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POLICY NUMBER: LEBP555775 <br />COMMERCIAL GENERAL LIABILITY <br />THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. <br />ADDITIONAL INSURED - OWNERS, LESSEES OR <br />CONTRACTORS - (FORM B) <br />This endorsement modifies insurance provided under the following: <br />COMMERCIAL GENERAL LIABILITY COVERAGE PART. <br />SCHEDULE <br />Name of Person or Organization: <br />The City of Santa Ana and its departments, boards, officials, employees and agents. <br />Risk Management Division <br />20 Civic Center Plaza <br />Santa Ana, CA 9270 <br />(If no entry appears above, information required to complete this endorsement will be shown in the Declarations <br />as applicable to this endorsement.) <br />WHO IS AN INSURED (Section II) is amended to include as an insured the person or organization shown in the <br />Schedule, but only with respect to liability arising out of "your work" for that insured by or for you. <br />Rink Management DMsian <br />�?- REVIEWED & APPROVED BY: <br />Risk Management Specialist <br />CG 20 10 11 85 Copyright, Insurance Services Office, Inc., 1984 Page 1 of 1 ❑ <br />