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AGENCY CUSTOMER ID: ORANCOU-05 <br /> _ LOC#: <br /> Ac"" ADDITIONAL REMARKS SCHEDULE page 1 of 1 <br /> AGENCY NAMED INSURED <br /> (OC)Heffernan insurance Brokers Orange County's United Way <br /> 18012 Mitchell South <br /> POLICY NUMBER Irvine CA 92614-6008 <br /> CARRIER NAIC CODE <br /> EFFECTIVE DATE: <br /> ADDITIONAL REMARKS <br /> THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, <br /> FORM NUMBER: 25 FORM TITLE: CERTIFICATE OF LIABILITY INSURANCE <br /> Sexual Abuse and Molestation coverage-$1,000,000. <br /> The$5M Umbrella policy extends over the General Liability. <br /> Re:Agreement 2122-H-004:Housing Choice Voucher Program HUD-VASH.City of Santa Ana,its officers,employees,agents and representatives are Included <br /> as an additional insured(primary and non-Contributory)on General Liability policy per the attached endorsements,if required.This Certificate replaces and <br /> supersedes all previously Issued certificates. <br /> ACORD 101 (2008101) ©2008 ACORD CORPORATION. All rights reserved. <br /> The ACORD name and logo are registered marks of ACORD <br />