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POLICY NUMBER: GL 2095788109 A/S COMMERCIAL GENERAL LIABILITY <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 ar Organization: <br />CITY OF SANTA ANA, ITS OFFICERS 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 IT) is amended to include as an insured <br />the person or organization shown in the Schedule, but only with <br />respect to liability arising out of "your work" for that insured by <br />or for you. <br />'~®4'~ <br />~~ ~ <br />~Q~Q-v ~/~~'y,~0~~ot~e~ <br />PB #11972 Pyyy~a~~ <br />~~ <br />CG 20 10 11 85 Copyright, Insurance Services Office, Inc., 1989 <br />Serial #: 506062 <br />Page 2 <br />