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• 11~02i2003 15:36 F_Ag 949 3t31 9078 HOLBSHf IVSVRANC~ ~,voY <br />POLICY NUMBf:R: 680-46, Q5-A „JMMERCIOIL GENERAL I.IABILf~'y <br /> <br />THIS ENDORSEMENT CHANGES THE POLICY, PLEASE REAP h' CAREFULLY. <br />ADDITIONAL INSURED--.DESIGNATED PERSON OR <br />ORGANt7AT10tV <br />This endorsement modifies insurance provided under the fallowing: <br />COMMERCWL GENERAL LIAB~1'TY CUNERAGE PART, <br />SCHEDULE <br />Name of Person or Organization: <br />CITY OF SANTA ANA-CDBG M 25 <br />COMMUNITY DEVEi.(ypMENT AGENCY <br />P.4. BOX 1988 M 25 <br />SANTA ANA, CA 92702 <br />(If no entry appears above, information required to complete this endorsement will be shown in the Declarations <br />as applicable to the endorsemeni•) <br />WHO IS AN INSURED (Section Iq is amended to include as an insured the person or organ¢~tion shown in the <br />Schedule as an insured but onty with respect to liabiity arising out of your operattions or premises owned by or <br />rented to you. <br />CITY 4F SANTA ANA, RS OFFICERS, AGENTS, ERIPLOYEE$ AND VOLUNTEERS ARE NAMED AS <br />ADDITIONAL INSURED AS RESPECTS THEIR INTEREST IN CONNECTION WI?'H THE NAMED INSURED. <br />APPRUY~ll ~,,~ i U ~-~y.~.,, <br />2~ <br />_a~r~ Stitt Shte~-'"~' <br />au;~,~tai~t :_:;ty Attarne~- <br />Copyright, Insurance Services Office, Inc_ 1984 <br />