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AGENCY CUSTOMER ID: <br />LOC 4: <br />A`C)RV® ADDITIONAL REMARKS SCHEDULE <br />Page of <br />AGENCY <br />Venbrook Insurance Services <br />NAMED INSURED <br />Cannon Corporation <br />1050 Southwood Drive <br />San Luis Obispo CA 93401 <br />POLICY NUMBER <br />CARRIER <br />NAIC CORE <br />EFFECTIVE GATE: <br />ADDITIONAL REMARKS <br />THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, <br />FORM NUMBER: 25 FORM TITLE: Certificate of Liability Insurance (03/16) <br />HOLDER: City of Santa Ana Risk Management Division Attontion: Danny Mai <br />ADDRESS: 20 Civic Center Plaza Santa Ana CA 92702 <br />RE: Construction Management and Inspection Services for the Bristol Street Improvements <br />Project (RFP No. 24-139)- Cannon # 241137 <br />City of Santa Ana, its officers, employees, agents and representatives are named as <br />Additional Insured under the General Liability, Automobile Liability and Professional/ <br />Pollution Liability policy if required by written contract with the Named Insured but only <br />for coverage and limits provided by the policy and the additional insured endorsement. <br />Primary and Non -Contributory coverage applies to General Liability and Automobile <br />Liability. Waiver of Subrogation applies to General Liability, Automobile Liability, <br />Professional/Pollution Liability and Workers Compensation. Excess/Umbrella follows form. <br />*10 Days Notice of Cancellation for Non -Payment of Premium, 30 bays All Other. <br />ACORD 101 (2008101) © 2008 ACORD CORPORATION. All rights reserved. <br />The ACORD name and logo are registered marks of ACORD ADDENDUM <br />843122B5 1 24-25 GL/AL/WC/DM/PL I Isabella Saldiv 1 3/11/2025 11:19:55 AM IPDTI I Page 2 of 16 <br />