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AGENCY CUSTOMER ID: <br />_ LOC #: <br />ACoRV ADDITIONAL REMARKS SCHEDULE Page 2 of 2 <br />AGENCY <br />NAMED INSURED <br />Willie (Beiauda) Ltd. <br />Taller San Joao <br />Santa Ana,. CA G 92]01 <br />POLICY NUMBER <br />Bee Page 1 <br />CARRIER <br />NAIL CODE <br />Sae Page I <br />Bee Page 1 <br />EPPECTIVEDATE: See Page 1 <br />VI I.V.LRcIYAmna <br />THIS ADDrrIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, <br />FORM NUMBER: 2s FORM TITLE: Certificate of Liability Insurance <br />City of Santa Me, officers, agents, employees, and volunteer* are included as Additional Inaureda as respect, to <br />General Liability. <br />general Liability policy shall be Pri'7 and Non-contributory with any other insurance in force for or which may be <br />purchased by Additional Insureds. <br />REVIEWED & APPROVED <br />By Risk MaN4grMeN1 DlvislON <br />JIJ <br />2020 <br />ANC4i�� A"(CEVEdo <br />ACORD 101 (2008101) ® 2008 ACORD CORPORATION. All rights reserved. <br />The ACORD name and logo are registered marks of ACORD <br />SA ID: 19550047 BATCH: 1693972 CERTt W36573TT3 <br />