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POLICYNUMBER: P63050OD409204 COMMERCIAL GENERAL LIABILITY <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 />cZya011l11l1111a <br />Name of Person or Organization: <br />City of Santa Ana, Planning Division <br />Ms. Maya DeRose <br />20 civic Center Plaza, Ross Annex Bldg 2nd FL <br />PO Box 1988, M-20 <br />Santa Ana, CA 92702-1988 <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 II) is amended to include as an insured the person or organization shown in the <br />Schedule, but only with respect to liability arising out of "your work" for that insured by or for you. <br />Name of Person or Organization Continued: its officers, employees, <br />agents, volunteers and representatives <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 />SEVERABILITY OF INTEREST: <br />IT IS AGREED THAT EXCEPT WITH RESPECT TO THE LIMIT OF INSURANCE, THIS <br />COVERAGE SHALL APPLY AS III' EACH ADDITIONAL INSURED WERE THE ONLY INSURED <br />AND SEPARATELY TO EACH INSURED AGAINST WHOM CLAIM IS MADE OR SUIT IS <br />BROUGHT. <br />APPROVED AS `I'O FORM <br />Laura Stitt Sheedy <br />Assistant City Atiornc% <br />CG 20 10 11 85 <br />