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TF Policy NO. 92 CRP647 1 75-1404 CMP-4793 <br />Page 1 of 1 <br />THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY <br />CMP-4793 ADDITIONAL INSURED — STATE OR POLITICAL SUBDIVISIONS <br />(Permits Relating To Premises) <br />This endorsement modifies insurance provided under the following: <br />BUSINESSOWNERS COVERAGE FORM <br />SCHEDULE <br />Policy Number: 92 CRP647 1 <br />Named Insured: <br />JOHNSTON, SARAH <br />DBA SHOWTIME DANCE COMPANY <br />410 W 4TH ST STE A <br />SANTA ANA CA 92701-4567 <br />Name And Address Of Additional Insured Or Political Subdivision: <br />THE CITY OF SANTA ANA, ITS OFFICERS, EMPLOYEES, AND VOLUNTEERS ARE TO BE <br />COVERED AS ADDITIONAL INSURED WITH RESPECT TO LIABILITY ARISING OUT OF <br />WORK OR OPERATIONS PERFORMED BY OR ON BEHALF OF INSURED INCLUDING <br />MATERIALS, PARTS OR EQUIPMENT FURNISHED IN CONNECTION WITH SUCH WORK <br />20 CIVIC CENTER PLZ <br />SANTA ANA CA 92701-4058 <br />1. SECTION II — WHO IS AN INSURED of SECTION II — LIABILITY is amended to include, as an <br />additional insured, any state or political subdivision shown in the Schedule, but only with respect to <br />the following hazards for which the state or political subdivision has issued a permit in connection <br />with premises you own, rent or control and to which this insurance applies. <br />a. The existence, maintenance, repair, construction, erection or removal of advertising signs, awn- <br />ings, canopies, cellar entrances, coal holes, driveways, manholes, marquees, hoist away open- <br />ings, sidewalk vaults, street banners or decorations and similar exposures; or <br />b. The construction, erection or removal of elevators; or <br />c. The ownership, maintenance or use of any elevators covered by this insurance. <br />2. Any insurance provided to the additional insured shall only apply with respect to a claim made or a <br />"suit" brought for damages for which you are provided coverage. <br />3. Primary Insurance. The insurance afforded the additional insured shall be primary insurance. Any <br />insurance carried by the additional insured shall be noncontributory with respect to coverage pro- <br />vided by you. <br />All other policy provisions apply. <br />CMP-4793 1006226 137721.1 11-19-2013 <br />B, Copyright, State Farm Mutual Automobile Insurance Company, 2008 <br />Includes copyrighted material of Insurance Services Office, Inc., with its permission. <br />REVEWED&APPR0VMBr <br />®•. <br />- Risk Management Spedelist <br />