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POLICY NUMBER:72SBAAC2429 it <br /> THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. <br /> ADDITIONAL INSURED - OWNERS, LESSEES OR <br /> CONTRACTORS - COMPLETED OPERATIONS <br /> This endorsement modifies insurance provided under the following: <br /> BUSINESS LIABILITY COVERAGE FORM <br /> SCHEDULE <br /> Name Of Additional Insured Person(s) <br /> Or Or anization s : Location And Description Of Completed Operations <br /> he city of Santa Ana,Its officials,employees and greement for Administrative Services,A-2420-119, <br /> alunteers ity of Santa Ana PARS 3121 Part-Time Social Security <br /> Itemative Retirement Plan.. <br /> Information required to complete this Schedule, If not shown above,will be shown in the Declarations. <br /> Section C. — 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 with <br /> respect to liability for "bodily Injury" or "property <br /> damage"caused, In whole or in part, by "your work" <br /> at the location designated and described In the <br /> schedule of this endorsement performed for that <br /> additional insured and included In the "products- <br /> completed operations hazard". <br /> Form SS 41 71 06 11 Page 1 of 1 <br /> Process Date: Policy Expiration Date: <br /> © 2011,The Hartford <br /> (includes copyrighted material of Insurance Services Office, Inc.,with its permission) <br /> 85027131 124-25 CA OL-HNOA-WC-PI, I Sherry Young 1 4/28/2025 2!20t19 PM (POT) I Page 3 of 18 <br />