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HEALTHCARE PROVIDERS <br /> GENERAL LIABILITY COVERAGE PART ENDORSEMENT <br /> Additional Insured General Liability <br /> In consideration of the premium paid, and subject to the General Liability limit of liability shown on the <br /> certificate of insurance , it is agreed that the GENERAL LIABILITY COVERAGE PART is amended as <br /> follows: <br /> The person or entity named below (the "additional insured") is an insured under this Coverage Part but <br /> only as respects its liability arising out of named insured's operations, or premises owned by or rented <br /> by the named insured and solely to the extent that: <br /> 1. a general liability claim is made against the named insured and the additional insured; and <br /> 2. in any ensuing litigation arising out of such claim, the named insured and the additional insured <br /> remain as co-defendants. <br /> In no event is there any coverage provided under this policy for an occurrence that is the direct liability <br /> of the additional insured. <br /> Additional Insured: City of Santa Ana, it's Officers,Offical <br /> Employees or Volunteers <br /> 20 Civic Cntr P.O. Box 1988 <br /> Santa Ana, CA 92702-1988 <br /> This endorsement is a part of your policy and takes effect on the effective date of your policy, unless <br /> another effective date is shown below. All other provisions of the policy remain unchanged. <br /> Must Be Completed Complete Only When This Endorsement Is Not Prepared with the <br /> Policy <br /> Or Is Not to be Effective with the Policy <br /> ENDT. NO. POLICY NO. ISSUED TO ENDORSEMENT EFFECTIVE DATE <br /> 01 0697816243 ILuis Martinez 12/10/2025 <br /> G-123827-B (07/2001) Page 1 of 1 <br />