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` AGENCY CUSTOMER ID: LOC p: ACC>R" ADDITIONAL REMARKS SCHEDULE Page 2 of 2 AGENCY NAMED INSURED Marsh USA Inc. SimplexGrinnell LP POLICY NUMBER 12728 Shoemaker Avenue Santa Fe Springs, CA 90670 United States CARRIER NAIC EFFECTIVE DATE: I 1 IUNAL THIS ADDMONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, FORM NUMBER: 25 FORM TITLE: CERTIFICATE OF LIABILITY INSURANCE REGARDING POLICIES OF INSURANCE: Insurer Policy Number(s) Effective Date(s) Expiration Date(s) E WC 043464674 (MA, ND, OH, WA, WI, WY) 9/28/2012 10/1/2013 E WC 043464675 (CT,GA,PA,SC) 9/28/2012 10/1/2013 REGARDING NOTICE OF CANCELLATION TO CERTIFICATE HOLDERS: This endorsement modifies the notice of cancellation of insurance provided hereunder Should any of she above described policies be cancelled, other than for non-payment of premium, before the expiration date thereof, 30 days advice of cancellation will be delivered to certificate holders in accordance with the policy endorsements. 1 other terms and conditions of this policy remain unchanged. REGARDING ADDITIONAL INSURED STATUS: In accordance with the policy provisions, SANTA ANA POLICE DEPARTMENT is included as an additional insured under this policy, as a result of any contract or agreement entered into by the named insured and SANTA ANA POLICE DEPARTMENT. In accordance with the policy provisions, coverage afforded to an additional insured will apply as primary insurance where required by contract entered into by the named insured and the SANTA ANA POLICE DEPARTMENT. Any other insurance issued to such additional insured shall apply as excess and noncontributory insurance. Other Additional Insureds: The City of Santa Ana, 20 Civic Center Plaza, Santa Ana, California 92701; its officers, employees, agents, volunteers and representatives are named as additional insureds ("additional Insureds") with regard to libability and defense of suits arising frcT-.. the operations and uses performed by or on behalf of the named insured. REGARDING WAIVER OF SUBROGATION: in accordance with the policy provisions, the Waiver of Subrogation applies per contract or agreement entered into by the named insured and SANTA ANA POLICE DEPARTMENT. -- --------------------------------------------- ------------ -iS C_R-:= CAT_ C= IVS.U%C-c AAS G_%_RAT_:? AS: 3? EXG'.S RS. A:,,S --------"°------ ausiress process Au:oma9en for Risk Maragemer-_ Irsumrce. arm Trooe =lr artt -_ -- _ 2k.C - _- _ _ _ -e:s _ __ W, I4uvoly I I s' 2008 ACORD CORPORATION. All rights reserved. The ACORD name and logo are reegisteredmarks of ACORD,, - dm , /- ?^ " 1 ' ' C WZVO