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AGENCY CUSTOMER ID: <br />LOC 9: <br />A C ADDITIONAL REMARKS SCHEDULE <br />Page _of _ <br />AGENCY <br />ICA Insurance Services <br />NAMEDINSURED <br />AGA Engineers, Inc. <br />211 E. Imperial Hwwyy, Suite 208 <br />Fullerton CA 92835 <br />POLICY NUMBER <br />CARRIER <br />NAIC CODE <br />EFFECTIVE DATE: <br />THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, <br />HOLDER: City of Santa Ana <br />ADDRESS: 20 Civic Center Plaza, M-43 Santa Ana CA 92701 <br />Description of Operations Continued: 30 Day Notice of Cancellation / 10 Days for Non - <br />Payment in accordance with policy provisions. <br />,�. RFAEwmfiMFROvMBY: <br />ACORD 101 (2008/01) © 2008 ACORD C <br />The ACORD name and logo are registered marks of ACORD Risk Managelrlent Analyst <br />63664414 1 7/21-22 GL/A➢ 0/EXCESS/WC/PL Blanket Evdts I (AVC) Donna E.q ivel 1 8/30/2021 3:43:33 PM (PDT) I Page 2 of 6 <br />