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ADDITIONAL REMARKS SCHEDULE <br /> Intermediary <br /> Insured <br /> Policy Number <br /> Insurer <br /> Effective Date <br /> ADDITIONAL REMARKS <br /> This Additional Remarks form is a schedule to ACORD form, <br /> Form Title Benevate- City of Santa <br /> Form Number: Ana COI <br /> INSR TYPE OF ADDL SUBR POLICY POLICY EFF <br /> LTR INSURANCE INSD WVD NUMBER (MM/DDYYY) POLICY EXP(MM/DD/YYYY) LIMITS <br /> /Y <br /> ed by written contract. <br /> . Risk MangentetttDtvisIon <br /> REVIEWED&APPROVED BY: <br /> " irdi ripo7 l e.�: Acet:eotti <br /> :�, Risk Management Specialist <br /> ©1988-2016 ACORD CORPORATION.All rights reserved. <br /> ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD <br />