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<br />~ OOJ/OOJ <br />...... ~ ....;,~ ..f?,..,tl::.... ".i <br /> <br />... ""'"'';:IIl!'..!',z~ PD.2..",cc' ".~.n ~. c, <br /> <br />POLICY NUMBER: 6320019316 00 <br /> <br />COMI\EiIC/Al. GENERAl. UABllITY <br />CG20 10 1001 <br /> <br />llflS ENDORSEMENT CHANGES THE POUCY. PlEASE READ IT CAREFULLY. <br /> <br />ADDITIONAL INSURED - OWNERS, LESSEES OR <br />CONTRACTORS - SCHEDULED PERSON OR <br />ORGANIZATION <br /> <br />This Dodo""""",,, modifies Insurance prolllded under l/le following: <br /> <br />COMMERCIAL ,GENERAL UABllllY COVERAGE PART <br /> <br />SCH"DULE <br /> <br />_ or """"""' or OIpJizallon; <br />CITY OF SANTA ANA <br />PROJECT LOCATION: 1000 E. SAlSITA ANA BLVD. # 108 <br />1000 E. SANTA ANA BLVD. # lOB <br />SANTA ANA, CA USA 92101-0000 <br /> <br />(If no enlJy appeom above, information required to compl918 IIl1s entlorsemen' will bs shown in Ihe Declarations <br />lIS appllc8ble '" this endorsement) <br /> <br />A. Sedion n - Who I. An 1_ Is armndod to <br />inolude ... en Insured the pers"" or orgenTl:aIion <br />shown In lhe Sd1edule. but only with raspect to <br />UiIlllllly artsiog out of your ongoing ope/aHons <br />performed ror thai iosured. <br /> <br />8. Wil~ "'.pecl 10 lhe insurance atforded to lI18se <br />odd/dona! Insuneds. Ihe lollowlng ""cfusion Is <br />aided: <br /> <br />2. ElldWlions <br /> <br />This insurance doe. not applv to "bodily In- <br />jJryR or .properrv danage'" occurring after: <br /> <br />(1) All work, Indutljng maIIlrHIIs. palls Of <br />eqUlpmBnt furnIshed In connection <br />with such woll<. on lIle project (01119' <br />Ihan aervlc:a, mainl9nance or 1Bpait.) <br />10 be perlormod by 0< 01'1 be/1a11 or 1he <br />odditional Insured(s) at 'he Bile 01 the <br />rovered operaUons ~... been corn- <br />p1e19d; or <br /> <br />(2) ThaI portion or "your work" out 01 <br />~ictI I~e In)u/)' or dllrl18(le 8,1"". has <br />been put to ilB intended use by any <br />p9rsan or organJz:atlon other Ulan 8IlR <br />other conlractor or subcontractor en~ <br />98QAd in performing operations tor 3 <br />principal Q9 ,8 pari ollho same proJect. <br /> <br />CG 20 10 10 01 <br /> <br />o ISO P,operti... loc.. 2000 <br /> <br />Pagel 011 <br /> <br />o <br /> <br />'\PPROVED A~~;XQ"FORM <br /> <br />'-/~ '? ? / 2. <br /> <br />----.--- ._-;~:;~ (Stit-t Sheedy <br />,\sistant City Attorney <br /> <br />~~,;:;.:~- <br /> <br />'~C1\'C:or'.' <br /> <br />'-;-:-:'.",~:r:"7" <br /> <br />":~:';~:'.'~" <br /> <br />"',,-"~"'~'....~.:-~" <br />