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HEALTHCARE PROVIDERS <br />aRnFFRSIONAL LIABILITY COVERAGE PART ENDORSEMENT <br />Additional Insured — Healthcare Professional or Entity <br />In consideration of the additional premium paid, and subject to the Professional Liability limit of liability <br />shown on the certificate of insurance, it is agreed that the PROFESSIONAL LIABILITY COVERAGE <br />PART is 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 RISK MANAGEMENT DIVISION <br />20 CIVIC CENTER PLAZA <br />4TH FLOOR <br />SANTA ANA CA 92072 <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 />Must Be Completed Complete Only When This Endorsement Is Not Prepared with the Policy <br />Or is Not to be Effective with the Policy <br />ENDT. NO. POLICY NO. ISSUED TO ENDORSEMENT EFFECTIVE DATE <br />walntonaRR <br />1 697816243 LUIS MARTINEZ 12/102 4. RLVIE &�AyPPRW ft <br />RukMar,agenxn[CleiialAitle <br />G-141231-A (07/2001) — <br />