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. • � � i • _ � .v � ....J� ��1.G v L LfIL 1, .�. Il 1 1Iv .a v .� � ._ _ _ _ . ., . .. . <br />Additional Insured — Owners, Lessees or Contractors — AB 90 67 12 93 <br />Policy Amendment Section 11 <br />loitered_ Community Veterinary Hospital Policy !Number AZC80843887 <br />William A. Grant Ill, DVM <br />Producer Veterinary Ins Services Co Etreetive Date 10/01/09 <br />Schedule <br />Plume of Person(s) or Organization(s) <br />City of Sanra Ana, its officers, employees, agenic, volunteers and representatives <br />(Ifno entry appears above, information required to compiete 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- arising out of your work for that insured by or for <br />SUR -ED in the Business Liability Section ofthis policy you. <br />S. The person or organisation shown in the Schedule All other terms and conditions of the policy apply. <br />is also an insured, but only with respects to liability <br />This form must be attached to Chante Endorsement when issued after the policy is written. <br />one of the Fireman's Fund Insurance Companies as named in the policy. <br />.4a,T <br />secretary <br />Countersignature ol'Authorizcd Agent <br />An�ai9! 12-93 <br />Cu+�u cap�rimweA m—:.1 or.,�1ur.M.r s—w— Inc.. 19- <br />Wk6gvf9w La4ZP o <br />President <br />