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Additional Insured — Owners, Lessees or Contractors — AB 90 67 12 93 <br />Policy Amendment Section 11 <br />Insured: Community Veterinary Hospital Policy !Number AZC80843887 <br />William A. Grant 111, DVM <br />Producer Veterinary Ins Services Co Effective Date 10/01/09 <br />Schedule <br />Name of Person(s) or Organization(s) <br />City of Santa Ana, its officers, employees, agenic, volunteers and representatives <br />(If no entry appears above, information required to complete this Endorsement will be shown in the Declarations <br />as applicable to this Endorsement) <br />The following is Added to Part I — WHO IS AN IN- <br />SURED in the Business liability Section of this policy <br />S. The person or organization shown in the Schedule <br />is also an insured, but only with respects to liability <br />arising out of your work for that insured by or for <br />you. <br />All other terms and conditions of the policy apply. <br />This form muss be attached to Change Endorsemcnt whcn issucd after the policy is written. <br />Onc of the Fireman's Fund Insurance Companies as named in the policy. <br />saa tB. Na <br />Secretary <br />Countersignature ol'Authorizcd Agent <br />Ao90a7 12-93 <br />Conuins copyrighted Material ortniurenca Services 0Mces. Inc.. 191,4 <br />Mcfoef E LatRocco <br />President <br />L <br />