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<br />.' <br /> <br />ENDORSEMENT <br /> <br />THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. <br /> <br />NON-OWNED AUTO LIABILITY <br /> <br />This endorsement, effective on 1/7/2005 forms a part of <br />(12:01.'\.1\1. Standard Time) <br /> <br />Policy Number: 3CP9777 <br /> <br />Certificate Number: SSA04-0028 <br /> <br />Issued To: Jorgensen, Kent <br /> <br />By: <br /> <br />Essex Insurance Company <br /> <br />This endorsement modifies insurance provided under the following: <br /> <br />COMMERCIAL GENERAL LIABILITY COVERAGE PART <br /> <br />SCHEDULE <br /> <br />COVERAGE <br /> <br />ADDITIONAL PREMIUM <br /> <br />Non-Owned Auto Liability <br /> <br />$ 250.00 <br /> <br />Coverage applies only to The City of <br />Santa Ana as limited by the specific work <br />performed under this certificate. No coverage <br />afforded to certificate holder <br /> <br />NON-OWNED AUTO LIABILITY <br /> <br />The insurance provided under COVERAGE A (Section I) applies to "bodily injury" or "property damage" arising <br />out of the use of any "non-owned auto" in your business by any person other than you. <br /> <br />With respect to the insurance provided by this endorsement: <br /> <br />The exclusions, under COVERAGE A (Section I), other than exclusions a, b, d, f and i are deleted and the following <br />exclusions are added: <br /> <br />1. "Bodily injury" <br /> <br />(a) To an "employee" oflbe insured arising out of and in the course of employment by the insured; or <br /> <br />(b) To the spouse, child, parent, brother or sister of that "employee" as a consequence of paragraph (a) <br />above. <br /> <br />This exclusion applies: <br /> <br />(a) Whether the insured may be liable as an employer or in any other capacity; and <br /> <br />(b) To any obligation to share damages with or repay someone else who must pay damages because of the <br /> <br />lDJUry, <br /> <br />Page I of2 <br /> <br />APPROVED AS TO FORM <br /> <br />X~ S/V <br /> <br />Laura Stilt Sheedy <br />Assistant City Attornev <br /> <br />This exclusion does not apply to: <br />