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Policy Number: sxo1862926 <br />Owners Lessees or Contractors (Form B) <br />ADDITIbNAL INSURED <br />Change(s) Effective: 09/2B/200s <br />THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT <br />CAREFULLY. This endorsement modifies insurance policy under the following: <br />LIABILITY COVERAGE PART: <br />Schedule <br />Name of Person or Organization: <br />City Of Santa Ana <br />Attention: Mindy Ly <br />20 Civic Ctr Plaza, City Hall <br />Santa Ana, CA 92701 <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 />The certificate holder <br />general liability for <br />insured. <br />CUBF 22 40 03 95 <br />is named as an additional insured as respects <br />claims arising from the operations of the named <br />1'0 FORM <br />Z�Z <br />tr Needy <br />Attorney <br />