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MM Policy No. 96ESP9017 2118-F'A65 CMP-4786 Page 1 of 1 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY CMP-4786 ADDITIONAL INSURED —OWNERS, LESSEES, OR CONTRACTORS (Scheduled) This endorsement modifies insurance provided under the following: BUSINESSOWNERS COVERAGE FORM SCHEDULE Policy Number: 96ESP9017 Named Insured: 110% INC PO BOX 538 SALIDA CC 81201-0538 Name And Address Of Additional Insured Person Or Organization: City of Santa Ana, its City council., officers, employees, agents, and volunteers 20 Civic Center PLZ Santa Ana CA 92701-4058 1. SECTION II ---- WHO IS AN INSURED of b. Products-Completed Operations SECTION II — LIABILITY is amended to in- "Your work" performed for that additional clude, as an additional insured, any person insured and included in the "products- or organization shown in the Schedule, but completed operations hazard". only with respect to liability for "bodily in- 2. Any insurance provided to the additional in- jury", "property damage", or "personal and sured shall only apply with respect to a claim advertising injury" caused, in whole or in made or a "suit" brought for damages for park, by: which you are provided coverage. a. Ongoing Operations 3. Primary Insurance. The insurance afforded the additional insured shall be primary insur- (1) Your acts or omissions; or ance. Any insurance carried by the additional insured shall be noncontributory with respect (2) The acts or omissions of those acting to coverage provided by you, on your behalf; There will be no refund of premium in the event in the performance of your ongoing opera- this endorsement is cancelled. tions for that additional insured; or All other policy provisions apply. CMP-4786 1006104 137713.1 10-23-2013 ©,Copyright,State Farm Mutual Automobile Insurance Company,2008 Includes copyrighted material of Insurance Services Office, Inc„with its permission.