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AGENCY CUSTOMER ID: <br />LOC #: <br />ADDITIONAL REMARKS SCHEDULE <br />AGENCY <br />Willis Towers Watson Northeast, Inc. <br />POLICY NUMBER <br />See Page 1 <br />CARRIER <br />See Page 1 <br />NAMED INSURED <br />Pitney Howes Inc. <br />3001 Summer Street <br />Stamford, CT 06926 <br />NAIC CODE <br />See Page 1 I EFFECTIVE DATE; Be. Pave 1 <br />Page 2 Of 2 <br />THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, <br />FORM NUMBER: 25 FORM TITLE: Certificate of Liability Insurance <br />The City of Santa Ana, its officers, officials, employees, and volunteers are included as Additional Insureds as <br />respects to General Liability where required by written contract. <br />General Liability policy shall be Primary and Non-contributory with any other insurance in force for or which may be <br />purchased by Additional Insureds where required by written contract. <br />INSURER AFFORDING COVERAGE: ACE Fire Underwriters Insurance Company <br />POLICY NUMBER: SCF C6781471A EFF DATE: 07/01/2021 EXP DATE: 07/01/2022 <br />TYPE OF INSURANCE: LIMIT DESCRIPTION: LIMIT AMOUNT: <br />Workers Compensation and E.L. Each Accident 02,000,000 <br />Employers' Liability E.L. Disease -Ea Emp. $2,000,000 <br />Per Statute E.L. Disease Policy $2,000,000 <br />INSURER AFFORDING COVERAGE: National Fire & Marine Insurance Company <br />POLICY NUMBER: 42-XSF-316064-01 EFF DATE: 07/01/2021 EXP DATE: 07/01/2022 <br />TYPE OF INSURANCE: LIMIT DESCRIPTION: LIMIT AMOUNT: <br />Excess Business Auto Limit: 01M xs $2M <br />NAIC#: 20702 <br />NAIC#: 20079 <br />© 2008 ACORD <br />The ACORD name and logo are registered marks of ACORD <br />SR ID: 21927888 BATCH: 2336113 CERT: W23052463 <br />pp REMEWED &pPROVED BY: <br />W(MONIgeMentAnalyst <br />