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AGENCY CUSTOMER ID: INTEHOU-03 <br />LOC #: <br />ADDITIONAL REMARKS SCHEDULE page 1 of 1 <br />Gallagher & Co. <br />CARRIER <br />NAIL CODE <br />THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, <br />FORM NUMBER: 25 FORM TITLE: CERTIFICATE OF LIABILITY <br />rouIaiTerm: 10/01/2018 to <br />per m: $1,000.0001 AD <br />Liability <br />I - ability <br />/ Deductible : $25,000 <br />Company <br />3,000 / Retention: $0 <br />Seal Beach, CA 90740 <br />DATE: <br />City of Santa Ana, its officers, employees, agents, volunteers and representatives are named additional insured with respect to the operations of the named <br />red. Workers Compensation coverage is evidence only. <br />Insurance is Primary and Non -Contributory. Written notice shall be provided at least ten (10) days In advance of cancellation for non-payment of premium <br />thirty (30) days In advance for any other cancellation or policy change. <br />ACORD 101 (2008/01) - - - @ 2008 ACORD CORPORATION. All <br />The ame and logo are registered marks of ACORD <br />