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AGENCY CUSTOMER ID: <br />LOC #: <br />Ac Ro " ADDITIONAL REMARKS SCHEDULE <br />Page —Of <br />AGENCY <br />NAMEDINSURED <br />Cannon Corporation, <br />Venbrook Insurance Services <br />1050 Southwood Drive <br />San Luis Obispo CA 93401 <br />POLICY NUMBER <br />CARRIER <br />NAIC CODE <br />EFFECTIVE DATE: <br />THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, <br />FORM NUMBER: 25 FORM TITLE: Certificate of Liability Insurance (03/16) <br />HOLDER: City of Santa Ana Attention: Public Works Agency <br />ADDRESS: 20 Civic Center Plaza (M-21) Santa Ana CA 92702 <br />RE: On -Call Water Resources Engineering Services City of Santa Ana REP No. 24-083 Cannon <br />Project Number 240714 <br />City, its City Council, its officers, officials, employees, agents, and volunteers are <br />named as Additional Insured under the General Liability, Automobile Liability and <br />Professional Liability policy if required by written contract with the Named Insured but <br />only for coverage and limits provided by the policy and the additional insured <br />endorsement. Waiver of Subrogation applies to General Liability, Automobile Liability, <br />Professional Liability and Workers Compensation. Excess/Umbrella follows form. *10 Days <br />Notice of Cancellation for Non -Payment of Premium, 30 Days All Other. <br />Annon 4n4 /9nnAln91 <br />2008 ACORD CORPORATION. All <br />The ACORD name and logo are registered marks of ACORD <br />84347633 1 24-25 GL/AL/WC/UM/PL I Isabella Saldivav 1 3/13/2025 lli50:56 AM (PDT) I Page 2 of 15 <br />ADDENDUM <br />