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AGENCY CUSTOMER ID: <br />LOC# : <br />ADDITIONAL REMARKS SCHEDULE <br />22 <br />Pageof <br />AGENCYNAMED INSURED <br />BIZINSURE LLC/PHSHALL AQUATIC LIFE SUPPORT DESIGNS DBA HALL <br />POLICY NUMBER <br />AQUATIC DESIGN LLC <br />68!TCN!CM3633-!68!XFD!BD4N\[O!'!68!TCN!CM3633 <br />347 GRANT ST SE <br />SEE ACORD 25 <br />ATLANTAGA30312-2226 <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 />City of Santa Ana, Risk Management, it's officers, employees, agents, representatives, and volunteers are additional insured <br />per the Business Liability Coverage Form SS0008 attached to this policy. Notice of Cancellation will be provided in accordance <br />with Form SS1223, attached to this policy. Notice of Cancellation will be provided in accordance with Form WC990394, <br />attached to this policy. <br />ACORD 101 (2014/01)© 2014 ACORD CORPORATION. All rights reserved. <br />The ACORD name and logo are registered marks of ACORD <br /> <br />