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ACORO® <br />l _� <br />AGENCY CUSTOMER ID: <br />LOC #: <br />ADDITIONAL REMARKS SCHEDULE <br />Page of <br />AGENCY <br />NAMED INSURED <br />GMGS Risk Management & Insurance Services <br />POLICY NUMBER <br />EEC Environmental <br />dba Enviromenlal Ewireering Contracting Inc., <br />One City Boulevard West, Suite 1800 <br />Orange CA 92868 <br />CARRIER <br />NAIC CODE <br />EFFECTIVE DATE: <br />THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, <br />FORM NUMBER: 25 FORM TITLE: Certificate of Liability (03/16) <br />HOLDER: City of Santa Ana Risk Management Division <br />ADDRESS: 20 Civic Center Plaza, 4lh floor Santa Ana CA 92702 <br />RE: Job #W-1424.12T - Every Drop Counts - Santa Ana WDR <br />As respects General Liability coverage, City of Santa Ana, its officers, employees, agents <br />and representatives are added as Additional Insured per CG20101219 and CG20371219 <br />attached, and this insurance is primary per CG20011219 attached. <br />As respects General Liability coverage, 30-day written notice of cancellation (10 days for <br />non-payment of premium) applies per IL00171198 attached. <br />As respects Automobile Liability coverage, City of Santa Ana, its officers, employees, <br />agents and representatives are added as Additional Insured, and this insurance is primary <br />per AC85430618 attached. <br />As respects Automobile Liability coverage, 30-day written notice of cancellation (10 days <br />for non-payment of premium) applies per IL00171198 attached. <br />As respects Workers' Compensation coverage, 30-day written notice of cancellation (10 days <br />for non-payment of premium) applies per WC040601A attached. <br />S,y„ IUekMane&elnentl)iWalon <br />Sib REVIEWED & APPROVED Br <br />ACORD 101 (2008101) © 2008 ACORD C ( y , } �Lurau( <br />The ACORD name and logo are registered marks of ACORD M' Ruk Management Analyst <br />58383173 120-21 G/A/UPM/POLL/E&Q/WC Jennifer Barton 110/3D/2020 1:48:06 PM (PDT) I page 2 of 11 n'- <br />