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ExHiOiT 1101 <br />SAMPLE ADDITIONAL INSURED ENDORSEMENT <br />Insurance Company <br />This endorsement modifies such insurance as is afforded by the provisions of Policy # <br />relating to the following: <br />1. The City of Santa Ana, 20 Civic Center Plaza, Santa Ana, California 92701; its officers, <br />employees, agents and representatives are named as additional insureds ( "additional insureds ") <br />with regard to liability and defense of suits arising from the operations and uses performed by or on <br />behalf of the named insured. <br />2. With respect to claims arising out of the operations and uses performed by or on behalf of <br />the name insured, such insurance as is afforded by this policy is primary and is not <br />additional to or contributing with any other insurance carried by or for the benefit of the <br />additional insureds. <br />3. This insurance applies separately to each insured against whom claim is made or suit is <br />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 materially <br />reduced in coverage or limits except after thirty (30) days written notice has been given to <br />the City of Santa Ana, 20 Civic Center Plaza, Santa Ana, California 92701. <br />(Completion of the following, including countersignature, is required to make this endorsement <br />effective.) <br />Effective , the endorsement form as part of <br />Policy # <br />Issued to <br />Name Insured <br />Countersigned by <br />16 <br />