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AGENCY CUSTOMER ID:AIDSSER-01 <br /> _ LOC#: <br /> ACCOREP ADDITIONAL REMARKS SCHEDULE Page 1 of 1 <br /> AGENCY NAMEDINSURED <br /> CalNonprofits Insurance Services AIDS Services Foundation of Orange County,DBA:Radiant Health <br /> Centers <br /> POLICY NUMBER 17982 Sky Park Circle,Ste.J <br /> Irvine CA 92614 <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 /> required by written contract per Endorsement Form(s)NIA-061 GL 02 19,CG 20 26 12 19&NIA-102 BA 0126 attached.General Liability coverage Is Primary& <br /> Non-contributory and Blanket Waiver of Subrogation applies as required by written contract per Endorsement Form(s)NIA 061 GL 02 19 and NIA-026B GL 01 <br /> 25 attached,Business Auto Liability Coverage Blanket Waiver of Subrogation applies as required by written contract per Endorsement Form(s)CA 04 44 10 13 <br /> attached.30 Day Notice of Cancellation applies per Endorsement Form requested from the Carrier.Workers Compensation Waiver of Subrogation applies as <br /> required by written contract per Endorsement Form(s)WC 00 03 13(Ed.04-84)attached. <br /> City of Santa Ana,officers,agents,employees,and volunteers are named as additionally insured on this policy pursuant to written contract,agreement,or <br /> memorandum of understanding.Such Insurance as is afforded by this policy shall be primary,and any insurance carried by City shall be excess and <br /> noncontributory. <br /> ACORD 101 (2008101) ©2008 ACORD CORPORATION. All rights reserved. <br /> The ACORD name and logo are registered marks of ACORD <br />