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AGENCY CUSTOMER ID: 100129 <br />LOC #: Morristown <br />AC"Ra ADDITIONAL REMARKS SCHEDULE Page 2 of 2 <br />AGENCY <br />NAMEDINSURED <br />MARSH USA. INC. <br />SIEMENS INDUSTRY, INC. INCLUDING <br />BUILDING TECHNOLOGIES DIVISION <br />1000 DEERFIELD PARKWAY <br />POLICY NUMBER <br />BUFFALO GROVE, IL 60089 -4513 <br />CARRIER <br />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 />RE: JOB NO WA <br />THE CITY OF SANTA ANA, ITS OFFICERS, EMPLOYEES, AGENTS, AND REPRESENTATIVES ARE INCLUDED AS ADDITIONAL INSURED UNDERTHE ABOVE REFERENCED GENERAL LIABILITY AND <br />AUTOMOBILE LIABILITY INSURANCE POLICIES AND THE COVERAGE AFFORDED THE ADDITIONAL INSURED UNDER THESE POLICIES SHALL BE PRIMARY AND NONCONTRIBUTORY INSURANCE TO <br />THE EXTENT THAT A CLAIM ARISES FROM THE NEGLIGENCE OF SIEMENS INDUSTRY, INC. OR ITS SUBCONTRACTORS WITH RESPECT TO ALL OPERATIONS OF THE INSURED BUT ONLY WITH <br />RESPECT TO ALL WORK PERFORMED BY AND ON BEHALF OF THE NAMED INSURED, SIEMENS INDUSTRY, INC. FOR CERTIFICATE HOLDER UNDER CONTRACT. <br />COMPLETED OPERATIONS COVERAGE IS INCLUDED IN THE GENERAL LIABILITY POLICY. <br />IF THESE POLICIES ARE CANCELLED FOR ANY REASON OTHER THAN NON - PAYMENT OF PREMIUM, THE INSURER WILL DELIVER NOTICE OF CANCELLATION TO THE CERTIFICATE HOLDER UP TO 60 <br />DAYS PRIOR TO THE CANCELLATION OR AS REQUIRED BY WRITTEN CONTRACT, WHICHEVER IS LESS. <br />i <br />PROVED AS TO ORM <br />'V" CY'L A Q�d ✓ ��1/'l.i� <br />Laura A. Rossini <br />Assistant City Attorney <br />ACORD 101 12008/011 C 2008 ACORD CORPORATION. All rights reserved. <br />The ACORD name and logo are registered marks of ACORD <br />