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JLEEENG-01MICHAELA <br />AGENCY CUSTOMER ID: <br />1 <br />LOC #: <br />Page of <br />11 <br />ADDITIONAL REMARKS SCHEDULE <br />License # 0E67768 <br />AGENCYNAMED INSURED <br />JLee Engineering, Inc. <br />IOA Insurance Services <br />430 S. Garfield Avenue, #301 <br />Alhambra, CA 91801 <br />POLICY NUMBER <br />SEE PAGE 1 <br />CARRIERNAIC CODE <br />SEE PAGE 1SEE P 1 <br />EFFECTIVE DATE: <br />SEE PAGE 1 <br />ADDITIONAL REMARKS <br />THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, <br />ACORD 25Certificate of Liability Insurance <br />FORM NUMBER:FORM TITLE: <br />Description of Operations/Locations/Vehicles: <br />GENERAL LIABILITY ADDITIONAL INSURED INCLUDES THE FOLLOWING PERSON(S) OR ORGANIZATION(S): City of Santa Ana, its <br />officers, employees, and authorized agents <br />ACORD 101 (2008/01)© 2008 ACORD CORPORATION. All rights reserved. <br />The ACORD name and logo are registered marks of ACORD <br /> <br />