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<br />ENDORSEMENT <br /> <br />UNI-CGL-O3-01..o18 (1-14601-00-03) <br />*POLICY NUMBER: <br />*INSmŒD COMPANY NAME: AmerlcaD Unity Group <br /> <br />THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. <br /> <br />ADDITIONAL INSURED - DESIGNATED PERSON or <br />ORGANIZATION <br /> <br />This endorsement modifies insurance provided under the following: <br /> <br />COMMERCIAL GENERAL LIABILITY COVERAGE PART <br />SCHEDULE <br /> <br />Name of Person or Organization: <br /> <br />St. Josepb Health System <br /> <br />City of Santa Ana and its Offieers, Agents, Employees and <br />Volunteers are named as additional insured as respects their <br />interest in connection with the named insured. <br /> <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 /> <br />WHO IS AN INSURED (Section ll) is amended to inelude as an insured the person or <br />orgarúzation 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 /> <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 poqcy. <br /> <br />Agm", Sign,Im, .'~./ ;1' ~ ÆJ, KC <br /> <br />CG20101185 <br /> <br />(218)C SAMPLE - Additionallnsur.<I with Primary/Non.Contribulins Language Ac!dod <br /> <br />APPROVED AS TO FORI>; <br /> <br />Ln~~ <br /> <br />I)~pu[y City Attorney <br />