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<br />POLICY NUMBER: 57CESOA1659 <br /> <br />COMMERCIAL GENERAL LIABILITY <br /> <br />THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CARE FULL Y. <br /> <br />ADDITIONAL INSURED - OWNERS, lESSEES or <br />CONTRACTORS (FORM B) <br /> <br />This endorsement modifies insurance provided under the following: <br /> <br />COMMERCIAL GENERAL LIABILITY COVERAGE PART <br /> <br />SCHEDULE <br /> <br />Name of Person or Organization: <br /> <br />City of Santa Ana <br />Att: Kent Jorgensen <br />Public Works Agency <br />20 Civic Center Plaza; PO Box 1988 M36 <br />Santa Ana, CA 92702 <br /> <br />(If no entry appears above, information required to compiete this endorsement will be shown in the Declarations <br />as applicable to this endorsement.) <br /> <br />WHO IS AN INSURED (Section II) is amended to include as an insured the person or organization shown in the <br />Schedule, but oniy with respect to liability arising out of "your work" for that insured by or for you. <br /> <br />Additional Insured Continued: its officers, employees, agents, <br />volunteers and representatives <br /> <br />PRIMARY INSURANCE: <br />IT IS UNDERSTOOD AND AGREED THAT THIS INSURANCE IS PRIMARY <br />AND ANY OTHER INSURANCE MAINTAINED BY THE ADDITIONAL INSURED <br />SHALL BE EXCESS ONLY AND NOT CONTRIBUTING WITH THIS <br />INSURANCE. <br /> <br />APPROVED AS TO FORM <br /> <br />FxS :; J) <br />Laura Stitt Sheedy <br /> <br />\,~j,~ (,) <br /> <br />','; <br /> <br />CG 201011 85 <br />