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AGENCY CUSTOMER ID; <br />LOC #: <br />AC"RV ADDITIONAL REMARKS SCHEDULE Page of <br />AGENCY NAMED INSURED <br />GMGS Risk Management & Insurance Services EEC Environmental <br />dba Enviromentai En ineeringg Contracting Inc., <br />POLICY NUMBER One City Boulevard West, Sul a 1800 <br />Orange CA 92868 <br />CARRIER NAIC CODE <br />EFFECTWE DATE: <br />AIJUI I rUIVAL KLMAKKS <br />THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, <br />FORM NUMBER: 25 FORM TITLE: Certificate of Liability (03/16) <br />HOLDER: City of Santa Ana Risk Management Division <br />ADDRESS: 20 Civic Center Plaza, 4th floor Santa Ana CA 92702 <br />RE: Job #W-1424.12T - Every Drop Counts - ,Santa Ana WDR <br />As respects General Liability coverage, City of Santa Ana, its officers, employees, agents <br />and representatives are added as Additional Insured per CG20101219 and CG20371219 <br />attached, and this insurance is primary per CG20011219 attached. <br />As respects General Liability coverage, 30-day written notice of cancellation (10 days for <br />non-payment of premium) applies per IL00171198 attached. <br />As respects Automobile Liability coverage, City of Santa Ana, its officers, employees, <br />agents and representatives are added as Additional Insured, and this insurance is primary <br />per AC85430618 attached. <br />As respects Automobile Liability coverage, 30-day written notice of cancellation (10 days <br />for non --payment of premium) applies per IL00171198 attached. <br />As respects Workers' Compensation coverage, 30-day written notice of cancellation (10 days <br />for non-payment of premium) applies per WC040601A attached. <br />P%%,V IJ IV I tcuuaru I) © 2008 ACORD C <br />The ACORD name and logo are registered marks of ACORD <br />-98303113 20-21 G/A/UMB/POLL/ E&C/WC I Jennifer Barton 110/30/2C20 1A8:06 PM (PDT) I Page 2 ❑f 11 <br />„ RislcMan�m>r�ltAivlsltm <br />a, c RWrWED & RPPRoym BY: <br />A t F4AfW144 P1. Vim" <br />--ram R€skManagement Analyst <br />