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AGENCY CUSTOMER IO: <br />LOC #: <br />A ADDITIONAL REMARKS SCHEDULE <br />Page 2 of 2 <br />AGENCY <br />NAMED INSURED <br />SimplexGrinnell LP <br />Marsh USA Inc. <br />12728 Shoemaker Avenue <br />Santa Fe Springs, CA 90670 <br />POLICY NUMBER <br />United States <br />CARRIER <br />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 />REGARDING NOTICE OF CANCELLATION TO CERTIFICATE HOLDERS: <br />This endorsement modifies the notice of cancellation of insurance provided hereunder <br />Should any of the above described policies be cancelled, other than for non- payment of premium, before the <br />expiration date thereof, 30 days advice of cancellation will be delivered to certificate holders in <br />accordance with the policy endorsements. <br />All 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, voluteers and representatives <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 />FOR QUESTIONS REGARDING THIS CERTIFICATE OF INSURANCE CONTACT: <br />Carolina Vega (Email: cavega @simplexgrinnell.com Phone: 562- 405 -3800) <br />ACORD 101 120011/011 <br />THIS CERTIFICATE OF INSURANCE WAS GENERATED AND DELIVERED BY EXIGIS RiskWorks® rm.C.01ficatese <br />Business Process Automation for Risk Management, Insurance, and Trade Finance <br />The ACORD name and logo are registered marks of ACORD <br />rin h }c rumnrnd <br />