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AGENCY CUSTOMER ID: <br />LOC# : <br />ADDITIONAL REMARKS SCHEDULE <br />22 <br />Pageof <br />AGENCYNAMED INSURED <br />USI INSURANCE SERVICES LLC/PHS360 BC GROUP INC <br />POLICY NUMBER <br />1835 W ORANGEWOOD AVE STE 255 <br />ORANGE CA 92868-2066 <br />SEE ACORD 25 <br />CARRIERNAIC CODE <br />SEE ACORD 25 <br />EFFECTIVE DATE:SEE ACORD 25 <br />ADDITIONAL REMARKS <br />THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM <br />ACORD 25CERTIFICATE OF LIABILITY INSURANCE <br />FORM NUMBER:FORM TITLE: <br />The City of Santa Ana, its officers, officials, employees, and volunteers, but only as required by a valid written contract, <br />agreement, or permit is an additional insured as provided by the Blanket Additional Insured By Contract, Form SS 00 08 and <br />the Hired Auto and Non Owned Auto Endorsement SS0438 attached to this policy. Notice of Cancellation will be provided in <br />accordance with Form SS1223, attached to this policy. Coverage is primary and noncontributory per the Business Liability <br />Coverage Form SS0008, attached to this policy. Waiver of Subrogation applies in favor of the Certificate Holder per the <br />Business Liability Coverage Form SS0008, attached to this policy. <br />ACORD 101 (2014/01)© 2014 ACORD CORPORATION. All rights reserved. <br /> <br />The ACORD name and logo are registered marks of ACORD <br /> <br />