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AGENCY CUSTOMER ID: LOC #: ADDITIONAL REMARKS SCHEDULE Page 1 of AGENCY NAMEDINSURED FEDERATED MUTUAL INSURANCE COMPANY MARIPOSA LANDSCAPES INC 6232 SANTOS DIAZ ST IRWINDALE, CA 91702-3267 POLICY NUMBER SEE CERTIFICATE # 572.0 CARRIER NAIC CODE EFFECTIVE DATE: SEE CERTIFICATE # 572.0 SEE CERTIFICATE # 572.0 ADDITIONAL REMARKS THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, FORM NUMBER: 25 FORM TITLE: CERTIFICATE OF LIABILITY INSURANCE PROJECT NAME: CITY OF SANTA ANA LANDSCAPE MAINTENANCE SUBJECT TO THE TERMS AND CONDITIONS OF THE POLICY ADDITIONAL INSUREDS ALSO INCLUDE: CITY OF SANTA ANA , ITS CITY COUNCIL, ITS OFFICERS, OFFICIALS, EMPLOYEES, AGENTS, AND VOLUNTEERS SUBJECT TO THE TERMS AND CONDITIONS OF THE POLICY WAIVER OF SUBROGATION ALSO INCLUDES: CITY OF SANTA ANA, ITS CITY COUNCIL, ITS OFFICERS, OFFICIALS, EMPLOYEES, AGENTS, AND VOLUNTEERS COMMERCIAL GENERAL LIABILITY INCLUDES THE SEPARATION OF INSUREDS CONDITION WHICH STATES: "EXCEPT WITH RESPECT TO THE LIMITS OF INSURANCE, AND ANY RIGHTS OR DUTIES SPECIFICALLY ASSIGNED IN THIS COVERAGE PART TO THE FIRST NAMED INSURED, THIS INSURANCE APPLIES AS IF EACH NAMED INSURED WERE THE ONLY NAMED INSURED AND SEPARATELY TO EACH INSURED AGAINST WHOM CLAIM IS MADE OR "SUIT" IS BROUGHT. THE CERTIFICATE HOLDER IS AN ADDITIONAL INSURED ON GENERAL LIABILITY SUBJECT TO THE CONDITIONS OF THE ADDITIONAL INSURED - OWNERS, LESSEES OR CONTRACTORS (FORM B) ENDORSEMENT. THE CERTIFICATE HOLDER IS AN ADDITIONAL INSURED SUBJECT TO THE CONDITIONS OF THE ADDITIONAL INSURED BY CONTRACT ENDORSEMENT FOR BUSINESS AUTO LIABILITY. INSURANCE PROVIDED BY THE GENERAL LIABILITY COVERAGE IS PRIMARY AND NONCONTRIBUTORY OVER OTHER INSURANCE SUBJECT TO THE CONDITIONS OF THE PRIMARY AND NONCONTRIBUTORY CLAUSE- OTHER INSURANCE CONDITION. INSURANCE PROVIDED BY THE BUSINESS AUTO LIABILITY IS PRIMARY AND NONCONTRIBUTORY OVER OTHER INSURANCE SUBJECT TO THE CONDITIONS OF THE PRIMARY AND NONCONTRIBUTORY CLAUSE- OTHER INSURANCE CONDITION. GENERAL LIABILITY CONTAINS A WAIVER OF TRANSFER OF RIGHTS OF RECOVERY AGAINST OTHERS TO US (WAIVER OF SUBROGATION) - AUTOMATIC ENDORSEMENT BUSINESS AUTO LIABILITY CONTAINS A WAIVER OF SUBROGATION IN FAVOR OF THE CERTIFICATE HOLDER SUBJECT TO THE CONDITIONS OF THE BLANKET WAIVER OF TRANSFER OF RIGHTS OF RECOVERY ENDORSEMENT. FOR NON-PAYMENT OF PREMIUM, 10 DAYS NOTICE WILL BE PROVIDED TO THE CERTIFICATE HOLDER IN THE EVENT THAT THE ISSUING COMPANY CANCELS THE POLICY BEFORE THE EXPIRATION DATE OF THE POLICY. FOR REASONS OTHER THAN NON-PAYMENT OF PREMIUM, 30 DAYS NOTICE WILL BE PROVIDED TO THE CERTIFICATE HOLDER IN THE EVENT THAT THE ISSUING COMPANY CANCELS THE POLICY BEFORE THE EXPIRATION DATE OF THE POLICY. ACORD 101 (2008/01) © 2008 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD