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~~~ One Beacon <br />I v S l' K A R T F: <br />CG 20 10 07 04 <br />ADDITIONAL INSURED -- OWNERS, LESSEES OR CONTRACTORS - <br />SCHEDULED PERSON OR ORGANIZATION <br />This endorsement modifies insurance provided under the following: <br />COMMERCIAL GENERAL LIABILITY COVERAGE PART <br />SCHEDULE <br />Name of Additional Insured Person or Organization: <br />CITY OF SANTA ANA <br />Location(s) of Covered Operations: <br />1041 S PLACENTIA AVE <br />Information required to complete this Schedule, if not shown above, will be shown in the Declarations. <br />A. Section II -Who Is An Insured is amended to include This insurance does not apply to "bodily injury" or "prop- <br />as an additional insured the person(s) or organization(s) erty damage" occurring after: <br />shown in the Schedule, but only with respect to liability 1. All work includin materials arts or a ui ment <br />for "bodily injury", "property damage" or "personal and ~ g p q p <br />furnished in connection with such work, on the proj- <br />advertisinginjury caused, in whole or in part, by: ect (other than service, maintenance or repairs) to be <br />1. Your acts or omissions; or performed by or on behalf of the additional insureds) <br />2. The acts or omission of those acting on your behalf; at the location of the covered operations has been <br />in the performance of your ongoing operations for the completed; or <br />additional insureds) at the location(s) designated above. 2• That portion of "your work" out of which the injury or <br />B. With respect to the insurance afforded to these additional damage arises has been put to its intended use by <br />insureds, the following additional exclusions apply: any person or organization other than another con- <br />tractor orsubcontractor engaged in performing oper- <br />ationsfor aprincipal as a part of the same project. <br />POLICY NUMBER: 1U468B5 INSURED COPY <br />