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CLOWhIS~T}~L1S PAGE 03/07 <br />64/25/2007 17:01 7152464257 <br />POLICY NUMBER: CE07CGL00772900 ~. AR54ti0513 COMMERCIAL GENERAL LIABILITY <br />THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. <br />ADDITIONAL INSURED -OWNERS, LESSEES OR <br />CONTRACTORS -(FORM. B) <br />Tbis endorsement modifies insurance provided under the following: <br />COMMERCIAL GENERAL LIABILITY COVERAGE PART. <br />SCHEDULE <br />Name of Pcraoa or Organization: <br />A~ person or organizatioa for whom you are performing operations when you and such <br />person or organization Lave agreed in writing in a contract ar agreement that such person <br />or organization be added as an additional insured on yoar policy. <br />City of Santa Ana <br />Its officers, employees, agents, volunteers end representatives <br />20 Civic Center Plaza <br />Santa Ana, CA 92701 <br />Additional Insured with regard to liability and defenseof suits arising from the operations and uses <br />pertortned on behalf of Adrienne Chavez McMiAan. <br />With respect to claims arising out of the operations and uses performed by Adrienne Chavez <br />McMUlan, such insurance as is afforded by this policy is primary and is not additiona! to or <br />contn'buting with arty other insurance carried by or for the benefd of the additional insured. <br />This insurance applies separately to each insured against whom claim is made or suit is brought <br />except with respect to the company's limits of liability. The inclusion of any person or organization as <br />an insured shall not affect any right which such person or organization would have a claimant if not so <br />included. <br />With respect to the additional insured, this insurance shall not be cancelled, or materially reduced in <br />coverage or limits except after thirty (30) days written notice has been given to the City of Santa Ana, <br />20 Civic Center Plaza, Santa Ana, California 92701 <br />Effective Apri125, 2007, this endorsement form as a part of policy numbers CE07CGL00772900 & <br />AR5460513 Issued to Performers of the US & its club members. <br />(lf no entry appears above, information required to complete this endorsement will be shown io [he Declarations as <br />applicable to this endorsement.) <br />WHO IS AN INSURED (Section >n is amended to include as as insured the person or organization shown in the <br />Schedn1e, bnt only with respect to liability arising ont of "your work° for that insared by or for you. <br />CG 20 ]0 11 85 Copyright, Insurance Services Office, Ina 1984 p~~ `~br~M <br />Air"r?O~iL'J l.S <br />~~-zl- <br />Lacca Sr.[L y;...,e.ly <br />