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SB-300113-C <br />(Ed. 06/11) <br />THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. <br />ADDITIONAL INSURED - DESIGNATED PERSON OR ORGANIZATION <br />This endorsement modifies insurance provided under the following: <br />BUSINESSOWNERS LIABILITY COVERAGE FORM <br />SCHEDULE <br />Name Of Person Or <br />The City Of Santa Ana <br />20 Civic Center Plaza <br />Santa Ana, CA 92701 <br />Information required to complete this Schedule, if not shown on this endorsement, will be <br />The following is added to Paragraph C. Who Is An Insured: <br />4. Any person or organization shown in the Schedule is also an insured; but only with respect to "bodily Injury," or <br />"property damage" or "personal and advertising injury" caused, In whole or in part, by your acts or omissions or <br />the acts or omissions of those acting on your behalf in the performance of your ongoing operations or in <br />connection with your premises owned by or rented to you. <br />Re: RENEE ESCARIO DSA RE CONSULTING <br />Policy #6020765876 <br />SB-300113-C Includes copyrighted material of Insurance Services Office, Inc„ with its permission. Page 1 of 1 <br />(Ed. 06111) Copyright, Insurance Services Office, Inc. 2002 <br />