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POLICY NUMBER: PAS 36068105 COMMERCIAL GENERAL LIABILITY <br />INSURED: Mike Linares <br />EFFECTIVE DATE: 2/28/09 <br />THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. <br />ADDITIONAL INSURED -- OWNERS, LESSEES OR <br />CONTRACTORS (FORM B) <br />This endorsement modifies insurance provided under the following: <br />COMMERCIAL GENERAL LIABILITY COVERAGE PART. <br />SCHEDULE <br />Name of Person or Organization: The City of Santa Ana and its elected and appointed boards, <br />officers, agents and employees. <br />(If no entry appears above, information required to complete this <br />endorsement will be shown in the Declarations as applicable to this <br />endorsement.) <br />WHO IS AN INSURED (Section II) is amended to include as an insured the <br />person or organization shown in the Schedule, but only with respect to <br />liability arising out of "your work" for that insured by or for you. <br />CG 20 10 11 B5 Copyright, Insurance Services office, Inc., 1984 <br />