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INSURANCE COMPANY <br /> ADDITIONAL INSURED-DESIGNATED PERSON OR ORGANIZATION <br /> (GENERAL LIABILITY) <br /> Named insured <br /> '-,- i :1NL1rAlSH LI jAiTY i. 6tiL ` I ANttt5 <br /> Polic Number Endorsement Effective <br /> 5" S 31A A �+5S_`a o_, ,o 0 I _- c `e>r 1 <br /> t <br /> THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY 1 <br /> i <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 i <br /> I <br /> Person or Organization{Additional Insured): As Per Schedule on file with 1111/11111I1111/1,Underwriting Administrator I <br /> I <br /> City of Everett i <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 /> i <br /> source only and are subject to policy terms,conditions and exicuisons.Additional Insured endorsement is attached. <br /> I <br /> i <br /> t <br /> t <br /> f <br /> e <br /> f <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 I <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 I <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 j <br /> t <br /> 2. Declarations for this policy, 1 <br /> whichever is less.These Limits of Insurance are inclusive and not in addition to the Limits Of Insurance shown in the Declarations. <br /> T <br /> All other terms and conditions remain unchanged. <br /> I <br /> 1 <br /> s <br /> I <br /> Includes copyrighted material of the Insurance Services Office,Inc.,with its permission. i <br /> RL216312/12 Page 1of1 i <br /> 3435188 <br /> t <br /> t <br />