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POLICY NUMBER: 57CESOF4492 <br />COMMERCIAL GENERAL LIABILITY <br />CG 20 10 07 04 <br />THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. <br />ADDITIONAL INSURED - OWNERS, LESSEES OR <br />CONTRACTORS - SCHEDULED PERSON OR <br />ORGANIZATION <br />This endorsement modifies insurance provided under the following: <br />COMMERCIAL GENERAL LIABILITY COVERAGE PART <br />SCHEDULE <br />Name Of Additional Insured Person(s) <br />Or Organization(s): Location(s) Of Covered Operations <br />SCHEDULE NAME OF ADDITIONAL INSURED PERSONS OR ORGANIZATIONS CONT: The City <br />City of Santa Ana of Santa Ana, its officers, employees, agents, volunteers and respresentatives <br />Attn: Natalie Verlinich <br />20 Civic Center Plaza, M -37 <br />Santa Ana, CA 92701 <br />Information required to complete this Schedule, if not shown above, will be shown in the Declarations. <br />A. Section If — Who Is An Insured is amended to B. <br />With respect to the insurance afforded to these <br />include as an additional insured the person(s) or <br />additional insureds, the following additional <br />organization(s) shown in the Schedule, but only <br />exclusions apply: <br />with respect to liability for "bodily injury ", "property <br />This insurance does not apply to "bodily injury" or <br />damage" or "personal and advertising injury" <br />"property damage" occurring after: <br />caused, in whole or in part, by: <br />1. All work, including materials, parts or <br />1. Your acts or omissions; or <br />equipment furnished in connection with such <br />2. The acts or omissions of those acting on your <br />work, on the project (other than service, <br />behalf; <br />maintenance or repairs) to be performed by or <br />in the performance of your ongoing operations for <br />on behalf of the additional insured(s) at the <br />the additional insured(s) at the location(s) <br />location of the covered operations has been <br />designated above. <br />completed; or <br />2. That portion of "your work" out of which the <br />injury or damage arises has been put to its <br />intended use by any person or organization <br />other than another contractor or subcontractor <br />engaged in performing operations for a <br />principal as a part of the same project. <br />APPROVED A$ 1'05 <br />OIK" K <br />Assistant City Attorney <br />CG 20 10 07 04 © ISO Properties, Inc., <br />2004 Page 1 of 1 <br />