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AGENCY CUSTOMER ID. <br /> LOC#: <br /> AC"RE) ADDITIONAL REMARKS SCHEDULE Page 2 Of 2 <br /> 16. � <br /> AGENCY NAMED INSURED <br /> Willis "rowers Watson Insurance Services West, Inc. Alta Planning + design, Inc. <br /> 101 SW Main St., Ste 2000 <br /> POLICY NUMBER Portland, OR 97204 <br /> See Page I Berlin, NJ 08009 <br /> CARRIER NAIC CODE <br /> See Page 1 See Page 1 EFFECTIVE DATE: See Page 1 <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 /> RE: RFP 23-025 ON-CALL ENGINEERING SERVICES; ALT ON CALL NO. 00-ON23-013 AND ALL WORK ORDERS RELATING THERETO. <br /> The City, its officers, officials, employees and volunteers are included as Additional Insureds as respects to General <br /> Liability. <br /> General Liability policy shall be Primary and Non-Contributory with any other insurance in force for or which may be <br /> purchased by Additional Insureds. <br /> Waiver of Subrogation applies in favor of City of Santa Ana, its City Council, officers, officials, employees, agents, <br /> and volunteers with respects to General Liability, Auto Liability, Professional Liability and Workers Compensation as <br /> permitted by law. <br /> Alta Planning # Design, Inc is included as a Named Insured for Trilon Group, LLC. <br /> INSURER AFFORDING COVERAGE: National Union Fire Ins Co of Pittsburgh NAIC#: 19445 <br /> POLICY NUMBER: 042670160 EFF DATE. 12/31/2025 EXP DATE: 12/31/2026 <br /> SUBROGATION WAIVED: Y <br /> TYPE OF INSURANCE: LIMIT DESCRIPTION: LIMIT AMOUNT: <br /> Auto Liability - MA Combine Single Limit $5,000,000 <br /> Any Auto Each Accident. <br /> INSURER AFFORDING COVERAGE: AIU Insurance Company NAIC#: 19399 <br /> POLICY NUMBER: 042670161 EFF DATE: 12/31/2025 EXP DATE: 12/31/2026 <br /> SUBROGATION WAIVED: Y <br /> TYPE OF INSURANCE: LIMIT DESCRIPTION: LIMIT AMOUNT: <br /> Workers Compensation (WI) E.L. EACH ACCIDENT $1,000,000 <br /> & Employers Liability E.L. DISEASE - EA EMP $1,000,000 <br /> Per Statute E.L. DISEASE-POL LMT $1,000,000 <br /> INSURER AFFORDING COVERAGE: Lexington Insurance Company NAIC#: 19437 <br /> POLICY NUMBER: 012147867 EFF DATE: 12/31/2025 EXP DATE: 12/31/2026 <br /> TYPE OF INSURANCE: LIMIT DESCRIPTION: LIMIT AMOUNT: <br /> Excess Liability Each Occurrence $5,000,000 <br /> excess of $5,000,000 <br /> ACORD 101 (2008/01) 02008 ACORD CORPORATION, All rights reserved. <br /> The ACORD name and logo are registered marks of ACORD <br /> SR ID: 29220967 BATCH: 4270203 CERT: W43617133 <br />