LEGION CONTRACTORS, INC. (OUTDOOR LIBRARY AT JEROME PARK)

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AGENCY CUSTOMER ID: LOC #: ACO ® ADDITIONAL REMARKS SCHEDULE Page _of AGENCY GMGS Risk Management & Insurance Services 9 NAMED INSURED LogContractors, Inc. 4.4 S. Figueroa Street, Suite 2580 Los Angeles CA 90071 POLICY NUMBER CARRIER NAIC CODE EFFECTIVE DATE: THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, FORM NUMBER: 25 FORM TITLE: Certificate of Liability (03/16) HOLDER: City of Santa Ana ADDRESS. 20 Civic Center Plaza Santa Ana CA 92701 RE: Outdoor Library at Jerome Park; Project No. 22-1381 As respects General Liability coverage, City of Santa Ana, its City Council, officers, officials, employees, agents and volunteers are added as Additional Insured, per CG20101219 & CG20371219 attached, and this insurance is primary, per CG20011219 attached. As respects General Liability coverage, a Waiver of Subrogation is hereby included, per CG24041219 attached. As respects General Liability coverage, 30-day written notice of cancellation (10 days for non-payment of premium) applies per IL00171198 attached. As respects Automobile Liability coverage, City of Santa Ana, its City Council, officers, officials, employees, agents and volunteers are added as Additional Insured, per PBA300000422 attached, and this insurance is primary, per CA0449111G attached. As respects Automobile Liability coverage, a Waiver of Subrogation is hereby included, per CA04431120 attached. As respects Automobile Liability coverage, 30-day written notice of cancellation (10 days for non-payment of premium) applies per IL00171198 attached. As respects Workers' Compensation coverage, a Waiver of Subrogation is hereby included per (form number) attached. ACORD 101 (2008101) v cvve � The ACORD name and logo are registered marks of ACORD Risk MRnagrniaal. DMaIaR REVIEYVED&APPROVEDBY: ®' Risk Management Spedkist ADDENDUM 81566080 1 24-25 A 0 W %S POLL -PP I Chaziee P.zg .Cn 18/23/2024 1:36:4B . (PDT) I Page 2 of 12