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<br />p~P-~-2002 07:35 PM <br />08/20/JOOI 1%:11 FAX 504 B~8~ <br /> <br />PAC <br /> <br />'-' <br /> <br />P.03 <br />IllOOllooa <br /> <br />~:c~~. _ 1 IFJ/Af."ftJ #l lJd It! L II / 7 /~ 7Y'~~. j 1 T <br />THIS ENDORSEMENT CHA.NGES THE POLICY, PLEASE READ IT CAAEFULL'(. I <br />POLICY CHANGES <br /> <br />TIoIIS ENDORSEMENT PORMS A PART OF THE POLICY NUMBERED BELOW' <br />! f'Ol.Il:Y NVMlift I PO~ICI' C~A~G&S !-.--coMiiINV---- <br />E~feCTiVl! <br />I 860l/C\'243282 - 0 I oe-3o-a~o2 Mlrkellncurance Comlla~v <br />, <br />I <br />I NAMIUlINSVft~e <br />c.",pII.. US... <br />I <br /> <br />---'--1 <br /> <br />I <br />, <br />-- ----I <br />! <br /> <br />llUTMOftlZED ftiPft,SENTllTlVE <br />Bl'\lC' A, KIV <br /> <br />, <br />I <br />I <br />I <br />I <br />i <br />I <br />I <br />I <br />I <br />I'" eon.ideradon of In ,ddltlonal pnomiuM of $29,00, It I. '9'...d tnl'l the <br />: followlnlladdltlol"l8l inlured I. added aer form CG202!l: <br />I <br />'\ ,. n, CItY of Slnt' Ani, 20 Clvlc Clnter "Iail. Sente Ani, C.elllernla 92701: <br />IU offiC8l'I, 81'l'1ploycea, .n~., voIUMe.rs 1M repr..antldVeI Ire nlmeet <br />IS IddltionBllneureds ("addlllonal inlureelli", with relllrd to IIlbi'ity Ind <br />defense of ,ulta erlainll trom the oPlrltlonl Ir,d ua.. performed by or on behllf <br />of the nemld InJUred. <br /> <br />-- ---j <br /> <br />COVERAGE fllllTl AFf'ECTEO <br />C!8noral Liablll'y Packese <br /> <br />CHAN0!8 <br /> <br />----1 <br /> <br />2. WIth roopeotll '0 olaims arillng out of tha oplfltlona and una plrfo~med by or on <br />behalf of the IIlImeet ineurad. euch inlurence la i. efforded 10'11 thil polley il <br />orimary end I. not IIddltlonll to or ~cnlrlbutlns with anv ~ther ins~r.nQ. <br />clrrled b'll or ftlr the benefit of the addltlonellnlurado. <br /> <br />\3, <br /> <br />I <br />I <br />, <br /> <br />TIIlI i",~"nQ' eppll.. ,ep"etely to ugh Inlura.d ,sein.e whgm o'.lm i. mede 0' <br />lult i. bl'Oulll'rt: e~cept with respalll to 'he complny', IImlll ef Iiebnlty. TI1' <br />inclusion of any oe"on or organization I' an Inlured .hall nol affect sny <br />right wl1lcn euoh perron or or!l.nl~atlcn WO\.lid he~e .. I clalmsn, It not <br />10 in=t",clcd. <br /> <br />4. With r..pact to tnl lICkIitlonl: Inaurldl, thll i,"urane. Ihlll not loe g.ne,lIed.cr <br />materially redullad in coverllle or limits iaXcepl etlI. thirty 1301 days written <br />nodce n.. tleen given to the City Of santa Ano, 20 Civic Ce~ter Ple.e, <br />&llnraAna,Californi,S1l701. APPROVED AS TO FORM <br /> <br />I <br /> <br />\ All other terml end conditiOne romlin tho uml. <br />I <br /> <br /> <br />I <br /> <br />.-- <br /> <br />i <br />P- <br />I <br />I <br />I <br />I <br /> <br />PllliM1UM ADJUSTMENT I <br />PREMIUM OUI AT PO~ICV CHANQ& '_"riVE CATI I f~!VIOU8 INSTA~~iN'1' I NIlW ,"aTALl Mil;:;---- <br />AOOITlONA~ ft!TUftN 1_ PIlEMIUM I fft'EM1Ull_......J <br /> <br />. ... QO. I . I . I <br />U, I · ~ ._.-J <br /> <br />an....... K.v ~ ti.. oII~,; <br /> <br />Authorized Aapr..e~v. H1r';';;;;- <br /> <br />"OIL a 01 11 85 <br /> <br />coPyrilil',t. 180 Cummeroiel Risk Sa.vlces, 1M., 1983 <br /> <br />09.20-2002 <br />