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ADDITIONAL INSUREDS) ENDORSEMENT <br />Named Insured Endorsement Number <br />Reach Employee 1 <br />Assistance, Inc. <br />Policy Symbol Policy Number Policy Period Effective Date of Endorsement <br />AHM 149446 02/17/10 to 02/17/11 02/17/10 <br />Issued by (Name of Insurance Company) <br />ACE American Insurance Compan <br />THIS ENDORSEMENT CHANGES YOUR POLICY. PLEASE READ IT CAREFULLY. <br />It is agreed that the natural persons or organization(s) listed by name as an Additional Insured in the Schedule <br />below shall be considered "Insured(s)" under the Who Is An Insured provision of the applicable Coverage Part(s) <br />indicated below, but solely with respect to such Additional Insured's liability arising solely out of: <br />if Professional Liability coverage is indicated for such Additional Insured, "healthcare professional <br />services" performed by you or on your behalf for such Additional Insured; or <br />2. if General Liability coverage is indicated for such Additional Insured, "bodily injury", "property damage" or <br />"personal or advertising injury" caused by an "occurrence" or offense that was caused solely by: <br />i. you or your "employees" acting on your behalf; and <br />ii. within the scope of your duties to and performed on behalf of such Additional Insured. <br />Schedule <br />Additional Insured: Address: Additional Premium Applicable Coverage Part <br /> ® GENERAL LIABILITY <br /> COVERAGE PART <br />City of Santa Ana 20 Civic Center INCLUDED <br />Personnel Dept. Plaza M-34 ®PROFESSIONAL LIABILITY <br /> COVERAGE PART <br /> ^ GENERAL LIABILITY <br /> COVERAGE PART <br /> ^ PROFESSIONAL LIABILITY <br /> COVERAGE PART <br /> ^ GENERAL LIABILITY <br /> COVERAGE PART <br /> ^ PROFESSIONAL LIABILITY <br /> COVERAGE PART <br /> ^ GENERAL LIABILITY <br /> COVERAGE PART <br /> ^ PROFESSIONAL LIABILITY <br /> COVERAGE PART <br />All other terms, conditions and exclusions of this policy remain unchanged. <br />Authorized Agent <br />PF-12934d (05/07) ACE USA, Copyright 2005, 2006, 2007 <br />Page 1 of 1 <br />