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<br />. <br /> <br />NAMED INSURED: <br />POLICY NUMBER: <br /> <br />James H. Russell & Son, Inc. <br />SCP0420465 <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 (FORM B) <br /> <br />This endorsement modifies insurance provided under the following: <br /> <br />COMMERCIAL GENERAL LIABILITY COVERAGE PART. <br /> <br />SCHEDULE <br /> <br />Name of Person or Organization: <br /> <br />*See Below <br /> <br />(If no entry appears above, information required to complete this endorsement will be shown in the Declarations as <br />applicable to this endorsement.) <br />WHO IS AN INSURED (Section II) 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" for that insured by or fOT you. <br /> <br />*1) The City of Santa Ana, 20 Civic Center Plaza, Santa Ana, California 92701, its <br />officers, employees, agents, volunteers and representatives are named as additional <br />insureds (additional insureds') with regard to liability; and defense of suits arising from <br />the operations and uses performed by; or on behalf of the named insured. <br />2) With respect to claims arising out of the operations and uses performed by or on behalf <br />of the named insured, such insurance is afforded by this policy is primary and is not <br />additional to or contributing with any other insurance carried by or for the benefit of the <br />additional insured. <br />3) This insurance applies separately to each insured against whom claim is made of suit is <br />brought except with respect to the company's limits of liability. The inclusion of any <br />person or organization as an insured shall not affect any right which such person or <br />organization would have as a claimant ifnot so included. <br />4) With respect to The City of Santa Ana, and except for non-payment of premium this <br />insurance shall not be cancelled, or materially reduced in coverage or limits except after <br />thirty (30) days written notice has been given to the City of Santa Ana, 20 Civic Center <br />Plaza, Santa Ana, California 92701 <br /> <br />AP~~'ORM <br /> <br />-' CRISilNE LEE SHAW <br />Deputy City Attorney <br /> <br />CG2010JI85 <br /> <br />Copyright, Insurance Services Office, Inc., 1984 <br />