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<br />. <br /> <br />*POLICY NUMBER: <br /> <br />'-' <br />~OQ?:'- (")d-.\~-' <br /> <br />'-' <br /> <br />ENDORSEMENT <br /> <br />. <br /> <br />*INSURED COMPANY NAME: l.\.0\'" 9fl\~ l-\S 1"'!'. fu1i...cv, c.e. c,t (o..l ~f. <br /> <br />THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. <br /> <br />ADDITIONAL INSURED - DESIGNATED PERSON or ORGANIZATION <br /> <br />This endorsement modifies ins~ce provided under the following: <br /> <br />COMMERCIAL GENERAL LIABILITY COVERAGE PART <br /> <br />SCHEDULE <br /> <br />Name of Person or Organization: <br /> <br />City of Santa Ana and its Officers, Agents, Employees and Volunteers are <br />named as additional insured as respects their interest in connection with the <br />named insured. <br /> <br />(If no entry appears above, information required to complete this endorsement will be shown in the Declarations <br />as applicable to this endorsement.) <br /> <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 operations or premises owned by or rented to you. <br /> <br />IT IS AGREED THAT ANY INSURANCE MAINTAINED BY THE CITY OF SANTA ANA SHALL <br />APPLY IN EXCESS OF, AND NOT CONTRIBUTE WITH, INSURANCE PROVIDED BY THIS <br />POLICY. <br /> <br />Agent's Signatur~ (r/. <br /> <br />CO 2010 11 85 <br /> <br /> <br />(218)C SAMPLE - Additional Insured with PrimarylNon-Contributing Language Added <br /> <br />, L. , .; -~ ~__:.--"'.,,, j -..1 r OR1\1 <br /> <br />-Y() t~cl" <br />"~~~--;-~---'- <br />;V:~ur~: :)l,i".'~'l:Y <br />:;':f-'Uy' C;lY _-\Lror~lc); <br />