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POLICY NUMBER: UVEDE104595112 COMMERCIAL GENERAL LIABILITY <br />Chambers Group, Inc. <br />THIS ENDORSEMENT CHANGES THE POLICY, PLEASE READ IT CAREFULLY. <br />ADDITIONAL INSURED -- OWNERS, LESSEES OR <br />CONTRACTORS (FORM B) <br />This endorsement modifies insurance provided under the following: <br />COMMERCIAL GENERAL LIABILITY COVERAGE PART. <br />SCHEDULE <br />Name of Person or Organization: <br />Clerk of the City Council <br />City of Santa Ana <br />20 Civic Center Plaza (M-30) <br />P.O. Box 1988 <br />Santa Ana, Ca 92702 <br />(if no entry appears above, information 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 <br />shown in the Schedule, but only with respect to liability arising out of "your work" for that insured by or for <br />you. <br />Project Name: <br />,, •+ <br />To <br />APP,R0V'EI) AS <br />�--"`! LI. Attorney <br />Assista <br />nt City <br />CG 20 10 11 85 Copyright, Insurance Services Office, Inc., 1984 <br />