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AGENCY CUSTOMER ID: IMAGE <br />LOC X: <br />ACO ADDITIONAL REMARKS SCHEDULE Page of <br />AGENCY <br />NAMED INSURED <br />Kimbrell Insurance Agency <br />Images Dance Company, Inc <br />dba: ImagQes Dance Place <br />2017 N Nlaln St <br />Santa Ana CA 92706 <br />POLICY NUMBER <br />CP2574432 <br />CARRIER NAIC CODE <br />Mt. Vernon Fire Insurance Company <br />EFFECTIVE DATE: 6/20/2012 <br />THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, <br />FORM NUMBER: 25 FORM TITLE: Certificate of Liability (01/09) <br />CERTIFICATE HOLDER: City of Santa Ana, its officers, agents, employees and volunteers. <br />ADDRESS: 20 Civic Center Santa Ana CA 92701 <br />City of Santa Ana, its officers, agents, employees and volunteers are named additional <br />insured per attached endorsement. Insurance is primary and non-contributory as stated in <br />attached policy pages. <br />© 2008 ACORD CORPORATION. All rights reserved. <br />The ACORD name and logo are registered marks of ACORD ADDENDUM <br />CERT NO.: 13846970 CLIENT CODE: IMAGE -- Wa111y 0/13/2012 1:19:30 PM Pa 3 0£ 5 <br />