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AGENCY CUSTOMER ID: <br /> LOC#: <br /> Y'� ne• <br /> - ADDITIONAL REMARKS SCHEDULE Page 2 of 2 <br /> AGENCY NAMED INSURED <br /> BIZINSURE LLC/PHS HALL AQUATIC LIFE SUPPORT DESIGNS DBA HALL <br /> POLICY NUMBER AQUATIC DESIGN LLC <br /> SEE ACORD 25 26 ROLLINGBROOK VISTA <br /> CARRIER NAIC CODE NEWNAN GA 30265 <br /> SEE ACORD 25 EFFECTIVE DATE:SEE ACORD 25 <br /> ADDITIONAL REMARKS <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, it's officers, employees, agents and representatives are named as additional insured per the Business <br /> Liability Coverage Part includes a Blanket Additional Insured By Contract Endorsement, Form SL 30 32. Notice of Cancellation <br /> will be provided in accordance with Form SL 90 13, attached to this policy. Notice of Cancellation will be provided in accordance <br /> with Form WC990394, attached to this policy. Waiver of Subrogation applies in favor of the Certificate Holder per Waiver of our <br /> Right to Recover from Others Endorsement WC040306 attached to this policy. <br /> ACORD 101 (2014/01) ©2014 ACORD CORPORATION.All rights reserved. <br /> The ACORD name and logo are registered marks of ACORD <br />