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AGENCY CUSTOMER ID: <br />LOC #: <br />ADDITIONAL REMARKS SCHEDULE <br />Page 2 of 2 <br />AGENCY <br />NAMEDINSURED <br />Willie Towera Watson Northeast, Inc. <br />Pitney Bowes Inc. <br />3001 Summer Street <br />Stamford, CT 06926 <br />POLICY NUMBER <br />See Page 1 <br />CARRIER <br />NAIC CODE <br />Be. Page 1 <br />Sea 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 />Agreement: A-2022-032; First Amendment to the Master Services Agreement. <br />The City of Santa Ana, its officers, officials, employees, and volunteers are included as Additional Insureds as <br />respects to General Liability, Auto Liability where required by written contract and Umbrella/Excess Liability. <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 />Waiver of Subrogation applies in favor of Additional Insureds with respects to General Liability, Auto Liability and <br />Workers Compensation where required by written contract and as permitted by law. <br />Waiver of Subrogation applies in favor of Additional Insureds with respects to Umbrella/Excess Liability. <br />INSURER AFFORDING COVERAGE: ACE Fire Underwriters Insurance Company NAIC#: 20702 <br />POLICY NUMBER: SCF C70319615 EFF DATE: 07/01/2023 EXP DATE: 07/01/2024 <br />SUBROGATION WAIVED: Y <br />TYPE OF INSURANCE: LIMIT DESCRIPTION: LIMIT AMOUNT: <br />Workers Compensation and E.L. Each Accident $2,000,000 <br />Employers' Liability E.L. Disease - EA Emp $2,000,000 <br />Per Statute E.L. Disease-Pol LMT $2,000,000 <br />INSURER AFFORDING COVERAGE: Indemnity Insurance Company of North America NAIC#: 43575 <br />POLICY NUMBER: SCF C70305343 EFF DATE: 07/01/2023 EXP DATE: 07/01/2024 <br />SUBROGATION WAIVED: Y <br />TYPE OF INSURANCE: LIMIT DESCRIPTION: LIMIT AMOUNT: <br />Workers Compensation and E.L. Each Accident $2,000,000 <br />Employers' Liability E.L. Disease - EA Emp $2,000,000 <br />Per Statute E.L. Disease-Pol LMT $2,000,000 <br />ACORD 101 <br />© 2008 ACORD CORPORATION. All rights reserved. <br />The ACORD name and logo are registered marks of ACORD <br />SR ID: 24822087 BATCH: 3171.483 CERT: W30643210 <br />