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AGENCY CUSTOMER ID: HUITTZOL LOC #: AI ® ADDITIONAL REMARKS SCHEDULE Page 1 of 1 AGENCY MHBT, a Marsh & McLennan Agency, LLC company NAMED INSURED Huitt-Z011ars, Inc. 1717 McKinney Ave., Ste. 1400 Dallas TX 75202-1236 POLICY NUMBER CARRIER NAIC CODE EFFECTIVE DATE: ADDITIONAL REMARKS THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, FORM NUMBER: 25 FORM TITLE: CERTIFICATE OF LIABILITY INSURANCE Waiver of subrogation form #WC000313 edition 04/84 and #WC04 edition 03/05 and #WC420304B applies to the Workers Compensation policy. Notice of Cancellation form #I1-10307 edition 06/11 applies to the General Liability policy. Notice of Cancellation form #WC99 edition 03/94 and WC990531 applies to the Workers Compensation policy. Notice of Cancellation form #IH0307 edition 06/11 applies to the Umbrella Liability policy. Notice of Cancellation form IH0307 edition 06/11 applies to the Auto Liability policy. The General Liability policy contains language that provides additional insured status to the certificate holder only when there is a written contract between the named insured and the certificate holder that requires such status. The General Liability policy contains an endorsement with "Primary and Noncontributory" wording that may apply only when there is a written contract between the named insured and the certificate holder that requires such wording. The General Liability policy contains a blanket waiver of subrogation endorsement that may apply only when there is a written contract between the named insured and the certificate holder that requires such wording. The Automobile Liability policy contains language that provides additional insured status to the certificate holder only when there is a written contract between the named insured and the certificate holder that requires such status. The Automobile liability policy includes waiver of subrogation wording that may apply only when there is a written contract between the named insured and the certificate holder that requires such wording. The Auto Liability policy contains an endorsement with "Primary and Noncontributory" wording that may apply only when there is a written contract between the named insured and the certificate holder that requires such wording. The Worker's Compensation policy includes a waiver of subrogation endorsement that may apply only when there is a written contract between the named insured and the certificate holder that requires such wording. The General Liability, Auto. Worker's Compensation and Umbrella liability policies includes a blanket notice of cancellation to the certificate holder endorsement, providing for (30) days' advance written notice if the policy is canceled by the company, or 10 days' written notice before the policy is canceled for nonpayment of premium. Notice Is sent to certificate holders with mailing addresses on rile with the agent or the company. The endorsement does not provide for notice of cancellation to the certificate holder if the named insured requests cancellation. Re: Project 17-6883 Project No. Thorton Park Lot#2 Topography Project No.17-6801 Civic Center Traffic Circles No. 17-009 Certificate holder includes: City of Santa Ana ACORD 101 (2008101) © 2008 ACORD CORPORATION. All rights reserved The ACORD name and logo are registered marks of ACORD