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<br /> <br />DATE (MM/DDIYY) <br />12/28/04 <br /> <br />PRODUCER <br />MARSH RISK & INSURANCE SERVICES <br />P O. BOX 193880 <br />S~N FRANCISCO. CA 94119-3880 <br />CALIFORNIA LICENSE NO. 0437153 <br /> <br />COMPANY <br />E AMERICAN INTERNATIONAL SOUTH INSURANCE CO. <br /> <br />MISC .UNITE-W/PRO- U1T CA <br /> <br />COMPANY <br />F <br /> <br />INSURED <br />UNITED INSPECTION & TESTING INC <br />22620 GOLDENCREST DRIVE, SUITE 114 <br />MORENO VALLEY, CA 92553 <br /> <br />COMPANY <br />G <br /> <br />COMPANY <br />H <br /> <br /> <br />Note: This is the usual form we use and it fulfills the legal requirement of Form CG2010 11 85. <br />POLICY NUMBER: GL 933-3116 <br /> <br />COMMERCIAL GENERAL LIABILITY <br /> <br />THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. <br /> <br />ADDITIONAL INSURED - OWNERS, LESSEES OR CONTRACTORS <br />- SCHEDULED PERSON OR <br />ORGANIZATION <br /> <br />This endorsement modifies insurance provided under the following: <br />COMMERCIAL GENERAL LIABILITY COVERAGE PART. <br /> <br />SCHEDULE <br /> <br />Name of Person or Organization: <br />WHERE REQUIRED BY INSURED CONTRACT <br /> <br />--.-----------.----------------------------------------------------.------------------------------------.-..---------..--------..---.------.----.--------.------------.-..----------------. <br /> <br />----------....----------------.--.-----------.--------------.--..------------..-----------..----.-..----------------.--------.....-------.-.----------------------..--.-.---------...._---- <br /> <br />(If no entry appears above, information required to complete this endorsement will be shown in the Declarations <br />as applicable to this endorsement.) <br /> <br />A. Section II. Who Is An Insured is amended to (1) All work, including materials, parts or <br />include as an insured the person or organization equipment furnished in connection with <br />shown in the Schedule, but only with respect to such work, on the project (other than <br />liability arising out of your ongOing operations service, maintenance or repairs) to be <br />performed for that insured. performed by or on behalf of the additional <br />insured(s) at the site of the covered <br />operations has been completed; or <br /> <br />B. With respect to the insurance afforded to these <br />additional insureds, the follOWing exclusion is added: <br /> <br />2. Exclusion <br />This insurance does not apply to "bodily in- <br />jury" or "property damage' occurring after: <br /> <br />(2) That portion of "your work" out of which <br />the injury or damage arises has been put <br />to its intended use by any person or <br />organization other than another contractor <br />or subcontractor engaged in performing <br />operations for a principal as a part of the <br />same project. <br /> <br />PRIMARY INSURANCE <br /> <br />Such insurance as is afforded by this endorsement for the additional insureds shall apply as primary insurance. Any other insurance maintained by the <br />additional insureds or its officers and employees shall be excess only and not contributing negligence on part of the additional insureds. <br /> <br />CG20101001 <br /> <br />APPROVED AS TO FORM <br /> <br />'I~ Z/2 <br />Laura Stitt Sheet) <br />Assistant C:: <br /> <br />CITY OF SANTA ANA <br />PUBLIC WORKS AGENCY <br />CONSTRUCTION ENGINEERING <br />P.O. BOX 1988/M-22 <br />SANTA ANA, CA 92702 <br /> <br /> <br /> <br /> <br />MARSH USA INC. <br />BY: Mlchio Nekota <br /> <br />'b.dL-JULL <br /> <br /> <br />