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<br />SEP. -11' 00 (MaN) 12:54 A LAWRe ASSOC. <br /> <br />TEL:! 818.5472 <br /> <br />P 003 <br /> <br />POLICV NUMBER: 72SBAGA1988DX <br /> <br />COMMERCIAL GENERAL LIABILITY <br /> <br />THIS ENDORSEMENT CHANGES THE POLlCV. PLEASE READ IT CAREFULLY. <br />ADDITIONAL INSURED - OWNERS, LESSEESS or <br />CONTRACTORS [FORM B] <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 Organization: <br />City ot Santa Ana <br />workers Compensation Claims Adm <br />20 Civic Cgnter plaza (M-41) <br />Santa Ana, CA 92701-1988 <br /> <br />{If nO entry appears above, information required to complete this endorsement Will De shown in the Declarations <br />as applicable to tnlS endorsement.) <br /> <br />WHO IS AN INSURED (SeCtion II) is amended to incluoe as an insured the person or organization shown in <br />the Schedule, but only with respeel to liability arising out of ''your work" for that Insured by or for you. <br /> <br />The City of Santa Ana. its agents. officers, and employees <br />are named as additional insureds with regard to liability <br />and defense of suits arising from the operations and use <br />performed by or on behalt at the named insured No <br />termination. cancellation or change ot coverage or of <br /> <br />APi'ROVED AS TO FORM <br /> <br />CG20101185 <br /> <br />/-'~ '-:i ,. <br />. /Y:::::ccl./([{-.:."5.'",Cf"' t'~-/ <br />Laura Sheedy <br />""'),;puty City Attorney <br /> <br />pi it! <br />