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<br />Policy Number: BK01565403 <br /> <br />ownersbLessees or Contractors (Form B) <br />ADDITI NAL INSURED <br /> <br />Change(s) Effective: 10/19/05 <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 Dr Organization: <br /> <br />City of Santa Ana <br />Clerk of the City Council <br />20 Civic Center Plaza(M-30) <br />P.O. Box 1988 <br />Santa Ana, CA 92702-1988 <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 />City of Santa Ana, its officers, employees, consultants, special <br />council and representatives <br /> <br />WAIVER OF SUBROGATION: <br />IT IS UNDERSTOOD AND AGREED THAT THE COMPANY WAIVES THE RIGHT OF <br />SUBROGATION AGAINST THE ABOVE ADDITIONAL INSURED(S), BUT ONLY AS RESPECTS <br />THE JOB OR PREMISES DESCRIBED IN THE CERTIFICATE ATTACHED HERETO. <br /> <br />APPROVED AS TO FORM <br /> <br />CLlBF 22 40 03 95 <br /> <br />~ytj <br /> <br />taura Stitt SI,ocJy <br />^~::iistailt City Altorney <br />