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AGENCY CUSTOMER ID: <br />LOC#: <br />4cAo ADDITIONAL REMARKS SCHEDULE <br />Page 2 of 2 <br />AGENCY <br />NAMED INSURED <br />BALDWIN KRYSTYN SHERMAN PARTNERS <br />CEO LEADERSHIP ALLIANCE ORANGE, INC. <br />668 N COAST HWY APT 319 <br />POLICY NUMBER <br />SEE ACORD 25 <br />LAGUNA BEACH CA 92651-1513 <br />CARRIER <br />NAIC CODE <br />SEE ACORD 25 <br />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 />City of Santa Ana, its officers, officials, employees, and volunteers are an additional insured per the Business Liability Coverage <br />Form SS0008, attached to this policy and SAML policy(ies) with respect to liability arising out of work or operations performed <br />by or on behalf of the Speaker/Performer including materials, parts, or equipment furnished in connection with such work or <br />operations. <br />ACORD 101 (2014/01) © 2014 ACORD CORPOI <br />The ACORD name and logo are registered marks of ACORD <br />o <br />liialeM�agrnteMDrvislon <br />REVIE &APPROVED BY: <br />'� <br />Risk Management Speezlht <br />