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AGENCY CUSTOMER ID: <br />LOC: f«: <br />ADDITIONAL REMARKS SCHEDULE Page 2 of 2 <br />AGENCY NAMED INSURED: <br />Barrett Business Services, Inc. L/C/F <br />Lockton Affinity DEKRA-LITE INDUSTRIES, INCORPORATED <br />POLICY NUMBER 3102 W ALTON AVE <br />SANTA ANA, CA 92704 <br />16161110 <br />IACE American Insurance Company 122667 (EFFECTIVE DATE: 10/01/18 <br />ADDITIONAL REMARKS <br />THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, <br />FORM NUMBER: 25 FORM TITLE: Certificate of Liability (01/14) <br />CERTIFICATE HOLDER: City of Santa Ana <br />ADDRESS: 20 Civic Center Plaza Santa Ana CA 92701 <br />The City of Santa Ana; 30 Day Cancellation Notice <br />ACORD 101 (2008/01) c) 1988-2010 ACORD CORPORATION. All rights reserved. <br />The ACORD name and logo are registered marks of ACORD. t_v <br />