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AGENCY CUSTOMER ID: <br />LOC #: <br />A� ADDITIONAL REMARKS SCHEDULE <br />Page 2 Of 2 <br />AGENCY <br />NAMED INSURED <br />Willis Toxera Watson Northeast, Inc. <br />Elecnor Belco Electric, Inc. <br />14320 Albers Way <br />Chino, CA 91710 <br />POLICY NUMBER <br />See Page 1 <br />CARRIER <br />NAIC CODE <br />See Page 1 <br />Bee Page 1 <br />EFFECTIVE DATE: See Page 1 <br />THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, <br />FORM NUMBER: 25 FORM TITLE: Certificate of Liability Insurance <br />Waiver of Subrogation applies in favor of Additional Insured with respects to General Liability, Auto Liability and <br />Workers Compensation, as permitted by law. <br />Excess P0licy(ies) is excess over the General Liability, Automobile and Employers Liability. <br />PROJECT NO.: 18-6918 <br />Main Street at 15th Street New Traffic Signal Installation. <br />Federal Project No. HSIPL 5063(189) <br />Additional Insureds: City of Santa Ana, its officers, employees, agents and representatives <br />INSURER AFFORDING COVERAGE: Indian Harbor Insurance Company <br />POLICY NUMBER: CE0744635504 EFF DATE: 11/01/2021 EXP DATE: 11/01/2022 <br />TYPE OF INSURANCE: <br />Professional Liability <br />ACORD 101 (2008/01) <br />LIMIT DESCRIPTION: <br />Per Claim <br />Aggregate <br />SIR Per Claim <br />LIMIT AMOUNT: <br />$1,000,000 <br />$2,000,000 <br />$250,000 <br />n <br />The ACORD name and logo are registered marks of ACORD <br />SR ID: 22343213 HATCH: 2450760 CERT: W24171498 <br />NAIC4: 36940 <br />Rtvie&En6MrRovDDBr <br />Risk Management Supervise <br />