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AGENCY CUSTOMER ID: <br />LOC#: <br />`°� "® ADDITIONAL REMARKS SCHEDULE <br />Page2 of 2 <br />AGENCY <br />NAMED INSURED <br />Willis of <br />New York, Inc. <br />Atkins North America, Inc. <br />2001 NW 107th Avenue <br />Miami, FL 33172-2507 <br />POLICYNUMBER <br />See First <br />Page <br />CARRIER <br />NAIC CODE <br />See First <br />Page <br />EFFECTIVE DATE: See First Page <br />muuI. iwrYNL naw.Amno <br />THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, <br />FORM NUMBER: 25 FORM TITLE: CERTIFICATE OF LIABILITY INSURANCE <br />Re: Combined Project Study Report/Project Report (PSR/PR), Environmental Document (ED) and PS&E <br />preparation for the SR-55/MacArthur Blvd. Interchange Ramp Widening Project, Project Number: <br />07-2503. <br />Coverage for Contractual Liability is provided under the Automobile Liability policy. <br />The General Liability policy includes a Severability of Interest Clause. <br />The City of Santa Ana its officers, agents, representatives volunteers and employees are <br />included as Additional Insureds as respects to General Liabiiity and Auto Liability. <br />General Liability and Auto Liability policies shall be Primarand Non -Contributory with any other <br />insurance in force for or which may be purchased by Additionaly Insureds. <br />Waiver of Subrogation applies in favor of Additional Insureds with respects to General Liability, <br />Auto Liability and Workers Compensation policies permitted by law. <br />Umbrella policy is Follow Form. <br />Coll:4373372 TP1:1788066 Cert:21333303 ©2008 ACORD CORPORATION. All riahfe reeervcd <br />The ACORD name and logo are registered marks of ACORD <br />