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Liberly Surplus Insurance Corporation <br />ENDORSEMENT NO. <br />THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. <br />Endorsement Effective Date: 061"03/2012 Policy No.: 10000008273-02 <br />Insured: CROSSTOWN ELECTRICAL & DATA INC. <br />ADDITIONAL INSURED -OWNERS, LESSEES OR CONTRACTORS (FORM B) <br />SCHEDULE <br />Name of Person or Organization: <br />CITY OF SANTA ANA . ALONG WITH ITS OFFICERS, AGENTS, REPRESENTATIVES, & EMPLOYEES ARE LISTED AS ADDITIONAL <br />INSURED, RE- CITY OF SANTA ANA / TRAFFIC ENGINEERING (CT 1695) <br />(If no entry appears above, inforination required to complete this endorsement will be shown in the <br />Declarations as applicable to this endorsement.) <br />WHO IS AN INSURED (Section II) is amended to include as an insured the person or organization shown in <br />the Schedule, but only with respect to liability arising out of "your work" for that insured by or for you. <br />CGL 2010 1 185 Page I of 1