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AGENCY CUSTOMER ID: <br />LOC#: <br />AG' RLjt° <br />ADDITIONAL REMARKS SCHEDULE <br />Page 2 of 2 <br />AGENCY <br />BIZINSURE LLC/PHS <br />NAMED INSURED <br />HALL AQUATIC LIFE SUPPORT DESIGNS DBA HALL <br />AQUATIC DESIGN LLC <br />347 GRANT ST SE <br />ATLANTA GA 30312-2226 <br />POLICY NUMBER <br />SEE ACORD 25 <br />CARRIER <br />SEE ACORD 25 <br />NAIC CODE <br />EFFECTIVE DATE: SEE ACORD 25 <br />THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM <br />FORM NUMBER: ACORD 25 FORM TITLE: CERTIFICATE OF LIABILITY INSURANCE <br />City of Santa Ana, Risk Management, it's officers, employees, agents, representatives, and volunteers are additional insured <br />per the Business Liability Coverage Form SS0008 attached to this policy. Notice of Cancellation will be provided in accordance <br />with Form SS1223, attached to this policy. Notice of Cancellation will be provided in accordance with Form WC990394, <br />attached to this policy. <br />RgE VIEWiskED & APPRANAqEmrmpOV ON <br />D <br />M 09 <br />ACORD 101 (2014/01) © 2014 ACORD CORPORATION. All rights reserved. <br />The ACORD name and logo are registered marks of ACORD <br />