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AGENCY CUSTOMER ID: <br />LOC#: <br />AC aOg° <br />ADDITIONAL REMARKS SCHEDULE Page 2 of 2 <br />AGENCY <br />NAMEDINSURED <br />AUTO CLUB INSURANCE AGENCY LLC/PHS <br />FIVE ELEMENTS CONSULTING GROUP LLC <br />8100 E TOPIA ST <br />POLICY NUMBER <br />SEE ACORD 25 <br />LONG BEACH CA 90808-3339 <br />CARRIER <br />NAIC CODE <br />SEE ACORD 25 <br />EFFECTIVE DATE: SEE ACORD 25 <br />THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM <br />FORM NUMBER: ACORD 25 FORM TITLE: CERTIFICATE OF LIABILITY INSURANCE <br />City of Santa Ana, officers, agents, employees, and volunteers but only as required by a valid written contract, agreement, or <br />permit is an additional insured as provided by the Blanket Additional Insured By Contract, Form SS 00 08 attached to the policy. <br />Notice of Cancellation will be provided in accordance with Form SS1223, attached to this policy. Coverage is primary and <br />noncontributory per the Business Liability Coverage Form SS0008, attached to this policy. <br />RideMwvganmfDMd= <br />` REVIEWED&APPRovm BY: <br />ACORD 101 (2014101) © 2014 ACORD CORPORAT �,, IIuI TWy J" <br />The ACORD name and logo are registered marks of ACORD' <br />Risk Management Analyst <br />