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AGENCY CUSTOMER ID: NBSGOVE-01 ROBLY2 <br />LOG #: 1 <br />, lk. K <br />ADDITIONAL REMARKS SCHEDULE <br />`� Page 1 of 1 <br />AGENCY License # OL48969 NAMED INSURED <br />3 INBS Government Finance Group <br />Risk &Insurance Services <br />32605 Temecula Parkway, Suite 100 <br />POLICY NUMBER -Temecula, CA 92592 <br />EE PAGE 1 <br />CARRIER NAIC CODE <br />EE PAGE 1 SEE P 1 EFFECTIVE DATE: SEE PAGE 1 _ <br />THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, <br />FORM NUMBER: ACORD 25 FORM TITLE: Certificate of Liability Insurance <br />Description of Operations/Locations/Vehicles: <br />GENERAL LIABILITY: <br />Additional Insured -Special Broadening Endt: 391-1006 08 16 <br />Additional Insured -Completed Operations: 391-1602 08 16 <br />Primary & Non -Contributory: 391-1003 08 16 <br />Waiver of Subrogation: 391-1003 08 16 <br />Cancellation Provision: 391 -1003 08 16 <br />Umbrella Cancellation Provision: CU 02 23 09 12 <br />AUTO: <br />Additional Insured: CA20 48 02 99 <br />Primary & Non -Contributory: 461-0478 12 12 <br />Waiver of Subrogation: 461-0500 11 13 <br />Auto Broadening Endorsement: 461-0155 (9-97) <br />Auto Cancellation Provision:IL 00 17 11 98 <br />WORKERS' COMPENSATION: <br />Waiver of Subrogation: WC010306 (Ed 04-84) <br />Cancellation Provision California WC 040601 B <br />Cancellation Provision Arizona WC 02 06 01 C <br />Deductibles: <br />General Liability- $0 <br />Auto Liability- Comp Ded: $1,000 / Coll Ded: $1,000 <br />Umbrella: $0 <br />Professional Liability- $20,000 deductible (Per Claim). <br />Umbrella goes over General Liability, Employers Liability and Auto Liability. <br />City of Santa Ana, its officers, employees, agents, volunteers and representatives are named additional insured regarding General <br />Liability. <br />s RIelrMouganadIXviWan <br />€ RENEWED&APPRW®By: <br />A+.ga Auvule <br />Risk Management Speaalist <br />ACORD 101 (2008101) © 2008 ACORD CC <br />The ACORD name and logo are registered marks of ACORD <br />