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o�+r � "?t� i�f • t;:tC� � � i�y 1 <br />POLICY NUMBER: GLO 4649358 GLO 4641367 <br />Additional Insured - Owners, Lessees Or Contractors - Scheduled <br />Person Or Organization <br />No. Exp, Rate of Pol. Eff Date of End. Agency No. .._ Addl.. Prctn. Retarn Prom. <br />1111.115 11 /1/1.4 37385000 � <br />THIS ENDORSEMENT CH ANGES THE POLICY. PLEASE READ TT CAREFI3LLY. <br />Named Insured: BLACK & VEATCH CORPORATION <br />Address (including ZIP Code): <br />This endorsement modifies insurance provided under the: <br />Commercial. General Liability Coverage Part <br />SCHEDULE <br />Name Of Additional Insured Person(s) Or Organization: <br />City of Santa Ana <br />220 S. Daisy Avenue, M -85 <br />Santa Ana, CA 42703 <br />Location And Description of Cover Operations: <br />Information repaired to complete this Schedule, if not drown abom, will be slsuwn in tiro TDodarations. <br />A. Section II -'Who Is An Insured is amended to include as an 'insured any person or organization who you <br />are required to add as an additional insured on this policy under a written contract or written agreement, <br />I3. The insurance provided to the additional insured person or organization applies only to "bodily injury ", <br />"property damage" or "personal and advertising injury" covered under SECTION I - Coverage A - Bodily <br />Injury And Property Damage Liability and Section I - Coverage B - Personal And Advertising Injury <br />Liability, but only wiffi respect to liability for "bodily bijury" "property dainage" or "personal and <br />advertising injury" caused, in whole or in part„ by: <br />1. Your acts or omissions or <br />2. 'Clue acts or omissions of those acting on your behalf; and resulting directly front: <br />a. Your ongoing operations performed for the additional insured, which is the subject of the written <br />contract or written agreement; or <br />b, "Your work" completed as included in the "products - completed operations hazard ", performed for <br />the additional insured, which is the subject of the written contract or written agreement. <br />C. However, regardless of the provisions of paragraphs A. and B. above: <br />1. We will not extend any insurance coverage to any additional insured person or organization: <br />a, That is not provided to you hi this policy; or <br />Attachment Code, D481567 <br />Certificate ID: 11363208 <br />