MA 10-07-CS140711 (3)reT
This endorsement modifies insurance provided under the following:
SCHEDULE
Name Of Additional Insured Person(s)
Or Organization s): Location And Description Of Completed Operations
Information required to complete this Schedule, if not shown above, will be shown in the Declarations,
SectionN—WhobaAn!msured ksamended tninclude
an on additional insured the person(s) nrorgmniaotion(s)
shown in the 8chedu}e, but only with respect to liability
for "bodily injury" or "property damage" coused, in whole
or in part, by "your work" at the location designated and
described in the schedule of this endorsement
performed for that additional insured and included inthe
"prod u(ts-oornp|etedoperations hmzand"
PREMIUM I,500
CG 20 37 07 04 (9) ISO Properties, Inc., 2004 Page I of I
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