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AGENCY CUSTOMER ID: 100129 <br />LOG#: Morrlstown <br />ADDITIONAL REMARKS SCHEDULE <br />Page 2 of 2 <br />AGENCY <br />MARSH USA, INC. <br />NAMED INSURED <br />SIEMENS INDUSTRY, INC. <br />IWAY <br />BUFFALO GROVE, IL 006E-4513 <br />POLICY NUMBER <br />CARRIER <br />NAIC CODE <br />EFFECTIVE DATE: <br />AVVI FIVINAL KCNIAKNO <br />THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, <br />FORM NUMBER: — FORM TITLE: Certificate of Liabillty Insurance <br />RB 11476 <br />CITY OF SANTA ANA, TYRONE CHESANEK IS HEREBY ADDITIONAL INSURED AS OBLIGATED UNDER CONTRACT UNDERTHE REFERENCED GENERAL LIABILITYAND <br />AUTOMOBILE LIABILITY INSURANCE POLICIES. <br />SUCH INSURANCE AS IS AFFORDED BY THE ADDITIONAL INSURED ENDORSEMENTBHALL APPLY AS PRIMARY INSURANCE & OTHER INSURANCE MAINTAINED BY <br />THE CERTIFICATE HOLDER SHALL BE EXCESS ONLY& NOT CONTRIBUTING WITH IN8URANCE PROVIDED UNDER THIS POLICY, <br />111,00,1100 PROFESSIONAL LIABILITY IS INCLUDED UNDER THE GENERAL LIABILITY POLICY AND$1,000,001S INCLUDED UNDER THE UMBRELLA LIABILITY POLICY, <br />IFTHESE POLICIES ARE CANCELLED FOR ANY REASON OTHER THAN NON-PAYMENT OF PREMIUM, THE INSURER WILL DELVER NOTICE OF CANCELLATION TO <br />THE CERTIFICATE HOLDER UP TO 60 DAYS PRIOR TO THE CANCELLATION OR AS REQUIRED BYWR17EN CONTRACT, WHICHEVER 18 LE88, <br />REVIEWEb BY. EUNICE,kIEREDIA,(aG OF_ j <br />ACORD 101 (2008101) 0 2008 ACORD CORPORATION. All rights reserved. <br />The ACORD name and logo are registered marks of ACORD <br />