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AGENCY CUSTOMER ID: TRAIAND-01 <br />LOC #: 1 <br />DOLDENBERG <br />ACORV' <br />ADDITIONAL REMARKS SCHEDULE <br />Page 1 of 1 <br />AGENCY <br />nauf Maxwell Insurance Services <br />Llcense # L100460 <br />NAM® INSURED <br />Foundation <br />T"E.- and Research Foundation <br />t442in and Ave., Ste 371 <br />POLICY NUMBER <br />Orange, CA 92865 <br />SEE PAGE 1 <br />CARRIER <br />WIC CODE <br />SEE PAGE 1 <br />SEE P 1 <br />EFFECTP1E DATE: SEE PAGE 1 <br />THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, <br />FORM NUMBER: ACORD 25 FORM TITLE: Cer incate or Liability Insurance <br />Description of Operations/LocationsNehicles: <br />$0 retention/deductible <br />"Occurrence Form <br />City of Santa Ana, its officers, officials, employees and volunteers are also included as as Additional Insured, including Primary & <br />Non -Contributory wording, and Waiver of Subrogation applies as respects General Liability coverge; only as perthe attached <br />endorsement(s), regarding the Facilities Use Agreement (The City is the owner of Corbin Center located at 2215 West McFadden <br />Avenue and EI Salvador Center located at 1825 West Civic Center Drive, both in the City of Santa Ana). 30 day notice of cancellation <br />applies. <br />$4MM Um brella goes over underlying General Liability, Improper Sexual Abuse & Molestation Liability, Social Service Professional <br />Liability, Workers Compensation and Commercial Autombile Liability Coverage (H/NO only). <br />101/2008/011 <br />01 <br />RIA Morgenod DMdon <br />ReneAED6 ArrRovm Br. <br />IIYDD Rkk Mana9ement<Imral Aitle <br />The ACORD name and logo are registered marks of ACORD <br />