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FROM CORRECTIONAL MRNRGED CRRE MEDICAL CORP, (TUE)DEC 7 2004 13:48/ST,13;45/N0.6356309836 P 7 <br />ENDORSEMENT NO. 5 <br />This endorsement, effective 12:01 AM: August 1, 2004 <br />Forms a part of policy no.: 0314761 <br />Issued to: CORRECTIONAL MANAGED CARE MEDICAL CORP. <br />BY~ LEXINGTON INSURANCE COMPANY <br />SCHEDULE OF LOCATIONS ENDORSEMENT <br />The Poky is amended as fellows: <br />'fhe insurance provided by Coverage Part(s): <br />® HEALTHCARE GENERAL LIABILITY COVERAGE PART <br />® HFJILTHCARE PROFESSIONAL LIABILITY COVERAGE PART <br />shall be limited to the following location(s), unless otherwise provided For within the Policy: <br />ADDRESS <br />001 2040 S. SANTA CRUZ STREET, X100 <br />ANAHEIM, CA 92805 <br />002 MADERA COUNTY JAIL (CLINIC ONLY) <br />14791 ROAD 28 <br />MADERA, CA 93638 <br />003 MADERA COUNTY JWENILE FACILITIES (CLINIC ONLY) <br />28261 AVENUE 14 <br />MADERA, CA 93638 <br />004 SANTA ANA CITY JAIL (CLINIC ONLY) <br />62 CIVIC CENTER <br />SANTA ANA, CA 92702 <br />005 WESTERN MED CENTER (CLINIC ONLY) <br />1025 S. ANAHEIM 80ULEVARD <br />ANAHEIM, CA 92805 <br />All other terms, conditions, and exclusions of the Policy remain unchanged. <br />~... <br />Authorized RepresenlatNe <br />' g or countersignature (where required by law) <br /> <br />,Y~s ~/~ <br />74780 (12/99) <br />H00097 <br />INSURED'S COPY <br />Page 1 Of t <br />