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DocuSign Envelope ID:88E356F4-1642-4D25-97A9-483EB39AC1FD <br /> Agency Code 15-0415-00 Policy Number 112315-35778379 <br /> COMMERCIAL GENERAL LIABILITY <br /> 55168 (12.04) <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): <br /> ORANGE COUNTY <br /> 2. Name of Person or Organization (Additional Insured): <br /> 3. Additional Premium: <br /> (If no entry appears above, information required to complete this endorsement will be shown in the Declarations as <br /> applicable to this endorsement.) <br /> A. SECTION II-WHO IS INSURED is amended to in- the person or organization shown in the <br /> clude as an additional insured the person or organ- Schedule. <br /> ization shown in the Schedule but only with respect <br /> to liability arising out of the ownership, maintenance B. Under SECTION III-LIMITS OF INSURANCE, the <br /> or use of that part of the premises leased to you and following is added: <br /> shown in the Schedule and subject to the following <br /> additional exclusions: The limits of liability for the additional insured are <br /> those specified in the written contract or agreement <br /> This insurance does not apply to: between the insured and the manager or lessor of <br /> premises, not to exceed the limits provided in this <br /> 1. Any"occurrence"which takes place after you policy. These limits are inclusive of and not in ad- <br /> cease to be a tenant in that premises. dition to the limits of insurance shown in the Decla- <br /> rations. <br /> 2. Structural alterations, new construction or de- <br /> molition operations performed by or on behalf of <br /> Includes copyrighted material of Insurance Services Office, Inc., with its permission. <br /> 55168 (12-04) Copyright, Insurance Services Office, Inc., 1984, 2003. Page 1 of 1 <br />