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<br /> <br />PRODUCER <br />MARSH RISK & INSURANCE SERVICES <br />P. O. BOXJ93880 <br />S'l\N FRANCISCO, CA 94119-3880 <br />CALIFORNIA L1c:;ENSE NO. 0437153 <br /> <br /> <br />DATE (MMIDDIYY) <br />12/28/04 <br /> <br />NIES AFFORDING COVERAGE <br /> <br />COMPM1Y <br />E AMERICAN INTERNATIONAL SOUTH INSURANCE CO. <br /> <br />Mise -UNITE-W/PRO- UIT 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 />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 /> <br /> <br />COMMERCIAL GENERAL LIABILITY <br /> <br />THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. <br /> <br />ADDITIONAL INSURED - OWNERS, LESSEES OR <br />CONTRACTORS - COMPLETED OPERATIONS <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 WRITTEN CONTRACT <br /> <br />-n-n~n-nnn__~~_n_nn_n~~nnn__n_nn_nn___hnnnn____~_nn_nnn_hn-nn---uhn-n-_n_..n_nn__n_hnnn_nuhn_nn_nnunn_nnuhnnnn_n_hn_n__ <br /> <br />-----------~------------~------------~------------------------~----------~~-----------~~------------~----------~-~--------------------_____________________________n______________________ <br /> <br />Location And Description of Completed Operations: <br /> <br />Additional Premium: <br />o <br /> <br />-______n_____________________n_________h_______________---------~------_____~____________u__________h__________________________________.._____________________________________________ <br /> <br />-u~nn-n_n_nnnn____hnnnnnhnn_n___..nn____n_hn_n__n..n_nn__n_nnn-__n_hn_n__n_hn_n___nhn_n___n_hnnn_n_Un_n_n_______n_nn___h_nnn. <br /> <br />(If no entry appears above, information required to complete this endorsement will be shown in the Declara- <br />tions as applicable to this endorsement.) <br /> <br />Section II - Who Is An Insured is amended to include as an insured the person or organization shown in the <br />Schedule, but only with respect to liability arising out of "your work' at the location designated and described in <br />the schedule of this endorsement performed for that insured and included in the "products-completed <br />operations hazard". <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 />CG20371001 <br /> <br /> <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 />MARSH USA INC. <br />BY: Michlo Nekola <br />;':I./w~~~':" <br /> <br />~(dLL <br />