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PI-PHCP-05 (3-01) <br />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 INSURANCE POLICY <br />In consideration of the premium paid, this policy is amended as follows: <br />Citv Of Santa Ana is hereby added as an Additional Insured, solely for Damages arising out of <br />a Professional Incident covered under this policy. The Professional Incident must arise out <br />of services provided by the Insured, under contract with City Of Santa Ana. <br />Additional Insured Name and Mailing Address: <br />City Of Santa Ana <br />Risk Management Division <br />20 Civic Center Plaza, 4th Floor <br />Santa Ana, CA, 92702 <br />All other terms and conditions of this policy remain unchanged. <br />Policy M 025826 Endorsement #: PI-PHCP-05 (3 <br />-01) <br />Effective on or after: 08/31/2020 <br />Issued to: Nancy K. Bohl Inc. dba The Counseling Team <br />International <br />Expiration date: 08/31/2021 <br />Page 1 of 1 <br />Rime Management DMsion <br />REVIEWED&APPRDVEDBY: <br />'� Risk Management Analyst <br />