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AGENCY CUSTOMER ID: <br />LOC #: <br />ADDITIONAL REMARKS SCHEDULE <br />Page 2 Of 2 <br />AGENCY <br />Willis (Bermuda) Ltd. <br />NAMED INSURED <br />Taller San Jose <br />901 N. 13oed.ay <br />Santa Ana, CA 92701 <br />POLICY NUMBER <br />See Page I <br />CARRIER <br />NAIL CODE <br />See Page I <br />See Page 11 <br />EFFECTIVE DATE: See Page I <br />F-11M NJ I I Lejor-1 IN ".4 :1 .4A.1 <br />THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, <br />FORM NUMBER: 25 FORM TITLE: Certificate of Liability Insurance <br />City of Santa Ana, officers, agents, employees, and volunteers are included as Additional Insureds as respects to <br />General Liability. <br />General Liability policy shall be Primary and Non-contributory with any other insurance in force for or which may be <br />purchased by Additional Insureds, <br />ACORD 101 (2008101) @ 2008 ACORD CO <br />The ACORD name and logo are registered marks of ACORD <br />SR ID: 19650047 BATCH: 1693972 CERT: W16573773 <br />" 9""" Risk MwaganerdDMsiun REVIEWED & APPROVEDBY: <br />ARM= Risk Management Analyst <br />