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07/28/2009 15:31 7145278898 STATE FARM PAGE 03 <br />CORD POI[Cy NO,: 92-GA $133-8 FE- <br />eeo9 <br />.,.,,.. <br />SECTION tl ADDITIONAL INSURED ENDORSEMENT <br />Policy No.: 92-OA 8133-8 <br />Named Insured: DEOROE, MARfE 013A: ACT ONE ACADEMY OF DANCE <br />Additional Insured include address}: <br />CITY OF SANTA ANA <br />THEIR 4FFICER8 & EMPLOYEES <br />886 W SANTA ANA BLVD STE 200 <br />SANTA ANA CA 92701-4561 <br />WW© IS AN INSURED, under SECTION it DESlONATION OF INSURED, is amended to include as <br />an insured the Additional insured shown above, but only to the extent that Hasbiifty Is imposed on that <br />Additlonasl Insured solely because of your work ~rformed for that Addltional Insured shown above. <br />Any Insurance provided to the Additional Insured shall oniy apply with respect to a claim made or a <br />suit brought for damages for vrhioh you are provided coverage. <br />The Primary insurance coverage below applies oniy when there is an "X" In the box. <br />Primary insurance. The insurance provided to the Additional Insured shown above shall be <br />primary insurance. Any Insurance Carried by the Additional Insured shall be noncontributory <br />with respect to Coverage provided to you. <br />All other potlcy provisions apply. <br />FE-0609 Pdnled In tl,5.A, <br />