Reproduction of Insurance Services Office, Inc. Form

Insurer: ISO FORM CD 20 10 11 85: (MODIFIED)

POLICY NUMBER: COMMERICIAL GENERAL LIABILITY

ENDORSEMENT NUMBER: EXHIBIT 1-A

THIS ENDORSEMENT CHANGES THE POLICY, PLEASE READ IT CAREFULLY

ADDITIONAL INSURED—OWNERS, LESSEES OR

CONTRACTORS (FORM B)

This endorsement modifies insurance provided under the following:

COMMERICIAL GENERAL LIABILITY COVERAGE PART.

SCHEDULE

Name of Organization

(If no entry appears above, the information required to complete this endorsement will be shown in the Declarations as applicable to this endorsement.)

WHO IS AN INSURED (Section 11) is amended to include as an insured the person or organization shown in the Schedule, but only with respect to liability arising out of “your work” for that insured by or for you.

Modification to ISO form CG 20 10 11 85:

1. The insured scheduled above includes the Insured’s officers, officials, employees and volunteers.

2. This insurance shall be primary as respects the insured shown in the schedule above, or if excess, shall stand in an unbroken chain of coverage excess of the Named Insured’s scheduled underlying primary coverage. In either event, any other insurance maintained by the Insured scheduled above shall be in excess of this insurance and shall not be called upon to contribute with it.

3. The insurance afforded by this policy shall not be canceled except after thirty days prior written notice by certified mail return receipt requested has been given to the Entity.

4. Coverage shall not extend to any indemnity coverage for the active negligence of the additional insured in any case where an agreement to indemnify the additional insured would be invalid under Subdivision (b) of section 2782 of the Civil Code.

^{Signature-Authorized Representative}

^Address

^{CG
20 10 11 85}^{Insurance Services Office, Inc. Form (Modified)}

^{Insurance
Requirements in Contracts}23 ^{Edition: May 2000}

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