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CG 20 10 11 85 <br />DATE: JAN 15 08 <br />POLICY NUMBER: PHPK215316 <br />INSURED NAME: <br />CHOC V. LIE <br />4 FABRIANO <br />iRVINE CA 92620-25576 <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 work" 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 />shown shall be primary insurance, and any other insurance maintained by the additional insured(s) shall be excess <br />and non-contributory, 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 />Notice of Cancellation or Non -renewal it is agreed that the company will provide the additional insured shown below <br />with 30 days notice of cancellation of this policy in the event of cancellation due to company election only. <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 damage arising out of "your work" <br />done under a contract with that person or organization. The waiver applies only to the person or <br />organization shown in the schedule. <br />SCHEDULE <br />NAME OF PERSON OR ORGANIZATION <br />City of Santa Ana, it's Respective Officers, <br />Employees, Agents, Volunteers and Representatives. <br />20 Civic Center Plaza (M-25) <br />Santa Ana, CA 92701 <br />