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POLICYNUMBER: 013CA39996601 <br />BUSINESSOWNERS <br />BP 04 50 0106 <br />THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. <br />ADDITIONAL INSURED - OWNERS, LESSEES <br />OR CONTRACTORS - SCHEDULED PERSON <br />OR ORGANIZATION <br />This endorsement modifies insurance provided under the following: <br />BUSINESSOWNERS COVERAGE FORM <br />SCHEDULE <br />Name Of Additional Insured <br />Persons Or Organ lzations : <br />Locations Of Covered Operations <br />City of Santa Ana, its officers, employees, agents and representatives <br />20 Civic Center Plaza <br />Santa Ana, CA 92701 <br />Information required to complete this Schedule If not shown above will be shown in the Declarations. <br />The following is added to Paragraph C. Who Is An <br />Insured in Section 11— Liability: <br />3. Any person(s) or organization(s) shown in the <br />Schedule is also an additional insured, but only <br />with respect to liability for "bodily injury", "property <br />damage" or "personal and advertising injury" <br />caused, in whole or in part, by: <br />a. Your acts or omissions; or <br />b. The acts or omissions of those acting on your <br />behalf; <br />in the performance of your ongoing operations for <br />the additional insured(s) at the location(s) desig- <br />nated above. <br />With respect to the insurance afforded to these <br />additional insureds, the following additional exclu- <br />sions apply: <br />This insurance does not apply to "bodily injury" or <br />"property damage" occurring after: <br />a. <br />19 <br />All work, including materials, parts or equip- <br />ment furnished in connection with such work, <br />on the project (other than service, maintenance <br />or repairs) to be performed by or on behalf of <br />the additional insured(s) at the location of the <br />covered operations has been completed; or <br />That portion of "your work" out of which the <br />injury or damage arises has been put to its in- <br />tended use by any person or organization other <br />than another contractor or subcontractor en- <br />gaged in performing operations for a principal <br />as a part of the same project. <br />P,EVIEWEDBY: 1kJ, �f �,✓ i,,_. EUNICE NEREUTA(PG2,.OF-1) <br />BP 04 60 0106 Oc ISO Properties, Inc., 2005 Page 1 of 1 11 <br />