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INSURANCE COMPANY <br /> ADDITIONAL INSURED—DESIGNATED PERSON OR ORGANIZATION <br /> (GENERAL LIABILITY) <br /> Named insured <br /> 1C9tit��t tSH ec'svT f. OS <br /> 'Policy Number Endorsement Effective j <br /> 2 S[I; A . t55 5 0 10 I la l 0'5 <br /> • <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 /> 1 <br /> Person or Organization(Additional Insured): As Per Schedule on file with fI(l(lllllll/llli,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 /> . s <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 Adyertising injury caused in whole or in earthy 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 to 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 Limitss of Insurance are inclusive and not in addition to the Limits Of Insurance shown In the Declarations. <br /> AN other terms and conditions remain unchanged, <br /> Includes copyrighted material of the Insurance Services Office,inc.,with its permission. <br /> RL 2183 12112 Page 1 of 1 <br /> 3435188 <br />