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POLICY NO.15-7005165 COMMERCIAL GENERAL LIABILITY <br />NAME INSURED.Toyama Karate Do <br />THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. <br />ORGANIZATION <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, its officers, agents, and employees <br />20'Civic Center Plaza <br />Santa Ana, CA 92701 <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 11) Is amended to Include as an insured the person or orpulzation <br />shown In the schedule, as an Insured but only with respected to liability arising V j* aperatlons or <br />premtses owned by or rented to you. vie"7 <br />'T <br />Gat Nq' ecr <br />?PIGS <br />CG 202611 B5 --` Copyright, ISO Properties, Inc., 2004 Page 1 of 1 <br />