Free Reply - District Court of Arizona - Arizona

W _¤ PHICO lnsurance Company · · Y
One PHICO Drive (17050-2797} P.0.Box 85 Mechanicsburg. PA17055·0O85 (800) 382-1378 ‘
This endorsement forms a pan of the policy to which attached, effective on the lnceptiondate of the policy unless otherwise
stated herein. All policy provisions and conditions not amended herein remain unchanged. (The infomation in the heading I
of this endorsement is required only when the endorsement is issued subsequent to policy.) '
Named insured and Address: Producer Name and Address: _ i F
CORRECTIONAL MEDICAL SERVICES INC HEALTHCARE INSURANCE SERVICES INC g `
SPECTRUM HEALTHCARE SERVICES INC ETAL 620 GESSNER RD {
12647 OLIVE BLVD STE l¤00 ¥
ST LOUIS M0 63141-0000 HOUSTON TX 77024-0000 E
HIS/itil &
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i AUG 1 G Zlllii · .
Endorsement Number: 001a » Policy Number: HCL loses ’
Endorsement Effective Date: 10/01/1997 Pollcy4Perlod: SFrom 10/01/199*1 To 10/01/1998 _ E
12:01 am., standard time at the address of the named insured ‘
. i
In consideration of premium charged, this endorsement modifies policy provisions relating l
to Corporation Association or Partnership Liability (CL) to include any entity as an {
additional insured if the named insured agrees under a written contract to provide that {
entity the insurance afforded under the policy for claims arising from the conduct of an
insured for an event for which coverage is otherwise provided under the policy, subject r
the following provisions:
ll) The named insured shall act on behalf of such additional insureds in all matters §
pertaining to this insurance, including receipt of notice of cancellation or any othe {
notice provided for under the policy, payment of premium due, and receiving return 5
premium, if any, and payment of such dividends as may be declared by Company. Q
(2) No insurance is afforded to (an additional insured for clains arising from the conduc: Q
1 of the additional insured. ‘ I
(3) Nothing contained herein shall affect any right to recovery as a claimant which each
additional insured would have if not designated as such. (
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· AUTHORIZED COMPANY REPRESENTATIVE
Case 2:04-cv—00347-FJIVI Document 131-3 Filed 12/22/2005 Page 1 of 1

Case 2:04-cv-00347-FJM

Document 131-3

Filed 12/22/2005

Page 1 of 1