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AGENCY CUSTOMER ID: LOC#: ACa O® `—� ADDITIONAL REMARKS SCHEDULE Page of AGENCY BIN INSURANCE HOLDINGS LLC/PHS NAMED INSURED HJELMS TROM &AS SOC IATES 25072 WILKES PL LAGUNA HILLS CA 92553 POLICY NUMBER SEE ACORD 25 CARRIER SEE ACORD 25 NAIC CODE EFr-ECrnEDATE SEE ACORD 25 THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM FORMNUMEER: ACORD 25 FORMTITLE: CERTIFICATE OF LIABILITY INSURANCE Those usual to the Insured's Operations. 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 liability and defense of suits arising from the operations and uses performed by or on behalf of the named insured. With respect to claims arising out of the operations and uses performed by or on behalf of the named insured, such insurance as is afforded by this policy is primary and is not additional to or contributing with v any other insurance carried by or for the benefit of the additional insureds. This insurance applies separately to each insured against whom claim is made or suit is brought except with respect to the company's limits of liability.The inclusion of any person or organization as an insured shall not affect any right which such person or organization would have as a claimant if not so included. With respect to the additional insureds, this insurance shall not be cancelled after thirty (30) days written notice has been given to the City of Santa Ana, 20 Civic Center Plaza, Santa Ana, California 92701. Severability of Interest Insurance applies separately to each interest against whom claim is made or suit is brought per the Business Liability Coverage Form SS00080405 attached to this policy. ACORD 101 © 2014 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD REVIEWED BY: EUNICE HEREDIA (PG O )