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[FEB. -1 <br />10:33 <br />TEL:714 373 1234 <br />P.003/0101; <br />I' <br />POLICY ijI,UMBER: 72 UUN UR teas COMMERCIAL GENERAL LIABILITY <br />I1 i III 1 I 'I <br />THIS ENDORSEMENT CHANGES THE POLICY, PLEASE READ IT CAREFULLY. <br />ADDITIONAL. INSURED - OWNERS, LESSEES OR <br />CONTRACTORS (FORM B) <br />This endorsement modifies insurance provided under the following: <br />COMMERCIAL GENERAL LIABILITY COVERAGE PART. <br />SCHEDULE <br />Name of Person or Organization <br />The City of Santa Ana, 20 Civic Center Plaza, Santa Ana, California, 92702, its officers, <br />employees, agents and volunteers <br />(It 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 />i organizatio'jt shown in the Schedule, but only with respect to liability arising out of "your work" for <br />F I that Insured by or for you. <br />This insurance is primary with respect to the interests of the above additional insured(s), and any <br />other insurance maintained by or behalf of the above additional insured is excess and not <br />contributory with this Insurance. <br />APPROVEZ) AS TO WRM <br />ASSISLdn[ LILY ILLorney <br />I II I <br />C62o 10 11 85 Copyright insurance Services Office, Inc., 1984 <br />