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POLICY NUMBER: XLS0083703 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 Organ izations : <br />Locations Of Covered Operations <br />City of Santa Ana, its officers, agents and <br />Re: Job #8224, City of SA District 4. <br />employees, and representatives. <br />Information required to complete this Schedule, if not shown above, will be shown in the <br />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 />.i')7T-1 <br />