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<br />From: Sandi WFredericksen At: Wood-Gutmann insurance Brokers FaxlD: 714-573-1772 To: Laura/City of Santa Ana <br /> <br />Date: 3/15/1005 11 :00 AM Page: 4 of 5 <br /> <br />POLICY NUMBER: 042823782 <br /> <br />COMMERCIAL GENERAL LIABILITY <br /> <br />THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY, <br /> <br />ADDITIONAL INSURED - DESIGNATED PERSON OR <br />ORGANIZATION <br /> <br />This endorsement modifies insurance provided under the following: <br /> <br />COMMERCIAL GENERAL LIABILITY COVERAGE PART <br /> <br />SCHEDULE <br /> <br />Name of Person Dr Organization: <br /> <br />City of Santa Ana <br /> <br />and their respective officers, employees, <br />agents, volunteers, and representatives <br /> <br />As Required By Written Contra, <br /> <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 /> <br />WHO IS AN INSURED (Section II) is amended to include as an insured the person or organization shown in the <br />Schedule as an insured but only with respect to liability arising out of your operations or premises owned by or <br />rented to you. <br /> <br />APPROVED AS TO FÜli;.M <br /> <br />'/?1;J1'/C¡ ------ <br />, LalJr~~~-~U.iY <br /> <br />¡\S~l:->tan¡ tit y ,-1 ¡', <br /> <br />ò' <br /> <br />CG20261185 <br /> <br />Copyright, Insurance Services Office, Inc., 1984 <br /> <br />Page 1 of 1 <br /> <br />0 <br />