariaing oul of your operationa or <br />premisea owned by or rented to you. <br /> <br />APPROVED AS TO FORM <br /> <br />~'''':-' / <br />-<;;1':5 f 3 <br />Laura Slill Sheedy <br />Assistant City Attorney <br /> <br />CO 20 26 11 85 <br /> <br />COPYrlllht, Insura""" Services Office, Inc , 1964 <br /> <br />. <br />