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X1004 <br />07 /1Z /zee4 11,:00 FAR 714 :147 TABB <br />g.Tor RT RtC r1ANAGRMF.NT <br />ADDITIONAL INSURED ENDORSEMENT <br />FOR CO1V WRCIAL GENERAL LIABILITY POLICY <br />Insurance company: AMMWMV111i � <br />This endommneat modifies such insurance as is afforded by the provisions of Policy # <br />01- 02()ti 1AM1 -nn-W relating to the following: <br />uF>� <br />].. The City of Serifs Ana 20 Civic Center Plaza, Santa Ana, California 92701; its <br />cers employees, agents, volunteers and representatives are named as additional <br />of$ with nieureds (` and us pmfomrod b behalf of the named sue. suits arising from <br />the operate" <br />2, With respect to claims arising out of the operations and uses performed by or on <br />behalf of the named insured. sucb insurance as is afforded by this policy is primary and is <br />not additional to or contributing with any other insurance carried by or for the benefit of <br />the additional insureds. <br />3. This insurance applies separately to each insured against whom claim is made or suit <br />is brought except with respect to the company's limits of liability. The inclusion of any <br />person or organization as an insured shall not affect any right which such person or <br />organization would have as a claimant if not so included. <br />4. With respect to the additional insureds, this insurance shall not be cancelled, or <br />been given to the ity of Santa Ana�20 Civic Center PlazSanta days <br />na, Ca forma noticc 2701 <br />(Completion of the followin& including countersignature, is required to hake this <br />endorsement effective.) <br />Endorsement A3 <br />Effective 0[+/10104 to 06/30/05, this endorsement form as a part of <br />Policy# I -Q - 04 -01- 02011 - 14601-00 -041. <br />Issued to St roseoh Health Svstem <br />Named Insured <br />217-PROVED AS TO FCCountcrsignedby <br />Aurhori1W Representative <br />LISA E. Z TI UM R <br />City Attorney <br />