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AGENCY CUSTOMER ID: <br />LOC#: <br />AC'� Li <br />�-' ADDITIONAL REMARKS SCHEDULE <br />Page 2 of 2 <br />AGENCY <br />NAMEDINSURED <br />PAYCHEX INSURANCE AGENCY INC/PHS <br />PROUDCITY INC <br />2219 DAM UTH ST <br />POLICY NUMBER <br />SEE ACORD 25 <br />OAKLAND CA 94602-2411 <br />CARRIER <br />NAIC CODE <br />SEE ACORD 25 <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, officers, agents, employees, and volunteers are additional insured per Additional Insured: Owners, Lessees, <br />or Contractors; Scheduled Person or Organization Form SS4170 attached to this policy. Waiver of Subrogation applies in favor <br />of the Certificate Holder per the Business Liability Coverage Form SS0008 and the Hired Auto and Non Owned Auto <br />Endorsement SSO438 attached to this policy. Coverage is primary and noncontributory per the Business Liability Coverage <br />Form SS0008, attached to this policy. Notice of Cancellation will be provided in accordance with Form SS1223, attached to this <br />policy. <br />RFnLweD6MPRovm Br. <br />' IIeCC:e $coif'-(.t:ado.c <br />® Ruk Manager <br />ACORD 101 (2014/01) © 2014 ACORD CORPORATION. All rights reserved. <br />The ACORD name and logo are registered marks of ACORD <br />