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08119/2011 14:32 9189212288 <br />VETERINARY INS SVCS #3704 P.003/005 <br />Additional Insured — Owners% Lessees or Contractors — AB 90 67 12 93 <br />Policy Amendment Section II <br />Insured: Serrano Animal.ft Bird 1lodpits) Ppltcy Number AZC80865687 <br />Producer Veterinary ins Services Co Effective Date 07/01/1 l <br />Schedule <br />Nsme of Person(s) or Organization(s) <br />City of Santa Ann, Parks, Recreation & Community Service Agency <br />P.O. Sox 198SM-23 <br />Santa Ana, CA 92702 <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 1 — WHO IS AN IN- arising out of your work for that insured by or for <br />SURED In the Business Liability Section ofthis policy you. <br />5. The person or organization 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 Auaohed to Change Endorsement when Issued aRer the policy is written. <br />One of the Fireman's fund Insurance Companies as named in the policy. <br />4A was.y <br />Secretary <br />'�NtYiij '%Zoe <br />q Agent <br />AS9067 12-9% <br />ConUhu copyrighted Material of Itnurenee services Offices. Inc.. 1994 <br />wicSaMOE CaiRor-co <br />President <br />9/19/11 <br />