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<br />POLICY NUMBER: GL 2077470945 AIS COMMERCIAL GENERAL LIABILITY <br /> <br />THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY <br /> <br />ADDITIONAL INSURED - OWNERS, LESSEES OR <br />CONTRACTORS (FORM B) <br /> <br />This endorsement modifies insurance provided under the following: <br /> <br />COMMERCIAL GENERAL LIABILITY COVERAGE PART <br /> <br />SCHEDULE <br /> <br />Name of Person or Organization: <br /> <br />CITY OF SANTA ANA, ITS OFFICERS AND EMPLOYEES <br /> <br />(if no entry appears above, information required to complete this <br />endorsement will be shown in the Declarations as applicable to this <br />endorsement. ) <br /> <br />WHO IS AN INSURED (Section II) is amended to include as an insured <br />the person or organization shown in the Schedule, but only with <br />respect to liability arising Ollt of "yollr work" for that insured by <br />or for you. <br /> <br />tO~ <br />~ 'to <br />~~O~'O <br />f3 ,,;'\ O\l.C~l\e'l <br />\.\$1>> ~'C\\,j I>>I.\! t.{) <br />~l~ of <br /> <br /> <br /> <br />PB #11972 <br /> <br />CG 20 10 11 85 Copyright, InSllrance Services Office, Inc., 1984 <br /> <br />Serial #: 506062 <br /> <br />Page 2 <br /> <br />