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AGENCY CUSTOMER ID: <br />LOC#: <br />ADDITIONAL REMARKS SCHEDULE <br />Page 2 of ­_2 <br />AGENCY <br />NAMED INSURED <br />AUTOMATIC DATA PROCESSING INS/PAC <br />QPE TECHNICAL INSTITUTE INCORPORATED <br />1557 N GEMINI PL <br />POLICY NUMBER <br />SEE ACORD ")J; <br />ANAHEIM CA 92801-1153 <br />CARRIER <br />NAIL CO E <br />SEE ACORD 25 <br />EFFECTIVE DATE' SEE ACORD 25 <br />THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM <br />FORM NUMBER: ACORD25 FORM TITLE: CERTIFICATE OF LIABILITY INSURANCE <br />The City of Santa Ana, and their affiliates, subsidiaries, owners, officers, directors, employees, members, volunteers, <br />shareholders, partners, managers, but only as required by a valid written contract, agreement, or permit is an additional insured <br />as provided by the Blanket Additional Insured By Contract, Form SS 00, 08 attached to the policy. Waiver of Subrogation applies <br />per the Business Liability Coverage Form SS0008 attached to this policy. Coverage is primary & non-contributory per the Ir 11 <br />Business Liability Coverage Form SS0008, attached to, this policy. Severability of Interest Insurance applies separately to each <br />interest against whom claim is made or suit is brought per the Business Liability Coverage Form SS0008 attached to this policy. <br />JcF RislMamagementDMsiun <br />REVIEWED & APPROVED BY.- <br />F04c"�" P, *vd ACORD 101 (2014101) 0 2014 ACORD CORPORVX <br />The ACORD name and logo are registered marks of ACORD I I Wsk Pjanagement Anaipt <br />