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AGENCY CUSTOMER ID: <br />LOC #: <br />Alh.. `�O® ADDITIONAL REMARKS SCHEDULE <br />Page 2 of 2 <br />AGENCY <br />NAMEDINSURED <br />Willis Management (Bermuda) Limited <br />St. Joseph Health System <br />3345 Michelson Drive, Suite 100 <br />Irvine, CA 92612 <br />POLICY NUMBER <br />See First Page <br />CARRIER <br />NAIC CODE <br />EFFECTIVEDATE: See First Page <br />American Unity Group Limited <br />C0929 -001 <br />AUUI I IUNAL KEMAKKS <br />THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, <br />FORM NUMBER: 25 FORM TITLE: CERTIFICATE OF LIABILITY INSURANCE <br />Waiver of Subrogation applies in favor of Additional Insureds with respects to General Liability <br />when required by written contract. <br />Umbrella liability provides excess over the automobile liability which is represented on a <br />separate certificate. <br />ACORD 101(2008/01) Coll:4720652 Tpl:1973414 Cert:23354500 ©2008 ACORD CORPORATION. All rights reserved. <br />The ACORD name and logo are registered marks of ACORD <br />