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NOTICE: THESE POLICY FORMS AND THE APPLICABLE RATES ARE <br />EXEMPT FROM THE FILING REQUIREMENTS OF THE NEW YORK <br />INSURANCE LAW AND REGULATIONS. HOWEVER, THE FORMS AND RATES <br />MUST MEET THE MINIMUM STANDARDS OF THE NEW YORK INSURANCE <br />LAW AND REGULATIONS. <br />ADDITIONAL INSURED — STATE OR POLITICAL SUBDIVISIONS — PERMITS OR <br />AUTHORIZATIONS <br />Named Insured <br />Endorsement Number <br />Comcast Corporation <br />Policy Symbol <br />Polloy Number <br />Policy Period <br />Effective Date or Endorsement <br />XSL <br />G27871252 <br />12/01/2017 to 12/01/2018 <br />9/4/2018 <br />Issued By (Name or Insurance company) <br />ACE American Insurance <br />Company <br />......N--, ---111a- -- L..v uv ., np, v,auUllly rv4e4 uim eiiuuinmueinm I--auoe"yueui w lie Proycinuuu uilie poiwy. <br />THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. <br />This Endorsement modifies insurance provided under the following: <br />EXCESS COMMERCIAL GENERAL LIABILITY POLICY <br />SCHEDULE <br />The City of Santa Ana, 20 Civic Center Plaza, Santa Ana, California 92702; its officers, employees, agents and <br />volunteers. <br />(li no entry appears above, information required to complete this endorsement will be shown in the Declarations <br />as applicable to this endorsement.) <br />A. Section II — Who Is An Insured is amended to include as an additional insured any state or governmental <br />agency or subdivision or political subdivision shown in the Schedule, subject to the following provisions: <br />1. This insurance applies only with respect to operations performed by you or on your behalf for which the <br />state or governmental agency or subdivision or political subdivision has issued a permit or authorization. <br />However: <br />a. The insurance afforded to such additional insured only applies to the extent permitted by law; and <br />b, If coverage provided to the additional insured is required by a contract or agreement, the insurance <br />afforded to such additional insured will not be broader than that which you are required by the contract <br />or agreement to provide for such additional insured. <br />2. This insurance does not apply to: <br />a. 'Bodily injury", 'property damage" or "personal and advertising injury" arising out of operations per- <br />formed for the federal government, state or municipality; or <br />b. 'Bodily injury" or "property damage" included within the "products -completed operations hazard". <br />XS-21167b (04/13) Includes copyrighted material of Insurance Services office, Inc. with its permission. Page 1 of 2 <br />Class Code 2-14057 <br />