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<br />Ma~ 17 05 02:29p <br /> <br />T11ag1 <br /> <br />p.4 <br /> <br />Policy Number: BK01461996 <br /> <br />Owners..... Lessees or Contractors (Form B) <br />ADDITluNAL INSURED <br /> <br />Change(s) Effective: 05/09/05 <br /> <br />THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT <br />CAREFULLY. This endorsement modifies insurance policy under the following: <br /> <br />LIABILITY COVERAGE PART: <br /> <br />Schedule <br /> <br />Name of Person or Organization: <br /> <br />The Depot of Santa Ana <br />Attn: carolyn Fullerton <br />1000 E. Santa Ana Blvd., #108 <br />Santa Ana, CA 92701 <br /> <br />SECTION II - WHO IS AN INSURED is amended to include as an insured the <br />person or organization shown in the Schedule, but only with respect to liability <br />arising out of "your work" for that insured by or for you. <br /> <br />The City of Santa Ana, its officers, employees. agents and <br />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 />. ') A" TO fORM <br />APPROVb< " <br />, fC/( /') <br />'--- - ,)~2-2-L~---~- <br />La/ra SliU ~)hccdy <br />A::isistant City ;\\1'_lrn~:\ <br /> <br />CLlBF 22 40 03 95 <br />