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AGENCY CUSTOMER ID: <br /> LOC#: <br /> Accueco ADDITIONAL REMARKS SCHEDULE Page of <br /> AGENCY NAMED INSURED <br /> &Insurance Services Legion Contractors,Inc. <br /> GMGS Risk Management <br /> 445 S.Figueroa Street,Suite 2580 <br /> POLICY NUMBER Los Angeles CA 90071 <br /> CARRIER NAIC CODE <br /> EFFECTIVE DATE: <br /> ADDITIONAL REMARKS <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 <br /> ADDRESS:20 Civic Center Plaza Santa Ana CA 92701 <br /> RE: Outdoor Library at Jerome Park; Project No. 22-1381 <br /> As respects General Liability coverage, City of Santa Ana, its City Council, officers, <br /> officials, employees, agents and volunteers are added as Additional Insured, per <br /> CG20101219 & CG20371219 attached, and this insurance is primary, per CG20011219 attached. <br /> As respects General Liability coverage, a Waiver of Subrogation is hereby included, per <br /> CG24041219 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 City Council, officers, <br /> officials, employees, agents and volunteers are added as Additional Insured, per <br /> PBA300000422 attached, and this insurance is primary, per CA04491116 attached. <br /> As respects Automobile Liability coverage, a Waiver of Subrogation is hereby included, per <br /> CA04431120 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, a Waiver of Subrogation is hereby included per <br /> (form number) attached. <br /> g ,o�s Risk Management Division <br /> /�� � REVIEWED&APPROVED BY: <br /> `�u�fl111' Ai A/4 <br /> Risk Management Specialist <br /> ACORD 101 (2008/01) ©2008 ACORD 1/ <br /> The ACORD name and logo are registered marks of ACORD ADDENDUM <br /> 81566780 1 24-25 A G W XS POLL-PP 1 Chariae Ferguson 1 8/23/2024 1:36:48 PM (PDT) 1 Page 2 of 12 <br />