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AGENCY CUSTOMER ID: LOC#: ACCOR"® ADDITIONAL REMARKS SCHEDULE Page 2 of 2 AGENCY NAMED INSURED Willis Towers Watson Insurance Services West, Inc. Bernards Bros, Inc. 555 First Street POLICY NUMBER San Fernando, CA 91340 See Page 1 CARRIER NAIC CODE See Page 1 See Page 1 EFFECTIVE DATE: See Page 1 ADDITIONAL REMARKS THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, FORM NUMBER: 25 FORM TITLE: Certificate of Liability Insurance the named insured. As respects to General Liability, Waiver of Subrogation applies when required by written contract. As respects to General Liability, coverage is Primary and Non-contributory for additional insured(s) when required by written contract or agreement. The Excess Liability policy Follows Form. As respects to Workers Compensation, a Waiver of Subrogation is provided in favor of the Certificate Holder when required by written contract and as permitted by law. Contractor's Pollution/Professional Liability continued: $10,000,000 Each Claim - SubGap Indemnity Self Insured Retention: $100,000 Per Claim Retroactive Dates: 10/1/2008 Professional Liability Additional Insureds/Primary and Non-contributory/Waiver of Subrogation: City of Santa Ana, its City Council, officers, officials, employees, agents, and volunteers. If required by written contract, the Auto Liability policy includes an Additional Insured endorsement and Waiver of Subrogation endorsement in favor of Certificate Holder. Waiver of Subrogation for Workers Compensation: City for all work performed by Consultant, its employees, agents and sub-contractors. Waiver of Subrogation applies in favor of Additional Insureds with respects to Professional Liability. ACORD 101 (2008/01) ©2008 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD SR ID: 28461569 BATCH: 4124893 CERT: W40306383