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ISO I Commercial General Liability Forms 101/01/96 <br />POLICY NUMBER: XPK80968969 <br />Certificate Number: PEVD062171 <br />Effective Dates: 8/12/2017 to 8/13/2017 <br />COMMERCIAL <br />GENERAL LIABILITY <br />CG 20 1101 96 <br />THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. <br />ADDITIONAL INSURED - MANAGERS OR LESSORS OF PREMISES <br />This endorsement modifies insurance provided under the following: <br />COMMERCIAL GENERAL LIABILITY COVERAGE PART <br />SCHEDULE <br />I. Designation of Premises (Part Leased to You): <br />20 Civic Center Plaza Santa Ana . CA 92701 <br />2. Name of Person or Organization (Additional Insured): <br />City of Santa Ana <br />Additional Insured: The City of Santa Ana, it's officers, employees, agents and representatives are named as additional <br />insured. <br />3. Additional Premium: $0.00 <br />(If no entry appears above, the information required to complete this endorsement will be shown in the Declarations as <br />applicable to this endorsement.) <br />WHO IS AN INSURED (Section H ) is amended to include as an insured the person or organization shown in the Schedule <br />but only with respect to liability arising out of the ownership, maintenance or use of that part of the premises leased to you <br />and shown in the Schedule and subject to the following additional exclusions: <br />This insurance does not apply to: <br />1. Any "occurrence" which takes place after you cease to be a tenant in that premises. <br />2. Structural alterations, new construction or demolition operations performed by or on behalf of the person or organization <br />shown in the Schedule. <br />CG 20 11 0196 <br />NASEPWH055.doc © Insurance Services Office, Inc., 1994 <br />