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i.mimunnAnm ruviaruvmn mourwi%or. Loumr,+n r <br />This Endorsement Changes The Policy. Please Read It Carefully <br />ADDITIONAL INSURED - DESIGNATED <br />PERSON OR ORGANIZATION <br />This endorsement modifies insurance provided under the following: <br />MEDICAL PROFESSIONAL LIABILITY COVERAGE PART - CLAIMS MADE BASIS <br />COMMERCIAL GENERAL LIABILITY COVERAGE FORM - CLAIMS MADE <br />in consideration of the premium charged, it is agreed that the coverages afforded by this policy are amended as <br />follow: <br />Section If — Who is An Insured of the Commercial General Liability Coverage Part is amended to include the <br />following: <br />The City of Santa Ana, Its Officers, Employees, Agents, Volunteers and Representatives <br />62 CIVIC CENTER PLAZA <br />SANTA ANA, CA 92702 <br />Coverage provided under this policy is limited to Claims arising out of professional services at the medical clinic <br />or while in transport to a hospital or medical fscftty only, and performed by or on behalf of the Named Insured. <br />This policy does not provide coverage for any Bodily injury or Property Damage arising out of acts which occur <br />beyond the scope of the medical clinic. <br />Part 1, Section E, Covered Persons and Entities of the Medical Professional Liability Coverage Part is <br />amended to Include the following: <br />The City of Santa Ana, he Officers, Employees, Agents, Volunteers and Representatives <br />62 CIVIC CENTER PLAZA <br />SANTA ANA, CA 82702 <br />Coverage provided under this policy is limited to Claims arising out of professional services at the medical clinic <br />or while in transport to a hospital or medical balky only, and performed by or on behalf of the Named Insured. <br />This policy does not provide coverage arising out of acts which -occur beyond the scope of the medical clinic. <br />All other terms, conditions and warranties remaining unchanged. <br />This endorsement effective 08101/2010 <br />forms part of Policy Number LHC 814484 <br />issued to CORRECTIONAL MANAGED CARE Endorsement No.: 01 <br />MEDICAL CORPORATION Date Processed : 08/0312010 <br />by: Landmark American Insurance Company <br />MANUSCRIPT <br />