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AGENCY CUSTOMER ID. <br /> LOC#: <br /> ACCIORL> <br /> ADDITIONAL REMARKS SCHEDULE Pale t of I <br /> AGENCY NAMED INSURED <br /> Chrysalis Insurance Agency(Incorporated) Sunny Hills Associates Inc.dlbla SUNNY HILLS RESTORATION <br /> POLICY NUMBER <br /> BNUWC0152685,SUAU238218,12 EMP 22242 02, 12 ENIX 22243 02 <br /> CARRIER NAIC CODE <br /> MIDWEST EMPLOYERS CAS CO 23612,4235 1 EFFECTIVE DATE: <br /> ADDITIONAL REMARKS <br /> THIS ADDITIONAL REMARKS FORM 1S A SCHEDULE TO ACORD FORM, <br /> FORM NUMBER: 25 1 FORM TITLE: Certificate Of Liability Insurance <br /> City of Santa Ana and Santa Ana Police Department,Its Officers,Agents and Employees,Vendors are named as additional insured.30 days notice of <br /> cancellation. <br /> Waiver of Subrogation applies.Above coverage is primary and any insurance or self-insurance maintained by the Entity,its officers,officials,employees,or <br /> volunteers shall be excess of the Contractor's insurance and shall not contribute with it. <br /> ACORD 101 (2008101) O 2008 ACORD CORPORATION. All rights reserved. <br /> The ACORD name and logo are registered marks of ACORD <br />