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INSURANCE COMPANY Th C�v�kfo" <br /> ADDITIONAL INSURED—DESIGNATED PERSON OR ORGANIZATION <br /> (GENERAL LIABILITY) <br /> Named Insured <br /> n COO YVV6V1 COJA‘'4 (� c11 SzoJc,c-C> <br /> Policy Number Endorsement Effective <br /> Sd seA AC -153S tU(13.0ao (.0 03/O1I)O3t <br /> THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY <br /> This endorsement modifies insurance provided under the following: <br /> GENERAL LIABILITY COVERAGE PART <br /> This endors ement changes the policy effective on the inception date of the policy unless another date is indicated above. <br /> Schedule <br /> Person or Organization(Additional Insured): As Per Schedule on file with 1//ll/ll//I/I//1/,Underwriting Administrator <br /> City of Everett <br /> 2930 Wetmore Ave STE 8A <br /> Everett,WA 98201 <br /> Regarding funding source.City of Everett,its officers,employees and agents are named as Additional Insureds regarding this <br /> source only and are subject to policy terms,conditions and exicuisons.Additional Insured endorsement is attached. <br /> A. With respects to the General Liability Coverage Part only,the definition of Insured in the Liability Conditions,Definitions <br /> and Exclusions section of this policy is amended to include as an Insured the Person or Organization shown in the above <br /> Schedule.Such Person or Organization is an insured only with respect to liability for Bodily Injury,Property Damage,or <br /> Personal and Advertising Injury caused in whole or in part by your acts or omissions or the acts or omissions of those <br /> acting on your behalf: <br /> 1. in performance of your ongoing operations;or <br /> 2. In connection with your premises owned or rented tc you, <br /> B. The Limits of Insurance applicable to the additional Insured are those specified in either the; <br /> 1. Written contract or written agreement;or <br /> 2. Declarations for this policy, <br /> whichever is less.These Limits of Insurance are inclusive and not in addition to the Limits Of Insurance shown in the Declarations. <br /> Ali other terms and conditions remain unchanged. <br /> Includes copyrighted material of the Insurance Services Office,Inc.,with its permission. <br /> RL 2163 12/12 Page 1 of <br /> 3435188 <br />