encroachment permit application form - the City of Lompoc!

EXAMPLEPOLICY NUMBER:COMMERCIAL GENERAL LIABILITYTHIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.ADDITIONAL INSURED – OWNERS, LESSEES ORCONTRACTORS (FORM B)This endorsement modifies insurance provided under the following:COMMERCIAL GENERAL LIABILITY COVERAGE PARTName of Persons or Organization:SCHEDULECity of Lompoc, Its Officials, Officers, Employees and Volunteers.Re: (Name of project and location)(If no entry appears above, information required to complete this endorsement will be shownin the Declarations applicable to this endorsement.)WHO IS INSURED (Section II) is amended to include as an insured the person ororganization shown in the Schedule, but only with the respect to liability arising out of orrelated to “your” work” or its supervision for that insured by or for you.7/1/08 6

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