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ACORO® <br />L� <br />AGENCY CUSTOMER ID: 06510 <br />LOC A: Los Angeles <br />ADDITIONAL REMARKS SCHEDULE <br />Page 3 of 5 <br />AGENCY <br />NAMED INSURED <br />Mash Risk &Insurance Services <br />AECOM Technical Service, Inc. <br />Qk.a DMJM Harris) <br />999 Town and Country <br />POLICY NUMBER <br />Orange, CA 92868 <br />CARRIER <br />NAIC CODE <br />EFFECTIVE DATE: <br />THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, <br />FORM NUMBER: 25 FORM TITLE: Certificate of Liability Insurance <br />Waiver of Transfer Of Rights 01 Recovery Against Others To US <br />POLICY NUMBER BAP696589304 ER. DateolPol -Esp Daeh Pot Far Date of End Agency No AVJdI. Prem Return Poem <br />4/1/13 411/12 <br />This endorsement is issued by the company, named in the Declarations. II changes the policy on the effeclive dale listed above at the hour staled in the Declarations. <br />THIS ENDORSEMENT CHANGES THE POLICY, PLEASE READ IT CAREFULLY. <br />Namedimmed <br />AECOM Technical Service, Inc IT a. DMJM Harris) <br />This i n leemovenl modifiesinsurance prov✓Jed under. <br />BUSINESS AUTO COVERAGE FORM <br />MOTOR CARRIERS COVERAGE FORM <br />TRUCKERS COVERAGE FORM <br />GARAGE COVERAGE FORM <br />SCHEDULE <br />Name of Person or Organizafion <br />The Cry of Santa Ana <br />Public Works Design Engineering <br />20 Civic Center Plaza <br />Santa Ana, CA 92701 <br />CONTRACT N0. A-2008-216, ON CALL CONTRACT FOR ENGINEERING AND LANDSCAPING DESIGN SERVICES IAECOM CONTRACT NO 60100644t <br />THE CITY OF SANTA ANA, CA, ITS OFFICERS, EMPLOYEES <br />411/12- <br />We waive any right of recovery we may have against the designated person or organization shown in the schedule because of payments we make fer injury or damage caused by ar'accidenr or'loss' resulting hem the <br />ownership maintenance, or use of a covered'autC for which a Waiver of Subogation is required in conjunction with work performed by you for the designated person or mgmIzation. The waiver applies only b be <br />designated person or organization shown in the schedule. <br />U-CA-320-BCW 14(94) Page 1 of 1 <br />101(2008/01) <br />The ACORD name and logo are registered marks of ACORD <br />All riahts <br />