THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
<br /> THE
<br /> HARTFORD
<br /> ADDITIONAL INSURED - OWNERS, LESSEES OR
<br /> CONTRACTORS - COMPLETED OPERATIONS
<br /> POLICY NUMBER: 72SBABLVTP
<br /> This endorsement modifies insurance provided under the following:
<br /> BUSINESS LIABILITY COVERAGE FORM
<br /> Except as otherwise stated in this endorsement, the terms and conditions of the Policy apply.
<br /> The following is added to Section C. WHO IS AN INSURED:
<br /> Additional Insured—Owners, Lessees Or Contractors—Completed Operations
<br /> a. The person(s) or organization(s) shown in the Schedule on the Declarations is also an additional insured, but
<br /> only with respect to liability for "bodily injury" or "property damage" caused, in whole or in part, by "your work"
<br /> and at the location designated and described in the Location And Description Of Completed Operations
<br /> Schedule in the Declarations performed for that additional insured and included in the "products-completed
<br /> operations hazard".
<br /> b. With respect to the insurance afforded to these additional insureds, this insurance does not apply to "bodily
<br /> injury", "property damage" or "personal and advertising injury" arising out of the rendering of, or the failure to
<br /> render, any professional architectural, engineering or surveying services, including:
<br /> (1) The preparing, approving, editing of or failure to prepare or approve, shop drawings, maps, opinions,
<br /> reports, surveys, change orders, field orders, designs, drawings, specifications, warnings,
<br /> recommendations, permit applications, payment requests, manuals or instructions;
<br /> (2) Supervisory, inspection, quality control, architectural, engineering or surveying activities or services;
<br /> (3) Maintenance of job site safety, construction administration, construction contracting, construction
<br /> management, computer consulting or design software development or programming service, or selection
<br /> of a contractor or programming service;
<br /> (4) Monitoring, sampling, or testing service necessary to perform any of the services included in (1), (2) or (3)
<br /> above;
<br /> (5) Supervision, hiring, employment, training or monitoring of others who are performing any of the services
<br /> included in (1), (2) or(3) above;
<br /> c. The insurance afforded to these additional insureds only applies to the extent permitted by law.
<br /> d. If coverage provided to these additional insureds is required by a written contract, agreement or written permit
<br /> issued by a state or governmental agency or subdivision or political subdivision, the insurance afforded to
<br /> these additional insureds will not be broader than that which you are required by the contract, agreement or
<br /> permit to provide for these additional insureds.
<br /> Name of Person or Organization:
<br /> The City of Santa Ana, its officials,employees and volunteers
<br /> Location of Covered Operations:
<br /> Agreement for Administrative Services,A-2020-119,
<br /> City of Santa Ana PARS 3121 Part-Time Social Security
<br /> Alternative Retirement Plan..
<br /> Form SL 30 36 10 18 Page 1 of 1
<br /> Process Date: ©2018, The Hartford Policy Expiration Date:
<br /> (May include copyrighted material of Insurance Services Office, Inc., with its permission)
<br /> 85926200 125-26 CA GL-HNOA-WC, 24-25 PL I Sherry Young 16/25/2025 9:41:22 AM (PDT) I Page 6 of 10
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