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ADDITIONAL REMARKS SCHEDULE <br />intermediary <br />Insured <br />Policy Number <br />Insurer <br />EQeedve Date <br />ADDITIONAL REMARKS <br />This Additional Remarks form is a schedule to ACORD form, <br />Form Number: <br />Form Title Benevate - City of Santa <br />Ana COI <br />INSR <br />LTR <br />TYPE OF <br />INSURANCE <br />ADDL <br />INSD <br />SUBR <br />W VD <br />POLICY <br />NUMBER <br />POLICY EFF <br />(MM/DDNYYY) <br />POLICY EXP (MM/DD/YYYY) <br />LIMITS <br />ed by written contract. <br />RWeMougemnttDhisfan <br />RFnEwED & APPRov®aV: <br />A,j-u Acwwte <br />® <br />Risk Management Spedalist <br />1988-2016 ACORD CORPORATION. All rights reserved. <br />ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD <br />