SULLY-MILLER CONTRACTING COMPANY (2)

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Policy Number: AS2-631-510805-015 Issued by: Liberty Mutual Fire Insurance Co. THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. DESIGNATED INSURED -NONCONTRIBUTING This endorsement modifies insurance provided under the following: BUSINESS AUTO COVERAGE FORM GARAGE COVERAGE. FORM MOTOR CARRIERS COVERGE FORM TRUCKERS COVERAGE FORM With respect to coverage provided by this endorsement,the provisions of the Coverage Form apply unless modified by this endorsement. This endorsement identifies person(s)or organization(s)who are"insureds" under the Who Is An Insured Provision of the Coverage Form. This endorsement does not alter coverage provided in the Coverage form. Schedule Name of Person(s)or Organizations(s): The City of Santa Ana, its City Council, officers, officials, employees, agents and volunteers are covered as additional insured with respect to liability arising out of work or operations performed by or on behalf of the Permittee including materials, parts or equipment furnished in connection with such work or operations Regarding Designated Contract or Project: 11-6741 Bristol Street Improvements from Warner Avenue to Saint Andrew Place 1 Project No.: 19-6499 Bristol Street (Phase 4) Water Main Each person or organization shown in the Schedule of this endorsement is an "insured"for Liability Coverage, but only to the extent that person or organization qualifies as an "insured" under the Who Is An Insured Provision contained in Section II of the Coverage Form. The following is added to the Other Insurance Condition: If you have agreed in a written agreement that this policy will be primary and without right of contribution from any insurance in force for an Additional Insured for liability arising out of your operations, and the agreement was executed priorto the"bodily injury"or"property damage",then this insurance will be primary and we will not seek contribution from such insurance. OUP INTERNACER4MS td ftnd partners Ou 120t ,,Li.eirtyA1Iutual Group of Companies. All rights reserved. Page 1 of 1 Includes copyrighted material of Insurance Services Office, Inc. with its permission.