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• • <br /> ENDORSEMENT 5 <br /> The following spaces preceded by an asterisk O need not be completed if this endorsement and the policy have the same inception date. <br /> ATTACHED TO AND FORMING 'EFFECTIVE DATE 'ISSUED TO <br /> PART OF POLICY NO. OF ENDORSEMENT <br /> GD04014009 06/01/04 Hoffman Corporation <br /> ADDITIONAL INSURED—OWNERS, LESSEES OR <br /> CONTRACTORS (FORM B) <br /> This endorsement modifies insurance provided under the following: <br /> COMMERCIAL GENERAL LIABILITY COVERAGE PART. <br /> SCHEDULE <br /> Name of Person or Organization: <br /> City of Everett,WA.and Brown and Caldwell. <br /> WHO IS AN INSURED(Section II)is amended to include as an insured the person or organization <br /> shown in the Schedule,but only with respect to liability arising out of"your work"for that insured by <br /> or for you. <br /> IT IS FURTHER AGREED THAT THE INSURANCE PROVIDED BY THIS ENDORSEMENT IS <br /> PRIMARY. OTHER INSURANCE AFFORDED TO THE ADDITIONAL INSURED SHALL <br /> APPLY AS EXCESS OF,AND DOES NOT CONTRIBUTE,WITH THE INSURANCE <br /> PROVIDED BY THIS ENDORSEMENT. <br /> All other terms and conditions remain unchanged. <br /> • <br /> s <br /> Authorized Representative <br /> Endorsement No. 29 <br /> Nothing herein contained shall be held to vary,alter,waive or extend any of the terms,conditions,provisions, <br /> . agreements or limitations of the above mentioned Policy,other than as above stated. <br /> Agency Name and Address Carrier Name and Address <br /> • ACIG Insurance Agency,Inc. • American Contractors Insurance Company • <br /> 12222 Merit Drive,Suite 1660 Risk Retention Group <br /> Dallas,TX 75251 12222 Merit Drive,Suite 1660 <br /> (972)702-9004 Dallas,TX 75251 <br /> • (972)702-9004 • <br /> CG 20 1011 85 NSP:16:216301INt06/17/04 <br /> 12 <br />