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*POLICY NUMBER: <br />UNI- CGL -03 -01 -018 (1- 14601 -00 -03) <br />*INSURED COMPANY NAME: <br />American Unity Group <br />ENDORSEMENT <br />THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. <br />ADDITIONAL INSURED — DESIGNATED PERSON or <br />ORGANIZATION <br />This endorsement modifies insurance provided under the following: <br />COMMERCIAL GENERAL LIABILITY COVERAGE PART <br />SCHEDULE <br />Name of Person or Organization: St. Joseph Health System <br />City of Santa Ana and its Officers, Agents, Employees and <br />Volunteers are named as additional insured as respects their <br />interest in connection with the named insured. <br />(If no entry appears above, information required to complete this endorsement will be <br />shown in the Declarations as applicable to this endorsement.) <br />WHO IS AN INSURED (Section II) is amended to include as an insured the person or <br />organization shown in the Schedule, but only with respect to liability arising out of your <br />operations or premises owned by or rented to you. <br />IT IS AGREED THAT ANY INSURANCE MAINTAINED BY THE CITY OF <br />SANTA ANA SHALL APPLY IN EXCESS OF, AND NOT CONTRIBUTE WITH, <br />INSURANCE PROVIDED BY THIS POLICY. <br />Agent's Signature: <br />CG 2010 11 85 <br />(21 B)C SAMPLE— Additional Insumd with Primary /Non- Contributing Language Added <br />APPROVED AS TO Vow,,; <br />LAraLAra Sheedy �.._ <br />D Puty City Attorney <br />