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ENDORSEMENT AGREEMENT <br />ADDITIONAL, INSURED EMPLOYER REP D1 <br />9040950-17 <br />RENEWAL <br />SP <br />5-28-05-97 <br />PAGE 1 <br />HOME OFFICE <br />SAN FRANCISCO EF'F'ECTIVE JANUARY 4, 2017 AT 12.01 A.M. <br />ALL EFFECTIVE DATES ARE <br />AT 12x1 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 />IRVINE, CA 92606 <br />ANYTHING IN THIS POLICY TO THE CONTRARY NOTWITHSTANDING, <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 WORT{ UNDER THE SIMUL'T'ANEOUS 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 SHALL REMAIN THE SOLE <br />RESPONSIBILITY OF THE PRIMARY INSURED. <br />NOTHING IN THIS ENDORSEMENT CONTAINED SHALL BE HELD TO VARY, ALTER, WAIVE 'me <br />OR EXTEND ANY OF THE TERMS, CONDITIONS, AGREEMENTS, OR LIMITATIONS OF THIS lz <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 ob <br />LIMITATIONS OF THIS ENDORSEMENT. <br />COUNTERSIGNED AND ISSUED AT SAN FRANCISCO: JANUARY 6, 2017 0015 <br />AUTHORIZED REPREvSENT. IVC PRESIDENT AND DEC <br />SCIF FORM 10217 IREWI.2014) OLD OP 217 <br />