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%2603 _: a7 -a83E9i~?ft CARE COUNSELING PAGE <br />THIS ElYDORSEMENT CAANGES THE POLICY. PLEASE READ IT CAREFULLY <br />Additional Insured Endorsement <br />This endorsement modifies insurance provided under tfie following: <br />ALLIEA I-IEALTHCARE PROVIDERS PROFESSIONAL <br />ANA SUPPLEMENTAL LIABILITY POLICY <br />Inconsideration of the premium paid, this policy is mended as follows: <br />City of Santa Ana is hereby added as an Additional Insurod, solely for D~watea arising out of a <br />Proteaabnal Incident covered under this policy. The Prrofaasional Incident must arise out of <br />services provided by the Inanred, under contract with City of Santa Ana. <br />City of Satta Ana <br />10 Civic Center Plana <br />Santa Ana, CA 92705 <br />Added at the additional prealinm of 530,42, eJj`ective b/30~(D3 until <br />expiration date 3/Z~/04. <br />All other temts and conditions of this Policy remain unchanged. This endorsement is part <br />of your Policy and takes effect on the effective date of your Policy, unless another <br />effective date is shown below. <br />Policy #: PHCP021386 <br />Effective on or after: 03/28!03 <br />Issued to: C.A.R.E Cotutseting Center <br />Expiration date. 03/28/04 <br />Endorsement #:PHCP-06 <br /> <br />Authorized Repreaetttative <br />APPROVEb AS TO FORI'vi <br />Laura Sheedy <br />Deputy City qtr-rney <br />Pl-PHCP-06 (3/0l j <br />