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AGENCY CUSTOMER ID: <br />LOC #: <br />oR0 ADDITIONAL REMARKS SCHEDULE Page of <br />AGENCY NAMED INSURED <br />GMGS Risk Management & Insurance Services Tait & Associates, Inc. <br />Tait Environmental Services, Inc. <br />POLICY NUMBER 701 Parkcenter Dr. <br />Santa Ana CA 92705 <br />CARRIER I NAIC CODE <br />EFFECTIVE DATE: <br />ADDITIONAL REMARKS <br />THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, <br />FORM NUMBER: 25 FORM TITLE: Certificate of Liability (03/16) <br />HOLDER: City of Santa Ana Risk Management Division <br />ADDRESS: 20 Civic Center Plaza Santa Ana CA 92702 <br />As respects Automobile Liability coverage, City of Santa Ana, officers, agents, employees, <br />and volunteers are added as Additional Insured as per CAT3530215 attached, and this <br />insurance is primary per CA00011013 attached. <br />As respects Automobile Liability coverage, 30-day written notice of cancellation (10 days <br />for non-payment of premium) applies per ILT0010107 attached. <br />As respects Workers' Compensation coverage, a Waiver of Subrogation is hereby included per <br />attached WC990376(00)-001. <br />As respects Workers' Compensation coverage, 30-day written notice of cancellation (10 days <br />for non-payment of premium) applies per WC040601(A) attached. <br />ACORD 101 (2008101) © 2008 ACORD <br />The ACORD name and logo are registered marks of ACORD <br />63540930 121-22 Auto/WC I Izabela Stachura 18/25/2021 9:11:48 AM (PDT) I Page 2 of 8 <br />�,y oRFN¢F R[skMwwgwnentDMslon <br />REVIEWED & APPROVED Or. <br />z <br />�1-� Risk Management Supervisor, <br />