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COMMERCIAL GENERAL LIABILITY <br />POLICY NUMBER: 2-680-2852P287-ACJ-11 ISSUE DATE: 12-03-10 <br />THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. <br />ADDITIONAL INSURED-STATE OR POLITICAL <br />SUBDIVISIONS-PERMITS RELATING TO PREMISES <br />This endorsement modifies insurance provided under the following: <br />COMMERCIAL GENERAL LIABILITY COVERAGE PART <br />SCHEDULE <br />State or Polltlcal Subdivision: <br />THE CITY OF SANTA ANA, ITS OFF2CERS, EMP <br />LOYEES, AGENTS, VOLUNTEERS AND REPRESENT <br />20 C2VIC CENTER PLAZA <br />SANTA ANA <br />CA 92701 <br />(If no entry appears above, information required to complete this endorsement will be shown in the Declarations <br />as applicable to this endorsement.) <br />WHO IS AN INSURED (Section II) is amended to ?. <br />include as an insured any state or political sub- <br />division shown in the Schedule, subject to the follow- <br />ing additional provision: <br />This insurance applies only with respect to the follow- <br />ing hazards for which the state or political sub- <br />division has issued a permit in connection with 2. <br />premises you own, rent, or control and to which this <br />insurance applies: <br />3. <br />The existence, maintenance, repair, construction, <br />erection, or removal of advertising signs, awn- <br />ings, canopies, cellar entrances, coal holes, <br />driveways, manholes, marquees, hoist away <br />openings, sidewalk vaults, street banners, or <br />decorations and similar exposures; or <br />The construction, erection, or removal of <br />elevators; or <br />The ownership, maintenance, or use of any <br />elevators covered by this insurance. <br />App OVED AS TO FORM <br />LISA E. STORCK <br />Assistant City Attorney <br />??- <br />CG 20 13 11 SS Copyright, Insurance Services Office, Inc., 1984 Page 1 of 1