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<br />U5/17/ZUU5 IJ:49 FAX <br /> <br />SPECIALTY-BUHAN_SERVlCES <br /> <br />IgJOOJ/OOJ <br /> <br />CQ 20 21 <br />(Ed. 11 851 <br /> <br />THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. <br /> <br />Am IT IClI\IAL I NStRED- -DES I GNATED PER8CJ\I OR ORGAN I ZA T I ON <br /> <br />This endorsoment modifies insurance provided undor the fol lowing: <br /> <br />COMMERCIAL GENERAL <br />POliCY #PAC5373885 <br />Mercy House <br /> <br />LIABILITY COVERAGE PART <br /> <br />SCHEDULE <br /> <br />Nomo of Peteon or Or.anl.aelon: <br />The City of Santa Ana, its officials, employees, representatives, and volunteer <br />are herebY named as Additional Insureds as respects the operations of or on <br />behalf of Mercy House Transitional Living Center, performed under contract <br />with the City of Santa Ana. <br /> <br />(If no entry appears above, information required to complete this endorsement <br />will be shown in the Declarations.. applicable to this endorsement.) <br /> <br />WHO IS AN INSURED (Section II) is amendod to include as an insured the person <br />or organization shown in the Schedule as an insured but only with respect to <br />liability arising out of your operations or premises owned by or rented to <br />you. <br /> <br />~~~ <br />" '-r" <br />APrROVED A.::- . . <br /> <br />~/0-2.l~ <br /> <br />--- t:l.id ". - <br />AS;>lstant Cu.) 1'-'-'~"- . <br /> <br />Copyr ight, Insurance Services Office. Inc.. 1984 <br />CG 2026 (Received TimeFMaY.17. 11:42AMIPage 1 of 1) <br />