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<br />'12/83/2002 21:20 <br /> <br />7148422538 <br /> <br /><I <br /> <br />PAGE 02/02 <br /> <br />, <br /> <br />W' <br /> <br />'-' <br /> <br />fR(I'l : <br /> <br />FAX~. : 714-647~9 <br /> <br />Nov. 22:2002 01: 01PM P:3 <br /> <br />ENDORSEMENT <br /> <br />"'POUCY NUMBER: <br /> <br />CP7781601 <br /> <br />"'INSURED COMPANY NAME: <br /> <br />Thomas House ,Temporary Shelter <br /> <br />TH!lS ENDORSEMENT CHANGES TUE POLlCY. PLEASE READ IT CAREFULLY. <br /> <br />ADDITIONAL INSURED - DESIGNATED PERSON or <br />ORGANIZATION <br /> <br />111is endorsement modifies insurance pl'Ovidad under the following: <br /> <br />COMMERCIAL GENE'RAL LlABIUTY COVERAGE PART <br />SCHEDULE <br /> <br />N~.cofPe~onQr~~o~ <br /> <br />City of Santa Ana and its OMcers, Agents, Employcees and <br />Volunteers are named as additional insured as respects their <br />interest in connection with the named insured. <br /> <br />(If no entry appelU'S above. informati011 rlXl.uircd to complete this end~lmlcnt will be <br />5hown in the DeClarations as applicable to tbis endurllemcnt.) <br /> <br />WHO IS AN lNSVRED (Section m is lltllCDdcd to include as an insured the person or <br />organization shown in the Schlldule, but only with respect to liability arising out of your <br />operations or premises owned by or rented to you, <br /> <br />IT tS AGREED THAT ANY INSURANCE MAINTAINED BY THE CITY OF <br />SANTA ANA SHALL Al"l"L Y (1'1 EXCESS OF, AND NOT CONTJUBU1'J.? WtTII, <br />INSURANCE PROVIDED BY'l'HJS POLlCY. <br /> <br /> <br />Agellt'~Signature: ~ ~.~ # <br />-ae · <br />~O l\.'P lie ... <br />t'~u\l <br />pt' , <br />c,10?Cv-. <br />\.\s~ fC;\~ r>-\\O\"e~ <br />(;G' 2010 II 85 ~SS\S\3\\\ r. j5) <br /> <br />(21 S)C $M'\PL~ _ AddidonD.lI.",r<<l wltlJ l'rlm.rylNon-C'.antribmins J,ongullAC Added ~D" . <br /> <br /> <br />