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AGENCY CUSTOMER ID. <br />LOC#: <br />►' ADDITIONAL REMARKS SCHEDULE <br />Page 2 of 2 <br />AGENCY <br />NAMEDINSURED <br />EMBROKER INSURANCE SERVICES LLC <br />GRAVITON CONSULTING SERVICES INC <br />8801 FOLSOM BLVD STE 120 <br />POLICY NUMBER <br />SEE ACORD 25 <br />SACRAMENTO CA 95826-3249 <br />CARRIER <br />NAIC CODE <br />SEE ACORD 25 <br />EFFECTIVE DATE: SEE ACORD 25 <br />ADDITIONAL REMARKS <br />THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM <br />FORM NUMBER: ACORD 25 FORM TITLE: CERTIFICATE OF LIABILITY INSURANCE <br />City of Santa Ana, its City Council, officers, Officials, employees, agents, and volunteers, but only as required by a valid written <br />contract, agreement, or permit is an additional insured as provided by Blanket Additional Insured By Contract Endorsement, <br />Form SL 30 32 attached to this policy. Waiver of Subrogation applies in favor of the Certificate Holder per the Business Liability <br />Coverage Form SL 00 00, attached to this policy. Blanket Waiver of Subrogation applies in favor of the Certificate Holder per <br />the Waiver of Our Right to Recover from Others Endorsement WC040306, attached to this policy. RE: State job is performed in: <br />CA <br />ACORD 101 (2014101) O 2014 ACORD CORPORATION. All rights reserved. <br />The ACORD name and logo are registered marks of ACORD <br />