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<br /> <br /> <br /> <br /> <br /> EXHIBIT "C" <br /> SAMPLE ADDITIONAL INSURED ENDORSEMENT <br /> <br /> Insurance Company <br /> <br /> <br /> This endorsement modifies such insurance as is afforded by the provisions of Policy # <br /> relating to the following: <br /> <br /> 1. The City of Santa Ana, 20 Civic Center Plaza, Santa Ana, California 92701; its officers, <br /> employees, agents and representatives are named as additional insured's ("additional <br /> insured's") with regard to liability and defense of suits arising from the operations and uses <br /> performed by or on behalf of the named insured. <br /> <br /> 2. With respect to claims arising out of the operations and uses performed by or on behalf of <br /> the name insured, such insurance as is afforded by this policy is primary and is not <br /> additional to or contributing with any other insurance carried by or for the benefit of the <br /> additional insured's. <br /> <br /> 3. This insurance applies separately to each insured against whom claim is made or suit is <br /> brought except with respect to the company's limits of liability. The inclusion of any <br /> person or organization as an insured shall not affect any right which such person or <br /> organization would have as a claimant if not so included. <br /> <br /> 4. With respect to the additional insured's, this insurance shall not be cancelled, or materially <br /> reduced in coverage or limits except after thirty (30) days written notice has been given to <br /> the City of Santa Ana, 20 Civic Center Plaza, Santa Ana, California 92701. <br /> <br /> <br /> (Completion of the following, including countersignature, is required to make this endorsement <br /> effective.) <br /> <br /> Effective , the endorsement form as part of <br /> <br /> Policy # <br /> <br /> Issued to <br /> Name Insured <br /> <br /> Countersigned by <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> 56 <br /> 25H-85 <br />