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04/17/2012 10:01 9169212266 VETERINARY INS SVCS 04314 P.003/003 <br />Additional Insured β€” Owners, Lessees or Contractors β€” AB 90 67 12 93 <br />Policy Amendment Section Il <br />Insured: Community Veterinary Hospital <br />Policy Number AZC9086833 1 <br />Pruducer Veterinary Ins Services Co Effective Date 10/01/11 <br />Schedule <br />Name of Person(s) or Organization(s) <br />City of Santa Ana, its officers, employees, agents, volunteers and representatives <br />Primary Insurance: It is agreed that any person or organization described above is an additional insured, but only <br />with respects to liability arising out of rhe operation performed for the additional insurance by or on behalf of the <br />named insured. The insurance afforded to such additional insured is primary. Any other insurance such additional <br />insured may have will be non-contributing. <br />(Ifno 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 β€” W140 19 AN IN- <br />SURED in the Business Liability Section ofthis policy <br />5_ 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 must be attnehcd to Change Endorsement when issued after the policy is written. <br />One of the Fireman's Fund Insurance Companies as named in the policy. <br />M&Lry <br />Secretary <br />Authorized Agent <br />AB9067 12-93 <br />Gonlu:ns copyrighted K4.1β€”ial ollnaunnee services Offices, 1no_, 198-4 <br />WkAasCgs. Lag oeeo <br />President <br />04/17/12 <br />APPROVED AS TO FORM <br />Ass' t City Attorney <br />