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POLICY NUMBER: COMMERCIAL GENERAL LIABILITY <br />CG 20 12 05 09 <br />THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. <br />ADDITIONAL INSURED - STATE OR GOVERNMENTAL <br />AGENCY OR SUBDIVISION OR POLITICAL <br />SUBDIVISION - PERMITS OR AUTHORIZATIONS <br />This endorsement modifies insurance provided under the following: <br />COMMERCIAL GENERAL LIABILITY COVERAGE PART <br />SCHEDULE <br />State Or Governmental Agency Or Subdivision Or Political Subdivision: <br />City of Santa Ana, It's officers, agents, employees, and volunteers: <br />Risk Management Division <br />20 Civic Center Plaza <br />Santa Ana, CA 92702 <br />Information re uired to complete this Schedule, if not shown above, will be shown in the Declarations. <br />Section 11 — Who Is An Insured is amended to <br />include 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 <br />operations performed by you or on your behalf for <br />which the state or governmental agency or <br />subdivision or political subdivision has issued a <br />permit or authorization. <br />Additional Premium: Included ($550.00) <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 />Other Insurance — subject to all terms and provisions of the policy, insurance as provided by this endorsement shall <br />be deemed primary and noncontributory, but only with respect to work performed by or on behalf of the named <br />insured in connection with the described project. <br />The person or organization named in the schedule above will be provided with a notice of cancellation if such <br />cancellation is initiated by us. Notice periods are 10 days for non-payment of premiums, 30 days for all other <br />reasons. <br />CG 20 12 05 09 <br />Services Office, Inc., 2008 Page 1 of 1 ❑ <br />