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AT'KINYSOR"TH AMERICA A-2010-005 REVIEWED BY°AGENCY CUSTOMER ID: -3 3004588 <br />EUNICE HEREDIA (PG 2 OF 13) <br />LOC#; <br />AC"JZa <br />llk.� ADDITIONAL REMARKS SCHEDULE Page-2- of -2— <br />AGENCY <br />NAMED INSURED <br />Atkins North America, Inc. <br />Willis of New York, Inc. <br />2001 NW 107th Avenue <br />Miami, FL 33172-2507 <br />POLICYNUMBER <br />See First Page <br />CARRIER J <br />NAIC CODE <br />,See First Page <br />I EFFECTIVEDATE: See First Page <br />Is ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, I <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 />reparation for the SR -55 /MacArthur Blvd. Interchange Ramp Widening Project, Project Number: <br />7-2503. <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 Kneral Liability and Auto Liability. <br />General Liability and Auto Liability policies shall be Primary and Non-Contributory with any other <br />insurance in force for or which may be purchased by Additional 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 />ACORD 101 (2008/01) Coll:4656054 Tpl:1935517 Cert:23001119 @ 2008 ACORD CORPORATION. All rights reserved. <br />The ACORD name and logo are registered marks of ACORD <br />