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AGENCY CUSTOMER ID: _ LOC M ADDITIONAL REMARKS SCHEDULE Page of AGENCY NAMED INSURED GMGS Risk Management&Insurance Services Legglon Contractors,Inc. 445 S.Figueroa Street,Suite 2580 POLICY NUMBER Los Angeles CA 90071 CARRIER NAIC CODE EFFECTIVE DATE: ADDITIONAL REMARKS THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, FORM NUMBER: 25 FORM TITLE:Certificate of Liability Insurance(03/16) HOLDER: City of Santa Ana ADDRESS:Attn:Public Works Agency 20 Civic Center Plaza,4th FI,Santa Ana CA 92701-4058 RE: Bristol - Tolliver Street Turban Greening, Project No. : 24-6600 As respects General Liability coverage, The City of Santa Ana, its officers, 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, The City of Santa Ana, its officers, employees, agents and volunteers are added as Additional Insured, per PBA300000422 attached, and this insurance is primary, per CA04491116 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 WC990634 attached. ACORD 101 (2008101) 02008 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD ADDENDUM 84452921 1 24-25 A G W 88 R&L I EXo1:OT3 CT4 I Charise Fergueon 1 3/20/2025 9;46;26 AM (POT) I page 2 of 13