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ACORD 101 (2014/01)© 2014 ACORD CORPORATION. All rights reserved. <br />The ACORD name and logo are registered marks of ACORD <br />AGENCY CUSTOMER ID: <br />LOC# : <br />ADDITIONAL REMARKS SCHEDULE Page 2 of 2 <br />AGENCY <br />THE DOCTORS COMPANY INS SVCS LLC <br />NAMED INSURED <br />SIMPLETHERAPY INC. ; HALCYON BEHAVIORAL, LLC <br />1080 W SHAW AVE STE 101 <br />FRESNO CA 93711-3722 <br />POLICY NUMBER <br />SEE ACORD 25 <br />CARRIER <br />SEE ACORD 25 <br />NAIC CODE <br />EFFECTIVE DATE:SEE ACORD 25 <br />ADDITIONAL REMARKS <br />THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM <br />FORM NUMBER:ACORD 25 FORM TITLE:CERTIFICATE OF LIABILITY INSURANCE <br />Waiver of Subrogation applies in favor of the City of Santa Ana per the Business Liability Coverage Form SL 00 00, attached to <br />this policy. Coverage is primary and noncontributory per the Business Liability Coverage Form SL 00 00, attached to this policy. <br />City of Santa Ana is included as Blanket Additional Insured By Contract Endorsement, Form SL 30 32. The Umbrella Liability <br />Supplemental Policy includes Blanket Additional Insured by Contract - Umbrella Endorsement SU 00 02.