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<br />DEC-12-Z0e5 07:05 AM TSI <br />.. . <br /> <br />949+852+8441 <br /> <br />P.0Z <br /> <br />. <br /> <br />ADDmONAL INSTJRRn ENDORseMENT <br />FOR C:OMURIlt'TAT. O~~ LIABIUTY POT Tt"V <br /> <br />~Com~ ~ ~~.t... , I~ S vftqNC:E <br /> <br />Tbla 1Ddor-.t modi&. IIIIllh laII\I:uco II ill atlimicd IIy the proviliollf of Policy <br />1# "Rl(cl 1;'''' 2-1./ q relatlDa to !he fonDwiII~ <br /> <br />1. 'I'M City otSlDta AlII. 20 Clvla CeII_ Pl_ SIIlIta AM. Californill92701; itt <br />omcen.lllJpl~ aaenu. volunteers IIId 1.."._n1atfv. are named II additional inllll'ed. <br />("l4Sditioaallll__") with IWpId to lilbility IIIll cW'eIIM or lUilllrillq from the operation. <br />IIId .. !""r~ by or OD bebIlf oftbe lIIlDtd inllftd. <br /> <br />], With rapect to cWme WIDa out of tho opaatione and IIIlII performed by or on <br />bcb&Itofthllllllled IuInd, I1IIlh iDIUr_ II IIIft'wded by 1111. policy ia prillllllY IIIlI il not <br />IIdditioaalto or llDlllrillutlna with lilY oIhtr m- curled by or Cor the benefil of \he <br />aIltIoIlIIlAtundII. <br /> <br />3. Tbis inIurmIce applIee IllpIra1ely to eech iDIurecl eaailllt whom clBim il made or <br />lIIIit iI brouabt except with rapect to the COIDIJIIIy'llimlll of Iilblllty. The lncllllion of III)' <br />penon or orp"lallioA 11l1li illllll'ed shaI1l1Ot deoIlIIY riaht which .uch pmon or orllllization <br />lIIO\llcl havCllI . clllmmt If JIlIt 10 inc1wW. <br /> <br />4. With IWJ*l to lira MdJtt-J iDIur~, diU illlurane4llhall not b4l11&n<lllned, or <br />IlIIteriaIly IWIacecIIn ccmnp or limlu IXcept efter thirty (30) ~ys written notice hH beea <br />pOQ to Ihe Ci17 of s.ta ADa, 20 CIYie CeDlillr Plea, !uta AIle, Califilmla 92 70 1. <br /> <br />(Compltiticm oftbe fbllowlq. iDoludil'l ~ II Nqllirecl to make thl, endorIemenl <br />~w.) <br /> <br />Eft'OllIivt '0- 0 I. ~Oo .S: <br />PoIloyt 'Il~ dl <j'(" I'L~ '1 <br />Iaued. to --r-R..A. I'll ""lL I..... ~ .ON <br /> <br />. thi, IlldorMmeat form .. I part of <br /> <br />.s:?ru"b,~'~ JIVC- <br />NIIIIId IIIIIIIIeCI <br /> <br />~b~ <br /> <br />~~ ~?Iz. <br /> <br />lIO"d <br /> <br />os: ~t SOO~ 6 ~8(] <br /> <br />~~8S-l~-~tl:XVj ~ )l1Bnd - ~ SAil) <br />