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r <br />8-09-2005 1-59PM <br />Fanning a Part of <br />FROM <br />P- 3 <br />PoNcyNurnW. C8P8054466 <br />Coverage Is Provided In GOLDEN EAGLE INSURANCE CORPORATION <br />Named Insured: <br />Agent: <br />CASA DE SALUD FAMILY HEALTH <br />EVEREST INSURANCE SERVICE INC <br />CLINIC <br />Agent Code: 4295101 Agent Phone: (714)-569-0800 <br />THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. <br />ADDITIONAL INSURED - DESIGNATED PERSON OR ORGANIZATION <br />Y his endorsement modifies insurance provided under the following! <br />COMMERCIAL GENERAL LIABILITY COVERAGE PART. <br />SCHEDULE <br />Name of Person or Organization: <br />Community Development Agency <br />City of Santa Ana <br />20 Civic Center Plaza <br />Santa Ana, CA 92702 <br />(If lw entry appears above, ""'nulirm "ifWl W V nVlele lllix efidW W1'1 V1 will be 4i1Qwn Ir. Uw t)uolaatkxl1 as <br />applicable to this endorsement.) <br />WHO IS AN INSURED (Section II) is amended to indude as an insured the person or organization shown in the <br />Scneoule as an insured out only witn respect to baoillty arising out of your operat1OA or premises Owned <br />by Or <br />rented M you. <br />APPROVED AS TO FORM <br />�— aura Stitt Shacdy�� <br />z nntlflt CIIV pit;n; ttey <br />Copy60hl. Ofsur911ce SBNM,pS OnkR, IAC, 1984 <br />GG 20 26 (11/85) <br />07211r21)05 8054458 NEU8%CM8)aM <br />POD10080D ,107861 GCAOPPN 00000834 P+Dr 49 <br />