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COVE R$Y <br />INSURANCE COMPANY <br />Attached to and forming <br />part of Policy Number: <br />First Named Insured: <br />Policy Perlod: <br />5-10013 _ <br />Falck USA, Inc.; Care Ambulance Services <br />10/1/2017-10/1/2018 <br />Policy Number: First Named Insured: <br />Policy Period: <br />Effective Date of Change: <br />5-10013 Feick USA, Inc.; Care Ambulance Services <br />10/1(2017-107112018 <br />10/1/2017 <br />THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY, <br />This endorsement modifies insurance provided under the following: <br />Commercial General Liability Coverage Part — Occurrence Coverage Form <br />SCHEDULE <br />Name of Person or <br />Organization <br />Party ID (if <br />applicable) <br />Retroactive Date <br />(if applicable) <br />Activities <br />The City of Santa Ana, its <br />We <br />n/a <br />Ambulance service as described in contract <br />officers, employees, agents, <br />volunteers and <br />representatives <br />Subject to all other terms and conditions of the POLICY, it is agreed and understood that Section II. Definition of <br />Insured is amended to include as an INSURED the Person(s) or Organization(s) shown in the Schedule above, but <br />only with respect to the activities Indicated above. <br />This additional insured shall share in the Limits of Liability of the FIRST NAMED INSURED, and this extension of <br />coverage shall not increase OUR Limit of Liability. <br />We agree to notify the Named Person or Organization in writing at least thirty (30) days in advance of cancellation <br />of this policy. <br />Nothing in this endorsement shall vary, alter, waive or extend any of the terms and conditions of the POLICY, other <br />than as expressly stated above. <br />"2 �•k�'� P?�tj e <br />Sam Mezzich Richard G. Hayes <br />President Treasurer <br />I I fZg1l7 <br />Activit No: <br />COM 003 CS 03115 Date Produced: 10/00/2015 Page 1 <br />