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AGENCY CUSTOMER ID:Z&KCONS-01 GLADYSCARRILLO <br /> LOC#: 1 <br /> A��� ADDITIONAL REMARKS SCHEDULE Page 1 of 1 <br /> AGENCY NAMED INSURED <br /> NFP Property&Casualty Services Inc. 2 2 K Consultants,Inc. <br /> p y y � 22295 Jessamine Way <br /> POLICY NUMBER Corona,CA 92883 <br /> EE PAGE 1 <br /> CARRIER NAIC CODE <br /> EE PAGE 1 SEEP 1 I EFFECTIVE DATE:SEE PAGE 1 <br /> ADDITIONAL REMARKS <br /> THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, <br /> FORM NUMBER: ACORD 25 FORM TITLE: Certlflcate of Liability Insurance <br /> Description of Operations/LocationsNehicies: <br /> additional insured, so long as a written contract or agreement to such exists prior to a loss, per endorsements CG D3 79 0219 <br /> and/or CG D3 8109 15 attached.A Waiver of subrogation in favor of the certificate holder applies as respects to General Liability <br /> coverage, per endorsement CG D3 8109 15 attached. General liability per-project aggregate applies per endorsement CG D4 02 06 19 <br /> attached. <br /> Umbrella/Excess Liability underlying policies include General Liability, Employers Liability, Professional Liability&Automobile <br /> Liability per schedules EU 00 03 08 18& PL0014US 12.20 attached. <br /> Certificate Holder is named as Additional Insured as respects to Automobile Liability so long as a written contract or agreement to <br /> such exists with the named insured prior to a loss, per endorsement CA T4 20 0215 attached.A Waiver of subrogation in favor of the <br /> certificate holder applies as respects to Automobile Liability coverage,per endorsement CA T4 20 02 15 attached. <br /> A Waiver of subrogation in favor of the certificate holder applies as respects to Workers Compensation coverage, per endorsement <br /> WC990376 A001 attached. <br /> Re: Department Name: Staff Responsible I Department Address: M XX, Santa Ana, CA 92701 <br /> City of Santa Ana, its City Council,officers, officials,employees, agents,and volunteers are named Additional insureds as respects <br /> to Automobile Liability so long as a written contract or agreement to such exists with the named insured prior to a loss.A Waiver of <br /> subrogation in favor of the additional insureds applies as respects to Automobile Liability and Workers compensation coverage so <br /> long as written contract or agreement exists as per attached endorsements CA T4 20 02 15 and WC 99 03 76(A)-001. <br /> ACORD 101 (2008101) ©2008 ACORD CORPORATION. All rights reserved. <br /> The ACORD name and logo are registered marks of ACORD <br />