CARE AMBULANCE SERVICES, INC.-2017

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Endorsement # 27 General Purpose Endorsement ZURICH Policy No. Eff. Date of Pol, E)p. Dale of Pol. Elf. Date of End. Producer Add) Prem. Return Prem, UMB 5414770-04 October 1, 2017 October' 201& October 1, 2017 18531000 -•• --- Named Insured and Mailing Address: Feick USA, Inc. 2154030th Drive SE, Ste. #250 Bothell, WA 98021 Producer: Willis of Seattle, Inc. 505 Fifth Avenue South, Ste. 200 Seattle, WA 98104 THIS ENDORSEMENT CHANGES THE POLICY, PLEASE READ IT CAREFULLY. This endorsement modifies insurance provided under the following: HEALTH CARE EXC ESS LIABILITY POLICY Paragraph 3, Persons or Entitles Insured of Section II: General Policy Provisions is amended to include as an additional Insured the person or organization shown in the Schedule of this endorsement, whom you are required to add as an additional insured on this policy under a written contract or written agreement. Such person or organization is an additional insured but only because of liability caused in whole or in part by your acts or omissions. The insurance provided by this endorsement will not be broader than that provided by the "governing underlying insurance policy', Subparagraph D., Cancellation, of Paragraph 6., Conditions, is amended to include the following: If we cancel this insurance by written notice to the first "Named Insured" for any reason otherthan nonpayment of premium, we will provide 30 -day written notice to the additional insured listed in the Schedule below. However, this advance notification of pending cancellation of coverage is intended as a courtesy only and our failure to provide such advance notification will not extend the effective date of cancellation nor negate cancellation of this insurance. Subparagraph M., Transfer of Any "Insured's" Rights and Duties, of Paragraph 6., Conditions, is amended to include the following: If the first "Named Insured" is required by written contractor agreementwith the person or organization shown in the Schedule below to waive its rights of recovery, we agree to waive our rights of recovery. This waiver of rights only applies to the extent required by written contract, however, the contract must be entered into prior to the "occurrence" or "medical incident" that gives rise to a claim and shall not be construed to be a waiver with respect to any other operations in which the first "Named Insured" has no contractual interest. SCHEDULE Name of Person or Organization (Additional Insured): City of Santa Ana ALL OTHER TERMS AND CONDITIONS OF THIS POLICYREM AIN UNCHANGED. l/l22/r7 A, U-HCU-405-ACW (21100) Page 1 of 1