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POLICY NUMBER: 6BRPGO000005515500 <br />COMMERCIAL GENERAL LIABILITY <br />CG 20 11 01 96 <br />THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. <br />ADDITIONAL INSURED - MANAGERS OR LESSORS OF <br />PREMISES <br />This endorsement modifies insurance provided under the following: <br />COMMERCIAL GENERAL LIABILITY COVERAGE PART <br />SCHEDULE <br />1. Designation of Premises (Part Leased to You): <br />Premises as described in the agreement or lease <br />2. Name of Person or Organization (Additional Insured): <br />City of Santa Ana, its officers, agents, and employees <br />1825 W Civic Center <br />Santa Ana, CA 92704 <br />Named Insured: Maria L Madrigal <br />Cert Policy #1002 <br />Effective 02/20/14-02/13/15 <br />3. Additional Premium: $0.00 <br />(If no entry appears above, the information required to complete this endorsement will be shown in the Declarations as <br />applicable to this endorsement.) <br />WHO IS AN INSURED (Section II) is amended to include as an insured the person or organization shown in the Schedule <br />but only with respect to liability arising out of the ownership, maintenance or use of that part of the premises leased to you <br />and shown in the Schedule and subject to the following additional exclusions: <br />This insurance does not apply to: <br />1. Any "occurrence" which takes place after you cease to be a tenant in that premises. <br />2. Structural alterations, new construction or demolition operations performed by or on behalf of the person or <br />organization shown in the Schedule. <br />CG 2011 01 96 Copyright, Insurance Services Office, Inc., 1994 Page 1 of 1 <br />