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AGENCY CUSTOMER ID: <br /> _ LOC : <br /> ACC>RLO ADDITIONAL REMARKS SCHEDULE Rage 2 Of 3 <br /> AGENCY NAMEDINSURED <br /> Willis Towers Watson Southeast, Inc. ABM Building Solutions, LLC <br /> an ABM Industries Incorporated Company <br /> POLICY NUMBER 4151 Ashfoxd Dunwoody Road, Suite 600 <br /> See Page 1 Atlanta, GA 30319 <br /> CARRIER NAIC CODE <br /> See Page 1 See Page 1 I EFFECTIVE DATE:See Page 1 <br /> ADDITIONAL REMARKS <br /> THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, <br /> FORM NUMBER' 25 FORM TITLE: Certificate of Liability Insurance <br /> Worksite Location: Various Facilities location in Santa Ana <br /> Description of Job: HVAC Services <br /> City of Santa Ana, its City Council, officers, officials, employees, agents, and volunteers are included as Additional <br /> Insureds as respects General Liability and Automobile Liability (Umbrella follows Form) as required by written contract <br /> with the Named insured. If required by the written contract or agreement with said Additional Insured, this insurance <br /> shall be primary insurance to any other insurance available to said insured covering the same loss. Such other <br /> insurance available to said Additional Insured shall be excess to and non-contributing to this insurance. Waiver of <br /> subrogation applies in favor of Additional Insured as respects General Liability, Automobile Liability and Workers <br /> Compensation, where allowed by law, (Umbrella follows form) as required by written contract with the Named Insured. <br /> Umbrella/Excess policy applies excess of General Liability, Auto Liability and Employers Liability Policies. <br /> INSURER AFFORDING COVERAGE: Federal Insurance Company NAIC#: 20281 <br /> POLICY NUMBER: J06105798 EFF DATE: 11/01/2024 EXP DATE: 11/01/2025 <br /> TYPE OF INSURANCE: LIMIT DESCRIPTION: LIMIT AMOUNT: <br /> Crime/Employee Dishonesty/ Each Occurrence $510001000 <br /> Fidelity <br /> INSURER AFFORDING COVERAGE: ACE American Insurance Company NAIC#: 22667 <br /> POLICY NUMBER: WCU C72624762 EFF DATE: 11/01/2024 EXP DATE: 11/01/2025 <br /> TYPE OF INSURANCE: LIMIT DESCRIPTION: LIMIT AMOUNT; <br /> Excess Workers Compensation EL Each Accident $1,000,000 <br /> WC-Statutory/CA-$1M: SIR EL Disease-Pol Limit $1,000,000 <br /> OH, WA, OR, IL, MI - $500K SIR EL Disease-Each Empl $1,000,000 <br /> ADDITIONAL REMARKS: <br /> ANY PROPRIETOR/PARTNER/EXECUTIVE/ OFFICER/MEMBER are included under Excess Workers Compensation policy #WCU C72624762 <br /> APPROVED <br /> By Cynthia Mora at 941 am, Novi 14 -2024 <br /> ACORD 101 (2008101) ©2008 ACORD CORPORATION. All rights reserved. <br /> The ACORD name and logo are registered marks of ACORD <br /> SR ID: 26730402 HATCB: 3693326 CERT. W36171869 <br />