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Forming a part of <br />Policy Number: CBP9595827 <br />Coverage Is Provided In GOLDEN EAGLE INSURANCE CORPORATION <br />Named Insured: <br />Agent: <br />HENNESSEY JOSEPH (INDIVIDUAL) <br />BOUSE-SHEFFIELD INSURANCE SERV <br />HENNESSEY SHARON (INDIVIDUAL) <br />Agent Code: 4295750 Agent Phone: (714)-692-2282 <br />THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. <br />ADDITIONAL INSURED - OWNERS, LESSEES OR <br />CONTRACTORS - SCHEDULED PERSON OR ORGANIZATION <br />This endorsement modifies insurance provided under the following: <br />COMMERCIAL GENERAL LIABILITY COVERAGE PART <br />SCHEDULE <br />Name Of Additional Insured Person(s) d ,I��n' ori( 0 vered Operations <br />Or Organization(s): t I'�'"�� �, <br />CITY OF SANTA ANA,, B C IMAGO -k CS NCY ) <br />20 CIVIC CENTER PLAZ M3 ', <br />PO BOX 1988 <br />SANTA ANA, CA 9A 02•-1 <br />Information required to complete this Schedule if not shown above, will be shown in the Declarations. <br />A. Section II — Who Is An Insured is amended to include as an additional insured the person(s) or <br />organization(s) shown in the Schedule, but only with respect to liability for "bodily injury", "property damage" or <br />"personal and advertising injury' caused, in whole or in part, by: <br />1. Your acts or omissions; or <br />2. The acts or omissions of those acting on your behalf; <br />in the performance of your ongoing operations for the additional insured(s) at the location(s) designated <br />above. <br />B. With respect to the insurance afforded to these additional insureds, the following additional exclusions apply: <br />This insurance does not apply to "bodily injury" or "property damage" occurring after: <br />1. All work, including materials, parts or equipment furnished in connection with such work, on the project <br />(other than service, maintenance or repairs) to be performed by or on behalf of the additional insured(s) at <br />the location of the covered operations has been completed; or <br />2. That portion of "your work" out of which the injury or damage arises has been put to its intended use by <br />any person or organization other than another contractor or subcontractor engaged in performing <br />operations for a principal as a part of the same project. <br />© ISO Properties, Inc., 2004 <br />CG 20 10 07 04 Page 1 of 1 <br />06/06/2008 9595827 NEUSXRCB3004 PGDM060D J29109 GCAFPPN 00008218 Page 13 <br />