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INSURANCE COMPANY <br /> ADDITIONAL INSURED DESIGNATED PERSON OR ORGANIZATION <br /> (GENERAL LIABILITY) <br /> Named Insured <br /> r ' klert#0 fats.#{ CO:,v("l)j Y [. b•qL.•:" f•A\)iris <br /> Policy Number Enddreement Effective <br /> S Pia .5q, : .Q3 Io I la I - . d51di (z9- <br /> THIS ENDORSEMENT CHANGES THE POLICY.PLEASE READ IT CAREFULLY • 1 <br /> This endorsement modifies insurance provided under the fallowing: <br /> 1 <br /> GENERAL LIABILITY COVERAGE PART i <br /> This ertdors ement changes the policy effective on the inception dale of the policy:unless another date Is Indlrated above. <br /> Schedule t <br /> I <br /> Person or Organization(Additional insured): - As Per Schedule on file with 1111!!(ti1l11111,Underwriting Administrator i <br /> r <br /> City of Everett <br /> 2930 Wetmore Ave STE 8A • <br /> Everett,WA 982131 <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,nonagons and exlcufeons.Additional insured endorsement Is attached. <br /> i <br /> 1 <br /> X <br /> A. With respects to the General Liability Coverage Part only,the definition of Insured In the Liability Condition;Definitions , <br /> and Exclusions section df.thls policy Is amended to Include as an Insured the Person or Organization shown in the above i <br /> Schedule.Such Persori or Organization Is an.liratired only with respect to liability for Bodily Injury,Property Dantage;or s <br /> Personal and Adyertlsing fnj_ury caused in vitiate or In part.by your acts or omissions or the acts or omissions of those <br /> acting on your behalf: <br /> I <br /> 1. In performance of your ongoing operations;or i <br /> 2. In connection with your premises owned.or rented to you. ;t <br /> B. The Limits of lnsurarice applicable to the additional insured are those specified in either the; s <br /> 1,. Written contract or written agreement;or <br /> 2. Declarations forfhis policy, i <br /> whichever Is fess.These Limits of Insurance are inclusive and not in addition to.the Limits Of Insurance shown In tile Declarations. <br /> i <br /> All other terms and conditions remain unchanged. i <br /> r <br /> ; <br /> t <br /> . r <br /> .. i <br /> ri <br /> Includes copyrighted material of the.Insurance Services Office,ino.,with Its permission. <br /> RI.2163 12f12 Page I of'I <br /> 3435168 - 5 <br /> 1 <br />