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<br />ENDORSEMENT <br /> <br />*POLICY NUMBER: UNI-CGL-O3-O1-O18 (1-14601-00-03) <br />*INSmŒD COMPANY NAME: American Unity Group <br /> <br />THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. <br /> <br />ADDITIONAL INSURED - DESIGNATED PERSON' or <br />ORGANIZATION <br /> <br />Thi5 çndorsement 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. Joseph Bealth System <br /> <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 /> <br />(If no entry appears above, infonnation required 'to complete this endorsement will be <br />shown in the Declarations as applicable to this endorsement.) <br /> <br />WHO IS AN INSURED (Section II) is amended to include as an iMUted 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 /> <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 /> <br />....,', Sign,"'" .d;,;&; -' (!' ~ kC <br />J' <br /> <br />CG2010118S <br /> <br />(218)C SAMPLE - Additional I'SUM! Wilh PrimarylNon-Conlributin¡ l.anguage Add.d <br /> <br />APPROVED AS TO FORI'; <br /> <br />Ln~d~ <br /> <br />1)~puIY CHy Altorney <br />