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AGENCY CUSTOMER ID: ORANCOU-19 <br />LOC #: <br />AC40R ® ADDITIONAL REMARKS SCHEDULE <br />Page 1 of 1 <br />AGENCY <br />Arthur J. Gallagher & Co. <br />NAMED INSURED <br />Orange County Conservation Corps <br />1853 N. Raymond Ave. <br />Anaheim, CA 92801 <br />POLICY NUMBER <br />CARRIER <br />NAIC CODE <br />EFFECTIVE GATE: <br />THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, <br />FORM NUMBER: 25 FORM TITLE: <br />Lice shall be provided at least ten (10) days In advance <br />policy change. <br />and any other insurance shall be excess only, and not cc <br />ment of premium and thirty (30) days in advance for any <br />© 2008 ACORD CI <br />The ACORD name and logo are registered marks of ACORD <br />y�se PJAManag wntDlWs(Dn <br />RkMewED & APPROVED RY: <br />Yn . <br />glttlaarlssl(Ii Fs.` <br />h. Risk Management Analyst <br />