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HEALTHCARE PROVIDERS <br />PROFESSIONAL LIABILITY COVERAGE PART ENDORSEMENT <br />Additional Insured — Person or Entity <br />In consideration of the premium paid, and subject to the Professional Liability limit of liability shown on the <br />certificate of insurance, it is agreed that the PROFESSIONAL LIABILITY COVERAGE PART is <br />amended as follows: <br />The person or entity named below (the "additional insured") is an insured under this Coverage Part but <br />only as respects its liability for your medical incidents and solely to the extent that: <br />1. a professional liability claim is made against you and the additional insured; and <br />2. in any ensuing litigation arising out of such claim, you and the additional insured remain as co- <br />defendants. <br />In no event is there any coverage provided under this policy for a medical incident that is the direct <br />liability of the additional insured. <br />Additional Insured: City of Santa Ana <br />20 Civic Center Plaza <br />S Tii� ZISKNG[rYXNS11111 <br />This endorsement is a part of your policy and takes effect on the effective date of your policy, unless <br />another effective date is shown below. All other provisions of the policy remain unchanged. <br />Complete Only When This Endorsement Is Not Prepared with the Policy <br />Or Is Not to he Effective with the Policy <br />ISSUED TO ENDORSEMENT EFFECTIVE DATE <br />Felica R Hernandez 12/19/2018 <br />G -121486-B (07/2001) Page 1 of 1 <br />Must Be Completed <br />ENDT. NO. <br />Policy <br />1 <br />619799393 <br />Complete Only When This Endorsement Is Not Prepared with the Policy <br />Or Is Not to he Effective with the Policy <br />ISSUED TO ENDORSEMENT EFFECTIVE DATE <br />Felica R Hernandez 12/19/2018 <br />G -121486-B (07/2001) Page 1 of 1 <br />