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AGENCY CUSTOMER ID: HUITTZOL LOC#: ,a`oRo ADDITIONAL REMARKS SCHEDULE Page 1 of 1 AGENCY NAMED INSURED Marsh&McLennan Agency LLC Huitt-Zollars, Inc. 5430 LBJ Freeway,Suite 1500 POLICY NUMBER Dallas TX 75240 CARRIER NAIC CODE EFFECTIVE DATE: ADDITIONAL REMARKS THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, FORM NUMBER: 25 FORM TITLE: CERTIFICATE OF LIABILITY INSURANCE Waiver of subrogation forms#WC000313,#WC040306 and#WC420304B apply to the Workers Compensation policy. Additional Insured form#XL0003 edition 09/16 applies to the Umbrella policy. Waiver of Subrogation form#XL0003 edition 09/16 applies to the Umbrella policy. Umbrella is follow form pursuant to form#XL0003 edition 09/16. Notice of Cancellation form#I1-10307 edition 6/11 applies to the General Liability policy. Notice of Cancellation form IH0307 edition 06/11 applies to the Auto Liability policy. Notice of Cancellation forms#WC990394 and#WC990531 apply to the Workers Compensation policy. Notice of Cancellation form#I1-10307 edition 6/11 applies to the Umbrella Liability policy. The General Liability policy contains language that provides additional insured status to the certificate holder only when there is a written contract between the named insured and the certificate holder that requires such status. The General Liability policy contains an endorsement with"Primary and NonContributory"wording that may apply only when there is a written contract between the named insured and the certificate holder that requires such wording. The General Liability policy contains a blanket waiver of subrogation endorsement that may apply only when there is a written contract between the named insured and the certificate holder that requires such wording. The Automobile Liability policy contains language that provides additional insured status to the certificate holder only when there is a written contract between the named insured and the certificate holder that requires such status. The Automobile liability policy includes waiver of subrogation wording that may apply only when there is a written contract between the named insured and the certificate holder that requires such wording. The Auto Liability policy contains an endorsement with"Primary and NonContributory"wording that may apply only when there is a written contract between the named insured and the certificate holder that requires such wording. The Umbrella policy includes additional insured endorsement to the certificate holder only when there is a written contract between the named insured and the certificate holder that requires such status. The Umbrella policy includes waiver of subrogation endorsement to the certificate holder only when there is a written contract between the named insured and the certificate holder that requires such status. The Worker's Compensation policy includes a waiver of subrogation endorsement that may apply only when there is a written contract between the named insured and the certificate holder that requires such wording. The General Liability,Auto Liability,Worker's Compensation and Umbrella Liability policies include a blanket notice of cancellation to the certificate holder endorsement,providing for(30)days'advance written notice if the policy is canceled by the company,or 10 days'written notice before the policy is canceled for nonpayment of premium. Notice is sent to certificate holders with mailing addresses on file with the agent or the company. The endorsement does not provide for notice of cancellation to the certificate holder if the named insured requests cancellation. RE:A-2023-088-03. Certificate Holder Includes: City of Santa Ana, its officers,employees,agents,volunteers and representatives. ACORD 101 (2008/01) ©2008 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD