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AC L) <br />l __ ✓ <br />AGENCY CUSTOMER ID: ORANCOU-19 <br />LOC #: <br />ADDITIONAL REMARKS SCHEDULE <br />Page 1 of <br />AGENCY <br />Arthur J. Gallagher & Co. <br />NAMEDINSURED <br />Orange County Conservation Corps <br />1863 N. Raymond Ave. <br />Anaheim, CA 92801 <br />POLICY NUMBER <br />CARRIER <br />NAIL CODE <br />EFFECTIVE DATE: <br />THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, <br />FORM NUMBER: 25 FORM TITLE: CERTIFICATE OF LIASILITY INSURANCE <br />Policy #: PAC 5164680 14 <br />Carder :Great American Alliance Insurance Co, NAIL: 26832 <br />Term: 10/01/2018-10/01/2019 <br />Each CDC: $1,000,000 <br />Aggregate : $3,000,000 <br />Tha City of Santa Ana, its officers, agents, employees and volunteers, and the State of California, its officers, employees, and volunteers are named additional <br />InsurediFunding Source with respa to the operations of the named insured per the attached CG 2026 endorsement. Such Insurance Is Primary and <br />Non -Contributory. Workers Compensation coverage evidence only. <br />Reviewed by Audrey Goodson , Paged of <br />ACORD 101 (2008101) q 2008 ACORD CORPORATION. All rights reserved. <br />I e AcoRO name and logo are registered marks of ACORD <br />