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<br />'-' <br /> <br />z <br /> <br />...., <br /> <br />GREAT DIVIDE INSURANCE COMPANY <br /> <br />POLICY NUMBER: GC030412 <br /> <br />LIABILITY ENDORSEMENT <br /> <br />THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. <br /> <br />ADDITIONAL INSURED ENDORSEMENT <br /> <br />This endorsement mod~ies insurance provided under the following: <br /> <br />COMMERCIAL GENERAL LIABILITY COVERAGE PART <br /> <br />SCHEDULE <br /> <br />Name of Person or Organization: <br />THE CITY OF SANTA ANA, <br />ATTN, JIM STIKELEATHER <br />20 CIVIC CENTER PLAZA, <br /> <br />Premium $ 50 <br />IT'S OFFICERS, EMPLOYEES, AGENTS AND VOLUNTEERS <br /> <br />SANTA ANA, CA 92702 <br /> <br />WHO IS AN INSURED (Section II) is amended to Include as an insured the person or organization shown in the Schedule <br />and only for liability arising out of your negligence and only ror occurrences or coverages no1 otherwise excluded in the <br />policy to which lhls endorsement applies. <br /> <br />Your DOIicy is p'rimary In the event of an occurrence caused by your sole negligence as respacts the job described below: <br />(MUS; BE COMPLETED) <br /> <br />Job Description: <br /> <br />TRAINING AND CONSULTING <br /> <br />All olherTerms and Conditions Of this Insurance remain unchanged. <br /> <br />S 114 (04/~) <br /> <br /> <br />cc:[~ 00, [, ~ON <br /> <br />c0d 60c <br /> <br />JOSS~ aN~ XI~HJ 3 ~ c~,pcc~6p6 <br />