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ISO I Commercial General Liability Forms 1 01/01/96 <br />POLICY NUMBER: XP K80968969 COMMERCIAL <br />Certificate Number: PEVD061936 GENERAL LIABILITY <br />Effective Dates: 7/6/2016 to 7/6/2017 CG 20 11 01 96 <br />THIS 'ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY, <br />ADDITIONAL INSURED - MANAGERS OR LESSORS OF PREMISES <br />This endorsement modifies insurance provided under the following: <br />CONYIERCIAL GENERAL LIABILITY COVERAGE PART <br />SCHEDULE <br />1. Designation of Premises (Part Leased to You): <br />20 Civic Center Plaza Santa Ana ,CA 92702 <br />2. Name of Person or Organization (Additional Insured): <br />City of Santa Ana <br />The City of Santa Ana, 20 Civic Center Plaza, Santa Ana,. California 92701; its officers, employees, agents and. volunteers <br />are named as additional insureds additional insureds. <br />3.. Additional Premium: $o.o0 <br />(If no entry appears above, the information required to complete this endorsement will be shown in the Declarations as <br />applicable to this endorsement.) <br />WHO IS AN INSURED (Section II ) is amended to include as an insured the person or organization shown in the Schedule <br />but only with respect to liability arising out of the ownership, maintenance or use of that part of the premises leased to you <br />and shown in the Schedule and subject to the following additional exclusions: <br />This insurance does not apply to: <br />I. Any 'occurrence" which takes place after you cease to be a tenant in that premises. <br />2. Structural alterations, now construction or demolition operations performed by or on behalf of the person or organization <br />shown in the Schedule. <br />CG 20 1101 96 <br />NASEPWI1055.cloc 0 Insurance Services Office, Inc., 1994 <br />