|
POLICY NUMBER: L13 M074308 00 COMMERCIAL GENERAL LIABILITY
<br />CG 20 12 12 19
<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 />1. City Of Downey And Their Agents, Officers And Employees,
<br />Attn: Engineering Division, Po Box 7016 Downey, CA 90241-7016
<br />2. The City Of Huntington Beach, Its Officers, Elected Or Appointed Officials, Employees, Agents And Volunteers 2000 Main Place, Hunti
<br />Beach. CA 92648
<br />3. City Of Santa Ana Risk Management Division 20 Civic Center Plaza, 4th Floor, Santa Ana, CA 92702, City Of Santa Ana, Risk
<br />Management, It's Officers, Employees, Agents, Representatives, And Volunteers
<br />4. The County Of Los Angeles And Public Entity Or Special District For Which The Los Angeles County Board Of Supervisors Is The
<br />Governing Body, And Their Agents Officers And Employees
<br />5. County Of Orange Row Permits, P.O. Box 4048, Santa Ana, CA 92702-4048
<br />6. The City Of Long Beach, It's Boards And Commissions, And Their Officials, Employees, And Agents City Of Long Beach Department Of
<br />Public Works, Project Management Division, 411 W. Ocean Blvd, 5th Floor, City Hall, Long Beach, CA 90802
<br />7. The County Of Los Angeles And Public Entity Or Special District For Which The Los Angeles County Board Of Supervisors Is The
<br />Governing Body, And Their Agents,Officers And Employees, Shall Be Additional Insured(s) While Acting Within The Scope Of Their Duties
<br />Against All Claims Arising Out Of Or In Connection With The Work To Be Performed Department Of Public Works / Land Development
<br />Division, Po Box 1460, Alhambra, CA 91802-1460
<br />8. The City Of El Cajon (And/Or The Successor Agency To The El Cajon Redevelopment Agency), And Its (Their) Elected And Appointed
<br />Officials, Officers, Employees And Volunteers (For Purposes Of This Policy, Individually And Collectively, The ("City Insured") As Additional
<br />Insureds.
<br />Information required to complete this Schedule, if not shown above, will be shown in the Declarations.
<br />CG 20 12 12 19 © Insurance Services Office, Inc., 2018 Page 1 of 2
<br />
|