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POLICY NO. AH-GA2692-004 COMMERCIAL GENERAL LIABILITY <br />NAME INSURED:Toyama Karate Do <br />THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. <br />ADDITIONAL INSURED — DESIGNATED PERSON OR <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 II) is amended to include as an Insured the person or organization <br />shown in the schedule, as an insured but only with respected to liability arising out of your operations or <br />premises owned by or rented to you. <br />CG 20261185 Copyright, ISO Properties, Inc., 2004 Page 1 of 1 <br />