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AGENCY CUSTOMER ID: BRUCAND-03 <br /> _ LOC#: <br /> ADDITIONAL REMARKS SCHEDULE Page 9 of 1 <br /> AGENCY NAMEDINSURED <br /> BHIS-Colossus-Alkeme Insurance Bruce Anderson Enterprises, Inc.dba A's Construction <br /> 1662 West McFadden Ave <br /> POLICY NUMBER Santa Ana CA 92704 <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 /> including primary non-contributory and waiver of subrogation in regards to business auto liability as respects to insureds operations per forms 50461AIS01, <br /> 500PNCV01,50461SWF01 as required by written contract with the named insured prior to an occurrence and subject to policy terms and conditions. <br /> City of Santa Ana,its City Council,ifs officers,officials,employees,agents and volunteers are additional insureds for ongoing and completed operations <br /> including primary non-contributory and waiver of subrogation in regards to pollution liability as respects to insureds operations per forms ENV32440922, <br /> ENV32511218, ENV32531218, ENV31430305 as required by written contract with the named insured prior to an occurrence and subject to policy terms and <br /> conditions. <br /> Workers Compensation Waiver of Subrogation applies in favor of additional insureds per form 25720225 as required by written contract with the named insured <br /> prior to an occurrence and subject to policy terms and conditions. <br /> Excess Coverage is follow form. <br /> 30 day notice of cancellation applies except in the event of cancellation for non-payment whereas 10 days applies. <br /> ACORD 101 (2008/01) ©2008 ACORD CORPORATION. All rights reserved. <br /> The ACORD name and logo are registered marks of ACORD <br />