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<br />From: Je""sica Chavez-Roy At: Bolton & Co. Fax!D: Bolton and Company To: CITY OF SANTA ANA <br /> <br />" <br /> <br />Date: 2/1712005 03:24 PM Page: 3 of 3 <br /> <br />. <br /> <br />SANT A1\3 <br />POLICY NUMBER <br />NAMED INSUREr) <br /> <br />Advanced Automated Systems, Inc <br />WCP 117003505200 <br /> <br />COMMERCIAL GENERAL LIABILITY <br /> <br />TIDS ENDORSEMENT CHANGES THE POLICY. PJ,EASE READ IT CAREFULLY. <br /> <br />CG 20091093 <br /> <br />ADDITIONAL INSllRED - OWNERS, LESSEES or CONTRACTORS [Form AJ <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 or Orgaruzation (Additional Insured): <br />The City ot" Santa Ana, its officers, employees, agents, volunteers !lnd representatives. <br /> <br />Location of Covered Operations <br />Operations of the Named Insured <br /> <br />Premium Basis <br /> <br />Rates <br /> <br />Advance Premium <br /> <br />Bodily InJmy and <br />Property Damage Liability <br /> <br />Cost <br /> <br />(Per $1,000 of Cost) <br /> <br />$ INCLUDED <br /> <br />Total Advance Premium <br /> <br />$ INCLUDED <br /> <br />or no entry appears above, information required to complete this endorsement will be shown in the Declarations as applicable to this <br />endorsement.) <br /> <br />1. WHO IS At'J INSURED (Section ll) IS amended to <br />include as an insrned the person or organization (called <br />"additional Insured") shown in the Schedule, but only <br />Wlth respect to liability arising out of: <br />A Your ongoing operations performed for the <br />additional insured(s) at the location designated <br />above, or <br />B. Acts of omissions of the additional insrned(s) in <br />connection with their general supervislon <br />of such operations. <br />2. With respect to the insurance affordeu these additional <br />insureds, the following additional provisions apply: <br />A ExclUSIons b., c" g" h,(I), j" k" Land n. under <br />COVERAGE A - BODILY INJURY AND <br />PROPERTY DAMAGE LIABILITY (section [ _ <br />Coverages) do not apply, <br />B. Additional Exclusions. This insurance does not <br />apply to: <br />(I) "Bodily Injury" or "property damage" <br />for which the additional insrned(s) are <br />obligated to pay damages by reason of <br />the assumption of liability in a contract or <br />agreement This exclusion does not apply to <br />liability for damages that the additional <br />insured)s) would have in the absence of the <br />contract or agreement. <br />(2) IP Bodily injury" or "property damage" occurring <br />after' <br />(a) All, work, including materials, parts or <br />""",..........."....t +"......;~h",,1 ;.., ""......,"'~t,,,.... n,;th <br /> <br />such work, on the project (other than <br />service, maintenance, or repairs) to be <br />performed by or on behalf of the addItIonal <br />insrned(s) at the site of the covered <br />operations has been completed; or <br />(b) That portion of "your work" out of which <br />injury or damage arises has been put to its <br />intended use by any person or organization <br />other than another contractor or <br />subcontractor engaged In performing <br />operations [or a principal as a part of the <br />same project. <br />(3) "Bodily injury" or "property damage" arising <br />out of any act or omission of the additional <br />insurcd(s) or any of their employees other <br />than the general supervision by the additional <br />insureds(s) of your ongoing operations <br />performed for the additional insured(s). <br />(4) "Property damage" to <br />(a) Property owned, used or occupied by or <br />rented to the additional msured(s); <br />(b) Property in the care, custody or control of <br />the additional insured(s) or over which the <br />additional insurcd(s) are for any purpose <br />exercising physical control; or <br />(c) Any work, including materials, parts or <br />equipm ent furnished in connectlOn with <br />such work, which is performed for the <br />additional insrned(s) by you. <br /> <br />CG20091093 <br /> <br />Copyright., Insrnance Service Office, Inc., 1992 <br /> <br />;\]>Pi<.' '\c' 10 FORM <br /> <br />~;>Z~Ofl <br /> <br />" , ,Sheedy <br />.li Attorney <br /> <br /> <br />