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AGENCY CUSTOMER ID: <br />LOC #: <br />L R ADDITIONAL REMARKS SCHEDULE <br />Pace of <br />AGENCY <br />NAMEDINSURED <br />Grayling Insurance Brokerage <br />Wiss, Janney, Elstner Associates, Inc <br />Alin <br />Alin: Sam Barbera <br />Pfingsten Rd. <br />POLICY NUMBER <br />Northbrook IL 60062 <br />CARRIER <br />NAIC cone <br />EFFECTIVE DATE: <br />A nnlTlnr.l Al e <br />THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, <br />FORM NUMBER: 25 FORM TITLE: Certificate of Liability (03/16) <br />HOLDER: City of Santa Ana Risk Management Division <br />ADDRESS: 20 Civic Center Plaza Santa Ana CA 92701 <br />Subject to the terms, conditions, limitations and exclusions of the policies evidenced <br />herein: The above are included as Additional Insureds when required by written contract <br />with the Named Insured under the general liability including ongoing operations and <br />products/completed operations and auto liability, but only with respect to services <br />provided by the Named Insured_, regarding the referenced project. <br />When agreed in written contract, coverage is provided on a primary and non-contributory <br />basis, subject to the terms and conditions of the policies. <br />REVIEWED & APPROVED <br />By Risk MANAGEMENT DIViS(ON <br />ACORD 101 (2008/01) 02008 ACORD CORPORATION. All rights reserved. <br />•:,o ,a„m a,m wgu are registers marKs Or ACURD ADDENDUM <br />55416223 120"1 G4 AV WC I Sam Barbara 15/11/2020 1:05:55 PM I©TI I F.9B 2 of 9 <br />