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AGENCY CUSTIDIVIER ID: <br />LOC #: <br />ADDITIONAL- REMARKS SCl-iEDULE <br />Whur,J. Gaflagher Msk Manager"IcIrlt Servic("S, Inc. <br />IOUCY NUMBER <br />'ARF dEk <br />ADDITIONAL REMARKS <br />NAMED INSURM <br />'� <br />� Dyll0Und Lines, Inc, <br />0 " <br />35M St. Paul Stroll <br />Mflas, TX 75201 <br />EFFECTWE DATE <br />THIS ADWTIONAL REMARKS F=,AIS A, SCIAEDULETO as ORD FORM, <br />FORM NUMBER25 FORM TITLE: gf-'.R'jFICA-f'E OF LIABILITY INSURANC E <br />lo: Leased tocation - Tho Depot at Santa Ana; 1000 East Santa Arm Boulevard, Santa Ana CA, <br />"ity of Santa Ana, Its agents, officers, c-miployees and VOILUACO'S rare included as Adrl¢tional @nsurcd as respects Ge ncual Liabdity(Wank(A <br />mclorsernemt-GU83644) Policy as evidenced hor6n on a priiiiziry/ii(�)ii-contril-,)utoi,y basi�as required by written contract w4h respect to <br />.ease Agreement for the above IDGaf1011 fflilltiOrled. A waiver of 'Ribrogation included unde (fre WorkersCompensation Policy(bl@nkel endl) <br />vi iecjured by written contiad witty t'(,ipect (o Lease Ag gement. <br />lotice of cancdlation: 30 days written notice/10 days for non -pay <br />REViEWED BY� <br />. E U P,J I (r, 13 i E RG D i A (P --'G 2 ()r��Z ) <br />ACORD 101 (2008/0-1) <br />2008 ACORD CORPORATION, Ail flqh�s <br />Hie ACORD PQgo jjjl(. marks of ACORD <br />