Laserfiche WebLink
ENDORSEMENT AGREEMENT <br />ADDITIONAL INSURED EMPLOYER REP DI <br />9040950-16 <br />RENEWAL <br />SC <br />5-28-05-97 <br />PAGE I <br />HOME OFFICE <br />SAN FRANCISCO EFFECTIVE JANUARY 28, 2016 AT 12.01 A.M. <br />ALL EFFECTIVE DATES ARE <br />AT 12:01 AM PACIFIC <br />STANDARD TIME OR THE <br />TIME INDICATED AT <br />PACIFIC STANDARD TIME <br />THE ILLUMINATION FOUNDATION <br />2691 RICHTER AVE STE 107 <br />IR'V'INE, CA 92606 <br />ANYTHING IN THIS POLICY TO THE CONTRARY NOTWITFIST'ANDING, <br />IT IS AGREED THAT <br />CITY OF SANTA ANA <br />IS HEREBY NAMED AS AN ADDITIONAL INSURED EMPLOYER ON THIS <br />POLICY BUT ONLY AS RESPECTS EMPLOYEES WHOSE NAMES APPEAR ON <br />THE PAYROLL RECORDS OF <br />THE ILLUMINATION FOUNDATION <br />(HEREIN CALLED THE PRIMARY INSURED) WHILE THOSE EMPLOYEES <br />ARE ENGAGED IN WORK UNDER THE SIMULTANEOUS DIRECTION AND <br />CONTROL OF THE PRIMARY INSURED AND THE ADDITIONAL INSURED <br />EMPLOYER. <br />IT IS FURTHER AGREED THAT THE PAYMENT OF THE FULL PREMIUM <br />DUE AND PAYABLE UNDER THIS POLICY SHALT, REMAIN THE SOLE <br />RESPONSIBILITY OF 'SI -IE PRIMARY INSURED, <br />NOTHING IN THIS ENDORSEMENT CONTAINED SHALL BE HELD TO VARY, ALTER, WAIVE <br />OR EXTEND ANY OF THE TERMS, CONDITIONS, AGREEMENTS, OR LIMITATIONS OF THIS <br />POLICY OTHER THAN AS STATED, NOTHING ELSEWHERE IN THIS POLICY SHALL BE <br />HELD TO VARY, ALTER, WAIVE OR LIMIT THE TERMS, CONDITIONS, AGREEMENTS OR <br />LIMITATIONS OF THIS ENDORSEMENT. <br />COUNTERSIGNED AND ISSUED AT S...,A�.yyyyyy///N FRANCISCO: FEBRUARY 1, 92016 1 0015 <br />AUTHORI7'ED I'tISPHE5R;NT1 PRESIDCNT AND CEO <br />$CIF FORM 10217 IREV.7.2014I OLD OP 217 <br />