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TH#S ENDORSEMENT CHANGES THE POLICY. i'LEASE READ #T CAREFULLY. <br /> . ~4DDITItJNAL ENSURED - pWNERS, Lf SSEES <br /> GC~NTRACTQRS -COMPLETED APE • OR <br /> RATi~NS <br /> This endorsement modrFes insurance provided under the following: <br /> COMMERCIAL GENERAL LIABILITY COVERAGE PART <br /> SCHEDULE <br /> Name Of Additional insured Person(s) Location And Description Of Completed Operattans <br /> Or Or anizatiQn s : <br /> City of Eugene Project: 2009 Pothole Repair-Job x{4624 <br /> Insurance is primary and non-contributory <br /> Information re wired to lets this Schedule, if not shown above, will be shown in the Declarations. <br /> Section II -Who IS An Insured is amended to <br /> include. as an additional insured the person(s) or <br /> organization(s) shown in the Schedule, but only with <br /> respect to liability for "bodily injury" or "property dam- <br /> age" caused, in whole or in part, by "your work" at <br /> the location designated and described in the sched- <br /> ule of this endorsement performed for that additional <br /> insured and included in .the "products-completed <br /> operations hazard". <br /> This endorsement is executed by the <br /> Premium $ <br /> Effectlve Date g-.1_.Og Expiration Date 9-1-09 <br /> For attachment to Policy No. <br /> Aud(t Basis TB2-CB5-004095-118 <br /> issued To <br /> d~ <br /> SEQtETARY~ PRESIDENT <br /> . Countersigned by ' <br /> Issued Autl~orked RepresenfalNe <br /> Sales Office and No. End. Serial No. <br /> <br /> CG ~O 4'r' V/ O~ llJ t.~.n ~IAAnY~fww Ir.. AAA ~ <br /> <br />