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AGENCY CUSTOMER ID: <br />LOC #: <br />ADDITIONAL REMARKS SCHEDULE Page 2 of 2 <br />AGENCY NAMED INSURED <br />Marsh, Inc. SimplexGrinnell, LP <br />POLICY NUMBER 1701 WEST SEQUOIA AVE <br /> ORANGE, CA 92868 <br /> United States <br />CARRIER NAIC <br /> EFFECTIVE DATE: <br />THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, <br />FORM NUMBER: 25 FORM TITLE: CERTIFICATE OF LIABILITY INSURANCE <br />.EGARDING POLICIES OF INSURANCE: <br />nsurer Policy Number(s) Effective Date(s) Expiration Date(s) <br />WC 026149615 (TX) 10/1/2010 10/1/2011 <br />WC 026149519 (AOS) 10/1/2010 10/1/2011 <br />WC 026149548 (MN) 10/1/2010 10/1/2011 <br />EGARDING NOTICE OF CANCELLATION TO CERTIFICATE HOLDERS: <br />his endorsement modifies the notice of cancellation of insurance provided hereunder: <br />hould any of the above described policies be cancelled before the expiration date thereof, the producer will <br />ndeavor to mail 30 days written notice to the certificate holder named herein, but failure to do so shall <br />mpose no obligation or liability of any kind upon the producer, its agents or representatives. <br />1 other terms and conditions of this policy remain unchanged. <br />REGARDING ADDITIONAL INSURED STATUS: <br />In accordance with the policy provisions, SANTA ANA POLICE DEPARTMENT is included as an additional insured <br />under this policy, as a result of any contract or agreement entered into by the named insured and SANTA ANA <br />POLICE DEPARTMENT. <br />In accordance with the policy provisions, coverage afforded to an additional insured will apply as primary <br />insurance where required by contract entered into by the named insured and the SANTA ANA POLICE DEPARTMENT. <br />Any other insurance issued to such additional insured shall apply as excess and noncontributory insurance. <br />Other Additional Insureds: The City of Santa Ana, 20 Civic Center Plaza, Santa Ana, California 92701; its <br />officers, employees, agents, volunteers and representatives are named as additional insureds ("additional <br />Insureds") with regard to libability and defense of suits arising from the operations and uses performed by <br />or on behalf of the named insured. <br />REGARDING WAIVER OF SUBROGATION: <br />In accordance with the policy provisions, the Waiver of Subrogation applies per contract or agreement entered <br />into by the named insured and SANTA ANA POLICE DEPARTMENT. <br />--- ._. I---- 1-1 V ZUUS ACORD CORPORATION. All rights reserved. <br />The ACORD name and logo are registered marks of ACORD <br />Generated by EXIGIS LLC. For more information visit www.exigis.com.