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CITY OF SANTA ANA <br />REQUEST FOR PROPOSALS FOR MEDICAL SERVICES REVIEW PROGRAM <br />SAMPLE ADDITIONAL INSURED ENDORSEMENT <br />FOR COMMERCIAL GENERAL LIABILITY POLICY <br />Insurance Compainy <br />This endorsement modifies such insurance as is afforded by the provisions of Policy # <br />relating to the following: <br />The City of Santa Ana, 20 Civic Center Plaza, Santa Ana, California 92701; its officers, employees, <br />agents, volunteers and representatives are named as additional insureds ("additional insureds") with <br />regard to liability and -defense of suits arising from the operations and uses performed by or on behalf of <br />the named insured. <br />2. With respect to claims arising out of the operations and uses performed by or on behalf of the named <br />insured, such insurance as is afforded by this policy is primary and is not additional to or contributing with <br />any other insurance carried by or for the benefit of the additional insureds. <br />3. This insurance applies separately to each insured against whom claim is made or suit is brought except <br />with respect to the company's limits of liability. The inclusion of any person or organization as an insured <br />shall not affect any right which such person or organization would have as a claimant if not so included. <br />4. With respect to the additional insureds, this insurance shall not be cancelled, or materially reduced in <br />coverage or limits except after thirty (30) days written notice has been given to the City of Santa Ana, <br />20 Civic Center Plaza, Santa Ana, California 92701. <br />(Completion of the following, including countersignature, is required to make this endorsement effective.) <br />Effective <br />Policy # <br />Issued to <br />this endorsement form as a part of <br />Named <br />Countersigned by <br />Authorized Representative <br />SAMPLE ONLY <br />City of Santa Ana Human Resources Department <br />RFP for Medical Services Review — August 27, 2018 <br />2tE 334 <br />