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POLICY NUMBER: 8502AH221369 COMMERCIAL GENERAL LIABILITY <br /> U.S. Lacrosse Association <br /> Policy Dates: 01/01/17-01/01/18 CG 20 11 01 96 <br /> THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. <br /> ADDITIONAL INSURED - MANAGERS OR LESSORS OF <br /> PREMISES <br /> This endorsement modifies insurance provided under the following: <br /> COMMERCIAL GENERAL LIABILITY COVERAGE PART. <br /> SCHEDULE <br /> 1. Designation of Premises(Part Leased to You): Athletic Facility <br /> 2. Name of Person or Organization(Additional Insured): <br /> City of Everett, its officers,agents and <br /> employees <br /> 802 Mukilteo Blvd. <br /> Everett,WA 98201 0000 <br /> Issued on behalf of: <br /> Everett Lacrosse Club <br /> 3. Additional Premium: NIL <br /> (If no entry appears above, the information required to complete this endorsement will be shown in the Declara- <br /> tions as applicable to this endorsement.) <br /> WHO IS INSURED (Section II)is amended to include as an insured the person or organization shown in the <br /> Schedule but only with respect to liability arising out of the ownership, maintenance or use of that part of the <br /> premises leased to you and shown in the Schedule and subject to the following additional exclusions: <br /> This insurance does not apply to: <br /> 1. Any"occurence"which takes place after you cease to be a tenant in that premises. <br /> 2. Structural alterations, new construction or demolition operations performed by or on behalf of the person or <br /> organization shown in the Schedule. <br /> CG 20 11 0196 Copyright, Insurance Services Office, Inc., 1994 Page 1 of 1 <br />