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CG 2010 1185 <br />DATE: NOV 27 07 <br />POLICY NUMBER: PHPK216316 <br />INSURED NAME: <br />FRANK ALMAZ <br />2234 SOUTH TOW NER ST <br />SANTA ANA CA 92707 <br />THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY <br />ADDITIONAL INSURED - OWNERS, LESSEES OR CONTRACTORS (FORM 0) <br />This endorsement modifies insurance provided under the following <br />COMMERCIAL GENERAL LIABILITY COVERAGE PART <br />SCHEDULE <br />Name of Person or Organization: City of Santo Ma, its officers, agents, employees, <br />repressnMlves, and volunteers <br />20 Civic Center Ping <br />Santa Ma, CA 92701 <br />JoblProjsct: <br />(If no entry appear$ above, information regrind to complete this endorsement will be shown in the Declaraoorn as <br />applicable to this endorsement.) <br />WHO IS AN INSURED (Section 11) is wonded to inckhde as an Insured the person or organization shown in the <br />Schedule. bee 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 bonefil of the addidwi&I insured <br />shown shah be primary 6snsance, and any other Insurance maintained by the addilionel insured(s) $hat be excess <br />and noncontrbutory, but only as respects any deim, bas or lability arising out of the *pardons of the named <br />ineured(s) or do subcontractors, and only if such claim, loss or liability is determined to be solely the negligence or <br />responsibW of the named Insured. <br />Notice of Camol[stion or Nonrrenswal 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 sueROGATION <br />It is agreed final we waive arty right of recovery we may have against the person or organization <br />shown in the schedule because of payment we make for irr ury of damage prking out of 'yourwoW <br />done under a contract with that person or organization. The waiver applies only to the person or <br />oNanizsllon shown in the schedule. <br />