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POLICY NUMBER: PK201700012085 COMMERCIAL GENERAL LIABILITY <br />CG 2012 06 09 <br />THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. <br />This endorsement modifies insurance provided under the folloN ling: <br />COMMERCIAL GENERAL LIABILITY COVERAGE PART <br />SCHEDULE <br />State Or Governmental Agency Or Subdivision Or Politica Subdivision: <br />The City of Santa Ana, its officers, employees, agents, and representatives are <br />included as an Additional Insured. <br />CITY OF SANTAANA <br />20 CIVIC CENTER PLAZA, PO BOX 1988, M-16, SANTA ANA, CA 92701 <br />Section II — Who Is An Insured is amended to in- <br />cfude as an insured any state or governmental <br />agency or subdivision or political subdivision shown In <br />the Schedule, subject to the following provisions: <br />1. This insurance applies only with respect to opera- <br />tions performed by you or on your behalf for which <br />the state or governmental agency or subdivision or <br />political subdivision has issued a permit or au- <br />thorization. <br />2. This insurance does not apply to: <br />a. 'Bodily injury", `property damage" or 'personal <br />and advertising injury" arising out of operations <br />performed for the federal government, state or <br />municipality; or <br />b. "Bodily injury' or 'property damage" included <br />within the 'products -completed operations <br />hazard". <br />e6VA <br />�ey�P (� <br />0 00, � <br />CG 2012 05 09 0 Insurance Services Office, Inc., 2008 Page 1 of 1 ❑ <br />