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<br />" <br />, , NAUTILUS INSURANCE COMPANY <br /> <br />POLICY NUMBER: NC400101 LIABILITY ENDORSEMENT <br /> <br />THIS ENDORSEMENT CHANGES THE POLICY, PLEASE READ IT CAREFULLY, <br /> <br />ADDITIONAL INSURED ENDORSEMENT <br /> <br />This endorsement modifies insurance provided under the following: <br />COMMERCIAL GENERAL LIABILITY COVERAGE PART <br /> <br />SCHEDULE <br /> <br />Name of Person or Organization: <br />THE CITY OF SANTA ANA ITS OFFICERS, EMPLOYEES, <br />REPRESENTATIVES ATTN, DAVE URBIN <br />Address: <br />220 s, DAISY AVE, BLDG A <br />SANTA ANA CA 92703- <br /> <br />Premium $ <br />AGENTS, VOLUNTEERS AND <br /> <br />350 <br /> <br />WHO IS AN INSURED (Section II) Is amended to Include as an insured the person or organization shown in the <br />Schedule and only for liability arising out of your negligence and only for occurrences or coverages not otherwise <br />excluded in the policy to which this endorsement applies, <br /> <br />Your policy is primary In the event of an occurrence caused by your sole negligence as respects the job described <br />below: (MUST BE COMPLETED) <br /> <br />Job Description: <br /> <br />Address: <br /> <br />All other Terms and Conditions of this Insurance remain unchanged, <br /> <br />\.0rO~ <br />} i\.~ <br /> <br />,. I"'....)' ~ <br /> <br /> <br />--. <br /> <br />8114 (04/97) <br />