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AGENCY CUSTOMER ID: <br />LOC#: <br />ADDITIONAL REMARKS SCHEDULE <br />Page 2 of 2 <br />AGENCY <br />NAMED INSURED <br />US[ INSURANCE SERVICES LLC/PHS <br />360 BC GROUP INC <br />1835 W ORANGEWOOD AVE STE 255 <br />POLICY NUMBER <br />SEE ACORD 25 <br />ORANGE CA 92868-2066 <br />CARRIER <br />NAIC CODE <br />SEE ACORD 25 <br />EFFECTIVE DATE: SEE ACORD 25 <br />THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM <br />FORM NUMBER: ACORD 25 FORM TITLE: CERTIFICATE OF LIABILITY INSURANCE <br />The City of Santa Ana, its officers, officials, employees, and volunteers, but only as required by a valid written contract, <br />agreement, or permit is an additional insured as provided by the Blanket Additional Insured By Contract, Form SS 00 08 and <br />the Hired Auto and Non Owned Auto Endorsement SSO438 attached to this policy. Notice of Cancellation will be provided in <br />accordance with Form SS1223, attached to this policy. Coverage is primary and noncontributory per the Business Liability <br />Coverage Form SS0008, attached to this policy. Waiver of Subrogation applies in favor of the Certificate Holder per the <br />Business Liability Coverage Form SS0008, attached to this policy. <br />Ren[wm 6 ANwwm Sr <br />I aax m.,,Ngc„m.umclaar <br />ACORD 101 (2014/01) ©2014 ACORD CORPORA <br />The ACORD name and logo are registered marks of ACORD <br />