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AGENCY CUSTOMER ID:JAMIENG-01 TSONY <br /> LOC#: 1 <br /> ACORO ADDITIONAL REMARKS SCHEDULE Page 1 of 1 <br /> AGENCY License#0757776 NAMED INSURED <br /> HUB International Insurance Services Inc. Jamison Engineering Contractors Inc. <br /> 2525 S.Yale St. <br /> POLICY NUMBER Santa Ana,CA 92704 <br /> SEE PAGE 1 <br /> CARRIER NAIC CODE <br /> SEE PAGE 1 SEE P 1 EFFECTIVE DATE:SEE PAGE 1 <br /> ADDITIONAL REMARKS <br /> THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, <br /> FORM NUMBER: ACORD 25 FORM TITLE: Certificate of Liability Insurance <br /> Description of Operations/Locations/Vehicles: <br /> by written contract, per the attached endorsement forms CGD361 03/05 and CG2037 07/04. Coverage is Primary&Non—Contributory <br /> with regard to the General Liability policy,when required by written contract, per the attached endorsement form CGT100 02/19. <br /> Waiver of Subrogation applies to the General Liability policy,when required by written contract, per the attached endorsement form <br /> CGD316 02/19.Additional Insured applies with regard to the Auto Liability policy,when required by written contract, per the attached <br /> endorsement form CAT499 02116.Waiver of Subrogation with regard to Auto Liability applies when required by written contract per <br /> the attached endorsement form CAT353 02/15.Waiver of Subrogation applies to the Workers Compensation policy,when required by <br /> written contract, per the attached endorsement form 2572. <br /> Should the policies be cancelled before the expiration date, Hub International Insurance Services Inc. (Hub), independent of any <br /> rights which may be afforded within the policies to the certificate holder named below, will provide to such certificate holder notice <br /> of such cancellation within thirty(30)days of the cancellation date,except in the event the cancellation is due to non-payment of <br /> premium, in which case Hub will provide to such certificate holder notice of such cancellation within ten (10)days of the cancellation <br /> date. <br /> ACORD 101 (2008/01) ©2008 ACORD CORPORATION. All rights reserved. <br /> The ACORD name and logo are registered marks of ACORD <br />