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AGENCY CUSTOMER ID: <br /> _ LOC#: <br /> ADDITIONAL REMARKS SCHEDULE Page 1 of 1 <br /> AGENCY NAMED INSURED <br /> Chrysalis Insurance Agency(Incorporated) Sunny Hills Associates Inc.d/b/a SUNNY HILLS RESTORATION <br /> POLICY NUMBER <br /> BNUWC0152685,SUAU238218, 12 EMP 22242 02, 12 EMX 22243 02 <br /> CARRIER NAIC CODE <br /> MIDWEST EMPLOYERS CAS CO 23612,423£1 EFFECTIVE DATE: <br /> ADDITIONAL REMARKS <br /> THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, <br /> FORM NUMBER: 25 FORM TITLE: Certificate Of Liability Insurance <br /> City of Santa Ana, Its Officers,Agents and Employees,Vendors are named as additional insured per attached ECP1004 04/10.30 days notice of cancellation. <br /> Waiver of Subrogation applies.Above coverage is primary and any insurance or self-insurance maintained by the Entity,its officers,officials,employees,or <br /> volunteers shall be excess of the Contractor?s insurance and shall not contribute with it. <br /> ACORD 101 (2008/01) ©2008 ACORD CORPORATION. All rights reserved. <br /> The ACORD name and logo are registered marks of ACORD <br />