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Attachment Code: D664321 Certificate ID: 19715405 <br />IRONSHORE SPECIALTY INSURANCE COMPANY <br />175 Berkeley Street <br />Boston, MA 02116 <br />Toll Free: (877) IRON411 <br />Endorsement # 14 <br />Policy Number: HC7CAB4HM9005 Effective Date of Endorsement: October 29, 2024 <br />Insured Name: HALCYON BEHAVIORAL LLC <br />THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. <br />AMEND DEFINITION OF INSURED ENDORSEMENT <br />In consideration of the premium charged, the term "Insured," as defined in Section II DEFINITIONS of this Policy, is <br />amended to include the following person and/or entities (each an "Additional Insured"): <br />• Simple Therapy, Inc. <br />• City of Santa Ana, its City Council, officers, officials, employees, agents, and volunteers <br />20 Civic Center Plaza <br />Santa Ana, CA 92702 <br />but only with respect to any Claim for any actual or alleged act, error or omission in the performance of, or failure to <br />perform, a Managed Care Service or Private Information Protection by any Insured, other than any Additional Insured; <br />provided that such Claim is made and continuously maintained against at least one Insured exclusive of any Additional <br />Insured. <br />All other terms, conditions and limitations of this Policy shall remain unchanged. <br />MC.P.014 (4.08 ed.) Page 1 of 1 <br />