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<br />POLICY NUMBER: I-6BO-4429ROB3-ACJ-11 <br /> <br />COMMERCIAL GENERAL LIABILITY <br />ISSUE DATE: OB-22-11 <br /> <br />THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. <br /> <br />ADDITIONAL INSURED-DESIGNATED PERSON <br />OR ORGANIZATION <br /> <br />This endorsement modifies insurance provided under the following: <br />COMMERCIAL GENERAL LIABILITY COVERAGE PART <br /> <br />SCHEDULE <br /> <br />Name of person or organization: <br /> <br />CITY OF SANTA ANA <br />IT'S OFFICERS, AGENTS AND EMPLOYEES <br />20 CIVIC CENTER PLAZA <br /> <br />P.O. BOX 19BB-M12 <br /> <br />SANTA ANA <br /> <br />CA 92702 <br /> <br />WHO IS AN INSURED (Section II) is amended to include as an insured the person or organization shown in the <br />Schedule as an insured but only with respect to liability arising out of your acts or omissions. <br /> <br />CGT4911188 <br /> <br />Copyright, Insurance Services Office, Inc., 1984 <br /> <br />Page 1 of 1 <br />