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POLICY NUMBER: PK201700012085 COMMERCIAL GENERAL LIABILITY <br />CG 20 12 05 09 <br />THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. <br />ADDITIONAL INSURED -- STATE OR GOVERNMENTAL <br />AGENCY OR SUBDIVISION OR POLITICAL <br />SUBDIVISION - PERMITS CAR AUTHORIZATIONS <br />This endorsement modifies insurance provided under the follow ring: <br />COMMERCIAL GENERAL LIABILITY COVERAGE PART <br />SCHEDULE <br />State Or Governmental Agency Or Subdivision Or Politics Subdivision: <br />The City of Santa Ana, its officers, employees, agents, and representatives are <br />included as an Additional Insured. <br />CITY OF SANTA ANA <br />20 CIVIC CENTER PLAZA, PO BOX 1988, M-16, SANTA ANA, CA 92701 <br />Information required to complete this Schedule, if not shown a love, will be shown in the Declarations. <br />Section If — Who Is An Insured is amended to in- <br />clude as an insured any state or governmental <br />agency or subdivision or political subdivision shown in <br />the Schedule, subject to the following provisions: <br />1. This insurance applies only with respect to opera- <br />tions performed by you or on your behalf for which <br />the state or governmental agency or subdivision or <br />political subdivision has issued a permit or au- <br />thorization. <br />2. This insurance does not apply to: <br />a. 'Bodily injury", "property damage" or "personal <br />and advertising injury" arising out of operations <br />performed for the federal government, state or <br />municipality; or <br />III "Bodily injury" or "property damage" included <br />within the "products -completed operations <br />hazard". <br />\CC <br />e <br />CG 2012 05 09 <br />Q Insurance Services Office, Inc., 2008 <br />Page 1 of 1 13 <br />