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DATE: DEC 17 2009 <br />POLICY UMBER: PHPK504907 <br />INSURED !AME: <br />Choc 11 L <br />Fabriano <br />Irvine, CA 92620 <br />CG 20 10 11 85 <br />THIS ENDORSEMENT CHANGES THE POLI <br />. PLEASE READ IT CAREFULLY <br />ADDITIONAL INSURED -OWNERS, LESSEES OR CONTRACTORS (FORM B) <br />This endorsement modifies insurance provided under the following - <br />COMMERCIAL IAL GENERAL LIABILITY COVERAGE PART <br />SCHEDULE <br />Name of Person or Organization: <br />The City of Santa Ana, its Respective Officers, <br />Employees, Agents, Volunteers and Representatives <br />20 Civic Center Plaza (M-25) Ana, CA 92701 <br />(If no entry appears above, information required to complete this endorsement will be shown in the Declarations a <br />applicable to this endorsement.) <br />WHO IS AN INSURED (Section 91) is amended to include as an insured the person or organization shown in the <br />Schedule, but 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 benefit of the additional <br />insured shown shall be primary insurance, and any other insurance maintained by the additional insured(s) shall be <br />excess and non-contributory, but only as respects any claim, less or liability arising out of the operations of the <br />named insured(s) or its subcontractors, and only if such claire, loss or liability is determined to be solely the <br />negligence or responsibility of the named insured. <br />Notice of Cancellation or fon-renewal 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 SUBROGATION <br />It is agreed that we waive any right of recovery we may have against the person or organization <br />shown in the schedule because of payment we reale for injury or damage arising out of "your work"' <br />done under a contract with that person or organization. The waiver applies only to the person or <br />organization shown in the schedule. <br />SCHEDULE <br />NAME OF PERSON OR ORGANIZATION <br />The City of Santa Ana, its Respective Officers, <br />Employees, Agents, Volunteers and Representatives <br />20 Civic Center Plaza (M-25) <br />Santa Ana, CA 92701 <br />