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<br />. <br /> <br />ISO I Commercial General Liability Forms I 07101/04 <br />POLICY NUMBER: <br /> <br />COMMERCIAL GENERAL <br />LIABILITY <br />CG 20 1007 04 <br /> <br />THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. <br /> <br />ADDITIONAL INSURED - OWNERS, LESSEES OR <br />CONTRACTORS - SCHEDULED PERSON OR <br />ORGANIZATION <br /> <br />This endorsement modifies insurance provided under the following: <br /> <br />COMMERCIAL GENERAL LIABILITY COVERAGE PART <br /> <br />City of Santa Ana, its officers, agents, <br />representatives, and volunteers <br />888 W Santa Ana Blvd <br />Ste 200 <br />P.O. Box ]988 M-23 <br />Santa Ana, CA 92702 <br /> <br />employees, <br /> <br />SCHEDULE <br /> <br />Name Of Additional Insured Person(s) <br />Or Oroanizationisl: <br /> <br />Location/s' Of Covered OllArations <br /> <br />Information reauired to comolete this Schedule, if not shown above, will be shown in the Declarations. <br /> <br />A. Section II - Who Is An Insured is amended to include as an additional insured the person(s) or organlzation(s) <br />shown in the Schedule, but only with respect to liability for "bodily Injury", "property damage" or 'personal and <br />advertising injury" caused, in whole or in part, by: <br /> <br />1. Your acts or omissions; or <br /> <br />2. The acts or omissions of those acting on your behalf: <br /> <br />in the pertormance of your ongoing operations for the additional insured(s) at the location(s) deSignated above. <br /> <br />B. With respect to the Insurance afforded to these additional insureds, the following additional exclusions apply: <br /> <br />This Insurance does not apply to "bodily injury" or "property damage" occurring after: <br /> <br />1. All work, including materials, parts or equipment fumished in connection with such work, on the project <br />(other than service, maintenance or repairs) to be pertormed by or on behalf of the additional insured(s) at the <br />location of the covered operations has been completed; or <br /> <br />2. That portion of "your work" out of which the injury or damage arises has been put to its intended use by any <br />person or organization other than another contractor or subcontractor engaged in performing operations for a <br />principal as a part of the same project. <br /> <br />CG 20 10 07 04 <br /> <br />,'e), d\" J.,:,:':' /\>~ PJ l'OrZJVI <br /> <br />'i/>/ .:>!, <br />/~-;;;?_-~~-",._,.~;._-_.._~-,,_._- ' <br /> <br />: I "'r~!~:\ <br />