Laserfiche WebLink
BLANKET ADDITIONAL INSUREDS - <br />OWNERS, LESSEES OR CONTRACTORS <br />This endorsement modifies insurance provided under the following: <br />0011VIIII11I 4 041011 111KCS111 011:.tea X a r-111 21111111111 1111111506191TAM :411-ILC 9-.1 <br />�1161 M 14 Bill 4 <br />Policy Number: NA104655703 <br />Named Insured <br />TOM BYSTRY <br />VIDEO ENGINEERING SERVICES <br />Endorsement Effective: 1/15/2016 12:01 am. <br />Countersigned By.- <br />9"L� W404� <br />SCHEDULE <br />Name of Person or Organization: <br />CITY OF SANTA ANA, CITY OF SANTA ANA FINANCE & MANAGEMENT SERVICES AGENCY <br />PURCHASING DIVISION, IT OFFICERS, EMPLOYEES, AND AGENTS <br />20 CIVIC CENTER PLAZA M-1 6 <br />SANTA ANA CA 92702 <br />... . ........... ... . ............................ . ..... <br />Location, - <br />VARIOUS LOCATIONS THROUGHOUT SANTA ANA, CA <br />(if no entry appears above, information required to complete this endorsement will be shown in the Declara <br />as applicable to this endorsement.) <br />A. Section 11 —Who Is An Insured is amended to include as an insured the person or <br />organization shown in the Schedule, but only to the extent that the person or organization <br />shown in the Schedule is held liable for your acts or omissions arising out of your ongoing <br />operations performed for that insured. <br />B. With respect to the insurance afforded to these additional insured, the following exdusion is <br />added: <br />2. Exclusions <br />This insurance does not apply to "bodily injury" or "property damage" occurring after: <br />(1) All work, including materials, parts or equipment furnished in connection with such <br />work, on the project (other than service, maintenance or repairs) to be performed by <br />or on behalf of the additional insured(s) at the scte of the covered operations has been <br />completed-, or <br />(2) That portion of "your work" out of which the injury or damage arises has been put to <br />its intended use by any person or organization other than another contractor or <br />subcontractor engaged in performing operations for a principal as a part of the same <br />project. <br />C. The words "you" and "your" refer to the Named Insured shown in the Declarations. <br />D. "Your work" means work or operations performed by you or on your behalf', and materials, parts <br />or equipment furnished in connection with such work or operations. <br />Primary Wording <br />If required by written contract or agreement Such insurance as is afforded by this policy shall be <br />primary insurance, and any insurance or self-insurance maintained by the above additional <br />insured(s) shall be excess of the insurance afforded to the named insured and shall not contri <br />to it. <br />Waiver of Subrogation <br />If required by written contract or agreement: We waive any right of recovery we may have <br />t� C <br />an entity that is an additional insured per the terms of this endorsement because of <br />pa <br />a make for injury or damage arising out of "your work" done under a contract with th erson, <br />organization. <br />Lions <br />49-0108 0711 May Include Copyrighted Material of Insurance Services Offices, Inc. Page 1 of 1 <br />Used with permission <br />