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AGENCY CUSTOMER ID: INTERCON35 <br />LOC #: <br />ADDITIONAL REMARKS SCHEDULE Page 1 of 1 <br />AGENCY NAMED INSURED <br />USI Colorado, LLC Prof Liab Interwest Consulting Group <br />POLICY NUMBER P.O. Box 18330 <br />Boulder CO 80308 <br />CARRIER I NAIC CODE <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 />provides excess coverage over the General Liability, Automobile Liability and Employers Liability. <br />Please note that Additional Insured status does not apply to Professional Liability or Workers' Compensation. <br />Additional Insured: The City of Santa Ana, its officers, agents and employees, agents and representatives <br />Policies include 30 Day Notice of Cancellation that will be mailed to the City of Santa Ana. <br />AUUKU 9U1 (ZUUtS/U1) © 2008 ACORD CORPORATION. All rights reserved. <br />The ACORD name and logo are registered marks of ACORD <br />