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CG 20 10 11 85 <br />DATE: FEB 28 07 <br />POLICY NUMBER: 5763733-00 <br />INSURED -NAME: -- <br />KARATE DO KIAI <br />CIO MARTIN TORRES <br />12692 RANCHERO WAY <br />GARDEN GROVE CA 92843 <br />THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY <br />ADDITIONAL INSURED - OWNERS, LESSEES OR CONTRACTORS (FORM B) <br />This endorsement modifies insurance provided under the following: <br />COMMERCIAL GENERAL LIABILITY COVERAGE PART <br />SCHEDULE <br />Name of Person or Organization: <br />job/Project: <br />(If no entry appears above, information required to complete this endorsement will be shown in the Declarations as <br />applicable to this endorsement.) <br />WHO IS AN INSURED (Section 11) 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 wo1V for that insured by or for you. <br />primary Insurance it is agreed that such insurance as is afforded by this policy for the benefit of the additional insured <br />ur <br />shown shall be primary insurance, and any other insurance mantaaned by the additional insured(s) shag be excess <br />and noncontributory, but only as respects any claim, loss or liability arising out of the operations of the named <br />insured(s) or its subcontractors, and only if such claim, loss or liability is determined to be solely the negligence or <br />responsibility of the named insured. <br />that the company will Provide the additional elec6o sMytawn below <br />Notice of Cancellation or Non -renewal it is agreed <br />with 30 days notice of cancellation of this policy in the event of cancellation due to company <br />WAIVER OF SUBROGATION <br />It is agreed that we waive any right of recovery we may have against the person or organization <br />shown in the schedule because of payment we make for injury or dam rys only <br />Out of "your <br />w0W <br />done under a contract with that person or organization. The waiver apP e <br />organization shown in the schedule. <br />SCHEDULE <br />NAME OF PERSON OR ORGANIZATION <br />The City of Santa Ana, its officers, <br />employees, agents and representatives. <br />P.O. Box 1988 M-23 <br />Santa Ana CA 92702 <br />