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POLICY NUMBER:CBP8699930 <br />COMMERCIAL GENERAL LIABILITY <br />CG 20 10 07 04 <br />THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. <br />ADDITIONAL INSURED - OWNERS, LESSEES OR <br />CONTRACTORS - SCHEDULED PERSON OR <br />ORGANIZATION <br />This endorsement modifies insurance provided tinder the following: <br />COMMERCIAL GENERAL LIABILITY COVERAGE PART <br />SCHEDULE <br />Name Of Additional Insured Person(s) <br />Or Organization(s): <br />ocations Of Covered O erations <br />City of Santa Ana <br />S CA , #3011 <br />fEV <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 <br />include as an additional insured the person(s) or <br />organization(s) shown in the Schedule, but only <br />with respect to liability for "bodily injury ", 'property <br />damage" or 'personal and advertising irjury" <br />caused, in whole or in part, by: <br />1. Your acts or omissions; or <br />2. The acts or omissions of those acting on your <br />behalf; <br />in the performance of your ongoing operations for <br />the additional insured(s) at the location(s) desig- <br />nated above. <br />CG 20 10 07 04 <br />B. With respect to the insurance afforded to these <br />additional insureds, the following additional exclu- <br />sions apply: <br />This insurance does not apply to "bodily injury" or <br />"property damage" occurring after: <br />1. All work, including materials, parts or equip- <br />ment furnished in connection with such work, <br />on the project (other than service, maintenance <br />or repairs) to be performed by or on behalf of <br />the additional insured(s) at the location of the <br />covered operations has been completed; or <br />2. That portion of "your work' out of which the <br />injury or damage arises has been put to its in- <br />tended use by any person or organization other <br />than another contractor or subcontractor en- <br />gaged in performing operations for a principal <br />as a part of the same project. <br />© ISO Properties, Inc., 2004 <br />CERT W.: 5355439 CLIENT CODE: MERCH -1 Bolton Certificate Piotaeaing 1/13/2009 4:31:52 MII Page 3 of 5 <br />Page 1 of 1 ❑ <br />