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A6 <br />AGENCY CUSTOMER ID: CATHENT-01 <br />LOC #: 1 <br />ADDITIONAL REMARKS SCHEDULE <br />APETRONIO <br />Page 1 of 1 <br />AGENCY License # OF76001 <br />TK North American Insurance Services, LLC / INSURICA <br />NAMED INSURED <br />CathyJon Enterprises, Inc. <br />2120 Main Street, Ste 250 <br />Huntington Beach, CA 92648 <br />POLICY NUMBER <br />EE PAGE 1 <br />CARRIER <br />EE PAGE 1 <br />NAIC CODE <br />SEEP 1 <br />EFFECnyE DATE: SEE PAGE 1 <br />THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, <br />FORM NUMBER: ACORD 25 FORM TITLE: Certificate of Liability Insurance <br />Description of Operations/Locations/Vehicles: <br />Employment Practice Liability Insurance <br />Carrier: Everest Indemnity Insurance Company <br />Limits: $1M/$2M, Deductible $25,000 <br />Term Effective Date: 4/9/2021 to 4/9/2022 <br />Policy #91PLN00013211 <br />Contract # A-2018-147 <br />The City of Santa Ana, its officers, employees, agents, and representatives are named as additional insured as respects to general <br />and auto liabilty. The City of Santa Ana shall be goven 30 days written notice of cancellation. Insurance afforded is primary and <br />non-contributory. Separation of Insured endorsement. "All Owned Auto" does not apply as the insured does not own any company <br />autos and there is no exposure for their type of operations. <br />ACORD 101 (2008101) © 2008 ACORD CO <br />The ACORD name and logo are registered marks of ACORD <br />?,S, Maruga"aa DNialon <br />+ REvIEUED & APPRw®BY: <br />Risk Manager ntAmtpt <br />