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P0I10y Nun 1b0r: CBP8903147 <br />Covorage is Provided In PEERLESS INSURANCE COMPANY -A STOCK COMPANY <br />Named Ensured: Agent: <br />Dekra -Cite Industries, Inc. <br />SPECTRUM RISK MANAGEMENT 8, INS <br />Agent Code: <129595g Agent Phone: (949) -756-5730 <br />THIS ENDORSEMENT CHANGES -rpiE POLICY, PLEASE READ IT CAREFULLY. <br />ADDITIONAL, INSURED -- OWNERS, LESSEES OR <br />CONTRACTORS _- COMPLETED OPERATIONS <br />This endorserent modifies insurance provided under the following: <br />COMMERCIAL GENERAL LIABILITY COVERAGE PART <br />Section iE — Who Is An Insured Is amended to include as an additional insured the person(s) or organizalion(s) <br />shown in the Schedule, but only with respect to liability for "bodEly injury "' cr "propelty darnage" Cauaed, In vahole or in <br />port, by "your work" at the location designated and described In the schedule of this endorsement performed for that <br />additional insured and included in the "products - completed operations hazard ". <br />SCHEDULE <br />Name Of Additional Insured Person(s) Or Organization(s): <br />ANY PERSON OR ORGANIZATION WHEN YOU AND SUCH PERSON OR <br />ORGANIZATION HAVE A: RLED IN WRITING IN A CONTRACT, <br />AGREEMENT OR PERMIT THAT SUCH PERSON OR ORGANIZATION <br />BE ADDED AS AN ADD'L INSURED ON YOUR POLICY TO PROVIDE <br />INSURANCE SUCH AS IS AFFC)RDED UNDER THIS COVERAGE PART' <br />Location And Description Of Completed Operations: <br />ANY LOCATION AT WHICH YOU PERFOMED WORK DESCRIBED IN <br />WRITING IN THE CONTRACT", AGREEMENT OR PE_A,MIT FOR A <br />PERSON OR ORGANIZATION THAT HAS BEEN QUALIFIED AS AN <br />ADDITIONAL. INSURED IN THIS ENDORSEMENT', <br />Information required to complete this .Schedule, if not fihown above, will he shown in the Declarations. <br />1001410 139018 NN173635 2809 <br />CERT NO.: 15990584 Lea Panda 419/2013 0:43:10 AM Page 2 of 2 <br />A'pp'?, '�WFD AS TO FORM <br />t J'0 r— STORCK <br />sslstarlt G::r Attorney, <br />004 <br />priDM0rs0ri 1.1HJ1418 GCAFPPN 00061222 Pap, 15 <br />