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POLICY NUMBER: TUE019374700 EXCESS LIABILITY <br />THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. <br />ADDITIONAL INSURED - OWNERS, LESSEES OR <br />CONTRACTORS (FORM B) <br />This endorsement modifies insurance provided under the following: <br />EXCESS LIABILITY COVERAGE PART <br />SCHEDULE <br />Name Of Additional Insured Person(s) <br />Or Organization(s): <br />Locations Of Covered Operations <br />City of Santa Ana, its officers, agents and employees <br />Re: Job #8224, City of SA District 4. <br />and representatives <br />Information required to complete this Schedule, if not shown above, will be shown in the Declarations. <br />WHO IS AN INSURED (Section II) is amended to include as an insured the person(s) or <br />organization(s) shown in the Schedule, but only with respect to liability arising out of "your work" for <br />that insured by or for you. <br />T <br />9ssi9 v O't'O <br />stdnt 2cF <br />iy RC�f <br />�� y <br />