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AGENCY CUSTOMER ID: <br />LOC #: <br />A`� �® ADDITIONAL REMARKS SCHEDULE <br />Page 1 of 1 <br />AGENCY <br />Chrysalis Insurance Agency (Incorporated) <br />NAMED INSURED <br />Sunny Hills Associates Inc. di SUNNY HILLS RESTORATION <br />POLICY NUMBER <br />BNUW00152685, SUAU238218, 12 EMP 22242 02,12 EMX 22243 02 <br />CARRIER <br />MIDWEST EMPLOYERS CAS CO <br />NAIC CODE <br />23612, 423E <br />EFFECTIVE DATE: <br />ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, <br />FORM NUMBER: 25 FORM TITLE: <br />City of Santa Ana, Its Officers, Agents and Employees, Vendors are named as additional insured per attached ECP1004 04/10. 30 days notice of cancellation. <br />Waiver of Subrogation applies. Above coverage is primary and any insurance or self-insurance maintained by the Entity, its officers, officials, employees, or <br />volunteers shall be excess of the Contractor?s insurance and shall not contribute with it. <br />ACORD 101120081011 <br />n 2008 ACORD CORPORATION_ All rinhts <br />The ACORD name and logo are registered marks of ACORD <br />