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AGENCY CUSTOMER ID: _ LOC #: ADDITIONAL REMARKS SCHEDULE Page 2 of 2 AGENCY NAMEDINSURED Marsh, Inc. SimplexGdnnell, LP 1701 WEST SEQUOIA AVE POLICY NUMBER ORANGE, CA 92868 United States - CARRIER NAIC EFFECTIVE DATE: ADDITIONAL REMARKS THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, FORM NUMBER: 25 FORM TITLE: CERTIFICATE OF LIABILITY INSURANCE CARDING POLICIES OF INSURANCE: surer Policy Number(s) Effective Date(s) Expiration Date(s) WC 026149515 (TX) 10/1/2010 10/1/2011 WC 026149519 (AOS) 10/1/2010 10/1/2011 WC 026149548 (MN) 10/1/2010 10/1/2011 3ARDING NOTICE OF CANCELLATION TO CERTIFICATE HOLDERS: is endorsement modifies the notice of cancellation of insurance provided hereunder Should any of the above described policies be cancelled before the expiration date thereof, the producer will endeavor to mail 30 days written notice to the certificate holder named herein, but failure to do so shall impose no obligation or liability of any kind upon the producer, its agents or representatives. other terms and conditions of this policy remain unchanged. REGARDING ADDITIONAL INSURED STATUS: In accordance with the policy provisions, SANTA ANA POLICE DEPARTMENT is included as an additional insured under this policy, as a result of any contract or agreement entered into by the named insured and SANTA ANA POLICE DEPARTMENT. In accordance with the policy provisions, coverage afforded to an additional insured will apply as primary insurance where required by contract entered into by the named insured and the SANTA ANA POLICE DEPARTMENT. Any other insurance issued to such additional insured shall apply as excess and noncontributory insurance. Other Additional Insureds: The City of Santa Ana, 20 Civic Center Plaza, Santa Ana, California 92701; its officers, employees, agents, volunteers and representatives are named as additional insureds ( "additional Insureds ") with regard to libability and defense of suits arising from the operations and uses performed by or on behalf of the named insured. REGARDING WAIVER OF SUBROGATION: In accordance with the policy provisions, the Waiver of Subrogation applies per contract or agreement entered into by the named insured and SANTA ANA POLICE DEPARTMENT. /A%,U cU I vI tZUU01U I I (0 2008 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD Generated by EXIGIS LLC. For more information visit www.exigis.com.