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<br />D~c !2 00 1?:4Gp <br /> <br />DPt? . t 0.0 08 ~ 2':~~ <br /> <br />5.ant,a .an:i?l 1'11""::5<:1 <br />~ri~ ~r~ ~~jcklnsuFance <br /> <br />7 :1. 4'~:;7:f_ 4235 <br /> <br />f!-'.4- <br /> <br />IR581e-bIJ(;() <br /> <br />p.3 <br /> <br />i\IF' MUfflit & Fr1cfrJhsurance ~, Ihe. <br />~";'~:':'.:-_--::'~':;~ -:--'-_.._~_.,---::=:~... <br /> <br />This I'ndorscmcnt changes the Commercial Liability Policy. PLEASE read it caret'll!!)' <br /> <br />TilL'> emiurscme1l1, cfkctlVC on 08/011)(HKJ.., Standard hme sho,,,, on the Policy Ded,r."o'~" Ion,",., P'''" ofP"li,y <br />Number n'(J'11:''j60C_9~ lS,<:;U(:.;! to P(;h~r M1mgl.:l;sing #O-JT1819 by GenmJ Sw IndemT'.lly. <br /> <br />End(lrs.ement Numb/;':'l' 001 <br /> <br />ThlS cndGr~emt'Jlt mQddirs immral1ce pru....l(kd foJ' under Ihe fOljmving: <br /> <br />(;OMMlRClAL GENIlRAL l.IADrUTY COV~CIlAGIi: PART <br /> <br />AODITIONAL INSlJHF.O BLANKET FORM <br /> <br />WIIO IS AN fNSFRED (Scrhon 11) lS iUilC,':ndo.:.>d 10 includ~ as an msured rhe pe.rson(s) Or orr.a:llizal/Qn(s)shm'm iu tlle <br />i:ichedule a.., an ll1StJl1:-G but only with r~::;l-1l.:f;lla liabIlity arising {.1ut of your Oper.at1(ln5 or premis.c-s owncU by or Ir;;nted to <br />you. <br /> <br />;'1a1)k oj l~usoll or Olganlzatiun <br /> <br />City OfSanla Am, <br />ib om~t':r~, t'mployee,\t agenh, "olun~a't"ll a.ud rtl"pn::se-ntalh,t.s <br />20 CivIc (:(<llh'-r P'2t~ <br />S:mt3 An,", eA 92"01 <br /> <br />AJi ccrtitl.:ate~ of inSUrance bolder:;; you have: agreed to indude as an Iru:;urcd prior to an "oct'tm-ellcc" or <br />alfensc <br /> <br />0;..97) <br /> <br />aao Stevens Avenue, F';lSt Floo,- .. SQlana Beach... CA 92D75-2068 <br />{BGG, 259-5800... Fax (658) 259-6069 . l1\;t::nt>tt; 0672756 <br /> <br />/uTiZOvicD AS 10 FORM <br /> <br />d:~o- ))JLU ri'r- <br />'L.{ura Sheedy <br />!)cputy City Attorney <br />