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<br />. <br /> <br />I <br />SPECIALTY-"UMAN_SERVICES <br /> <br />. <br /> <br />~003/003 <br /> <br />U5/17/2UU5 13:49 FAX <br /> <br />CG 20 28 <br />lEd. I I 85) <br /> <br />THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. <br /> <br />ADDITIOIIIAL INSUtED--DESICllATED PERSa'4 OR ORGANIZATION <br /> <br />Thia endorsement modifies insurance provided under the fol lowing: <br /> <br />COMMERCIAL GENERAL <br />POliCY #PAC5373885 <br />Mercy House <br /> <br />LIABILITY COVERAGE PART <br /> <br />SCHEDULE <br /> <br />Neme of Pereon Dr Or.ani.atlon: <br />The City of Santa Ana, its officials, employees, representatives, and volunteer <br />are hereby named as Additional Insureds as respects the operations of or on <br />behalf of Mercy House Transitional Living Center, performed under contract <br />with the Ci~y of Santa Ana. <br /> <br />(If no entry appears above. information required to complete this endorsement <br />wi II be shown in the Declaratlona as appl icable to this endorsement.) <br /> <br />WHO ISAN INSURED (Section II) i. amended to include as an insured the pe.rson <br />or organization shown in the Schedule as an insured but only with respect to <br />I iabi I ity ar ising out of your operations or premi... owned by or rented to <br />you. <br /> <br />.,~ <br />APPROVED "'.:; . <br /> <br />_f.~L)_~ <br />--- i~_>i" ~ <br /> <br />Assistanl Cil)_ t ~c,~..- <br /> <br />Copyright. Insurance Services Office. Inc., 1984 <br />CG 2026 (Received TimeFMav.17. 11:42AMIPage 1 of 1) <br />