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POLICY NUMBER: CPV0004862 <br />LIABILITY <br />COMMERCIAL GENERAL <br />CG 20 10 1186 <br />THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. <br />ADDITIONAL INSURED — OWNERS, <br />CONTRACTORS (FORM <br />This endorsement modifies insurance provided under the following: <br />COMMERCIAL GENERAL LIABILITY COVERAGE PART. <br />SCHEDULE <br />Name of Person or Organization: <br />City of Santa Ana <br />20 Civic Center Plaza, RM 97 <br />P.O. Box 1964 <br />Santa Ana, CA 92702 <br />LESSEES OR <br />B) <br />(If no entry appears above, information required to complete this endorsement will be shown in the Declarations <br />as applicable to this endorsement.) <br />WHO IS AN INSURED (Section ll) is amended to include as an insured the person or organization shown in the <br />Schedule, but only with respect to liability arising out of "your work" for that insured by or for you. <br />PRIMARY INSURANCE: Such insurance as is afforded by the General Liability policy is primary insurance and no <br />other insurance of the additional insured shall be called upon to contribute to a loss <br />7 �Z. 31z o / 5- <br />9 APPROVED <br />(v zb ePV1(PX4 4t�� <br />CG 20 101185 Copyright, insurance Services Office, Inc. , 1984 Page 1 of 1 ❑ <br />