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THIS ENDORSEMENT CHANGED THE POLICY. PLEASE READ IT CAREFULLY <br />Additional Insured Endorsement <br />This endorsement modifies insurance provided under the following: <br />ALLIED HEALTHCARE PROVIDERS PROFESSIONAL <br />AND SUPPLEMENTAL LIABILITY POLICY <br />In consideration of the premium paid, this policy is amended as follows: <br />City of Santa Ana, Its Officers, Employees, Agents, Volunteers & Representatives is hereby <br />added as an Additional Insured, solely for Damages arising out of a Professional Incident covered <br />under this policy. The Professional Incident must arise out of services provided by the Insured, under <br />contract with City of Santa Ana, Its Officers, Employees, Agents, Volunteers & Representatives. <br />Additional Insured Name and Mailing Address: <br />City of Santa Ana, Its Officers, Employees, Agents, Volunteers & Representatives <br />60 Civic Center Plaza <br />Santa Ana, CA, 92702 <br />All other terms and conditions of this policy remain unchanged. This endorsement is part of your policy <br />and takes effect on the effective date of your Policy, unless another effective date is shown below. <br />Policy #: 025826 Endorsement #: PI-PHCP-05 <br />(03/01) <br />Effective on or after: 01/25/2019 <br />Issued to: Nancy K. Bohl Inc. dba The Counseling Team <br />International <br />Expiration date: 08/31/2019 <br />/.0 i fe, le,? I & %SO L / e, ®`IL'F%,S l` C:61 . r <br />PI-PHCP-05 (03/01) <br />pl--�9�Rt F? Zvi "2Pf?'"2"w <br />�'thrs2 fb.PFi✓J'aa✓ <br />