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AGENCY CUSTOMER ID: <br />LOC #: <br />ADDITIONAL REMARKS SCHEDULE Page of <br />AGENCY NAMED INSURED <br />Venbrook Insurance Services Cannon Corporation <br />1050 Southwood Drive <br />POLICY NUMBER San Luis Obispo CA 93401 <br />CARRIER I NAIC CODE <br />EFFECTIVE DATE: <br />THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, <br />FORM NUMBER: 25 FORM TITLE: Certificate of Liability (03/16) <br />HOLDER: City of Santa Ana <br />ADDRESS: P.O. Box 1988 20 Civic Center Plaza Santa Ana CA 92702 <br />RE: City of Santa Ana - On -Call Construction Management and Inspection Services - 23-122- <br />Cannon # 230719 <br />The City, its officers, officials, employees, and volunteers are named as Additional <br />Insured under the General Liability and Automobile Liability policy if required by written <br />contract with the Named Insured but only for coverage and limits provided by the policy <br />and the additional insured endorsement. Primary and Non -Contributory coverage applies to <br />General Liability and Automobile Liability. Waiver of Subrogation applies to General <br />Liability, Automobile Liability and Workers Compensation. Excess/Umbrella follows form. <br />*10 Days Notice of Cancellation for Non -Payment of Premium, 30 Days All Other. <br />REVIEWED & APPROVED BY: <br />Aezv46 <br />®, <br />Risk Management Specialist <br />ACORD 101 (2008/01) ©2008 ACORD I <br />The ACORD name and logo are registered marks of ACORD ADDENDUM <br />814525BB 1 24-25 GL/AL/WC/UM/PL I Karen Smith 1 8/19/2024 1:32:46 PM (POT) I Page 2 of 13 <br />