PUBLIC AGENCY RETIREMENT SERVICES (PARS)

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POLICY NUMBER: 72SBAAC2429 it THIS ENDORSEMENT CHANGES THE POLICY, PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - OWNERS, LESSEES OR CONTRACTORS - SCHEDULED PERSON OR ORGANIZATION This endorsement modifies Insurance provided under the following: BUSINESS LIABILITY COVERAGE FORM SCHEDULE Name Of Additional Insured Person(s) Or Organization(s): Location(s)Of Covered Operations The City of Santa Ana,its officials,employees and Agreement for Administrative Services,A-2020-119, volunteers City of Santa Ana PARS 3121 Part-Time Social Security Alternative Retirement Plan. Information required to complete this Schedule, if not shown above,will be shown In the Declarations. A. ,Section C. — Who Is An Insured is amended to B. With respect to the insurance afforded to these include as an additional Insured the person(s) or additional insureds, the following additional organization(s) shown in the Schedule, but only exclusions apply: with respect to liability for "bodily Injury", "property This insurance does not apply to "bodily injury" or damage" or "personal and advertising injury" "property damage"occurring after: caused, in whole or in part, by: 1. All work, including materials, parts or 1. Your acts or omissions; or equipment furnished in connection with such 2. The acts or omissions of those acting on your work, on the project (other than service, behalf; maintenance or repairs) to be performed by or in the performance of your ongoing operations for on behalf of the additional insured(s) at the the additional insured(s) at the location(s) location of the covered operations has been designated above, completed; or 2. That portion of "your work" out of which the injury or damage arises has been put to its intended use by any person or organization other than another contractor or subcontractor engaged in performing operations for a principal as a part of the same project. Form SS 4170 06 11 Page 1 of 1 Process Data: Policy Expiration Date: © 2011.The Hartford (Includes copyrighted material of Insurance Services Office, Inc., with its permission) 85027131 24-25 CA GL-HNOA-WC-PT, I Sherry Young 1 4/28/2025 2:20:18 PM (PDT) I Page 2 of 18