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GASTELUM, JOSE STATE FARM AGENCY-2012
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GASTELUM, JOSE STATE FARM AGENCY-2012
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Last modified
5/14/2012 2:38:06 PM
Creation date
5/14/2012 2:32:01 PM
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Contracts
Company Name
JOSE GASTELUM STATE FARM AGENCY
Contract #
N-2012-046
Agency
COMMUNITY DEVELOPMENT
Expiration Date
6/25/2012
Insurance Exp Date
1/1/2013
Destruction Year
0
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ADDITIONAL INSURED ENDORSEMENT <br />Insurance Company c??? ? e- ?°? V ti1^ ?S? t/ a rn G -E' <br />This endorsement modifies such insurance as is afforded by the provisions of Policy <br /># C1z -C? - ? ?fs? Z relating to the following: <br />1 . The City of Santa Ana, 20 Civic Center Plaza, Santa Ana, California 9270 it officers, <br />employees, agents and representative are named as additional insureds ("additional <br />insureds") with regard to liability and defense of suits arising from the operations and uses <br />performed by or on behalf of the named insured. <br />2. With respect to claims arising out of the operations and uses performed by or on behalf of <br />the named insured, such insurance as is afforded by this policy is primary and is not <br />additional to or contributing with any other insurance carried by or for the benefit of the <br />additional insureds. <br />3. This insurance applies separately to each insured against whom claim is made or suit is <br />brought except with respect to the company's limits of liability. The inclusion of any person <br />or organization as an insured shall not affect any right which such person or organization <br />would have as a claimant if not so included- <br />4. With respect the additional insureds, this insurance shall not be cancelled, or materially <br />reduced in coverage or limits except after thirty (30) days written notice has been given to <br />the City of Santa Ana, 20 Civic Center Plaza, Santa Ana, California 92701 . <br />(Completion of the following, including countersignature, is required to make this endorsement effective.) <br />Effective ? I''? ? ?? ? ??lZ, this endorsement form as part of <br />Policy # ???Z/-G? " ?7 ??? - ? <br />Issued to L- / 7--t, a ? ?Ga-.-??G ?v? a <br />Name Insured <br />Countersigned?i } ? ?w r- ? <br />v v ... ' v R6RM <br />???®ii?? ?? `? <br />L1SA? ? RGK <br />Exhibit C Assistant Clty Attorney <br />??
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