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<br /> <br />CLERK'S OFFICE <br />(M30 - Tll) <br /> <br />'1'0: <br /> <br />FROM: <br /> <br />CI'l'Y ATTORNEY /) J <br />CLERK OF TIlE COONCIrJ'6;z-A/IA.- <br /> <br />ADDITIONAL <br />FOR COMMERCIAL <br /> <br />PLEASE REVIEW INSURANCE AND CO!1MENT. <br /> <br />Insurance Company _ <br /> <br />Agreement No. IV (;l~J, -OJ 0 <br />l~ith ;JrJlI...~I~,\pal D-€Clsiol1. "S:f.i~s <br />& Accept <br />o Reject <br />n~ W.+.h.:wT C~;,\{M"JC,""( <br /> <br />This endorsement modifies such insurance <br /># relating to the fc <br /> <br />1. The City of Santa Ana, 20 I <br />officers, employees, agents, volunteers an( <br />("additional insureds") with regard to liabi <br />and uses performed by or on behalf of the <br /> <br />(..eM<2;4..\ .,., .J../~;<, r.f.:;l SQ <br /> <br />2. With respect to claims arisi <br />behalf of the named insured, such insuranc <br />additional to or contributing with any othe <br />additional insureds. <br />----.- -"'.---"---' - <br /> <br />3. This insurance applies sepa tely to each insured against whom claim is made or <br />suit is brought except with respect to th~anY'S limits ofliability. The inclusion of any <br />person or organization as an insured s all not affect any right which such person or organization <br />would have as a claimant ifnot so' cluded. <br /> <br />'t!J <br />fV).1..~ <br /> <br />City At or e <br /> <br />4. With respect to e additional insureds, this insurance shall not be cancelled, or <br />materially reduced in cover e or limits except after thirty (30) days written notice has been <br />gi ven to the City of Santa a, 20 Civic Center Plaza, Santa Ana, California 9270 I. <br /> <br />(Completion of the fi owing, including countersignature, is required to make this endorsement <br />effective.) <br /> <br />Effective , this endorsement form as a part of <br />Policy # <br />Issued to <br /> <br />Named Insured <br /> <br />Countersigned by <br /> <br />Authorized Representative <br /> <br />~ NO ~~(kf(l..l/-k oJ. J.n.&{)(MW 170/ t):hr~{113 <br />rjJ~..v1 t2.t-'-D _ Nt) Mo / k p>>. ~ 0 I !'l/Wp 071 S; i ~ <br />--:? 8/L/O "'t~S d-vtv <br />?I<( tY?-S?2-? <br />