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AGENCY CUSTOMER ID: <br />LOC: #: <br />® ADDITIONAL REMARKS SCHEDULE <br />%Y NAMED INSURED <br />Barrett Business Services, Inc. <br />t Underwriting Inc. 8100 NE Parkway, Suite 200 <br />/ All RAPIMP Vancouver WA 98662 <br />RWC 048101562 <br />CARRIER NAIC CODE <br />ACE American Insurance Company 22667 EFFECTIVE DATE: 12/19/14 <br />ADDITIONAL REMARKS <br />THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, <br />FORM NUMBER: 25 FORM TITLE: Certificate of Liability (01114) <br />CERTIFICATE HOLDER: City of Santa Ana <br />ADDRESS: 20 Civic Center Plaza ,Ross Annex Santa Ana CA 92701 <br />of <br />Intersection of Raitt & Adams, et al, City of Santa Ana—Project #'s 12-6761, 14-6814 & 14-6818. <br />Public Street Work—Traffic Signal Installation <br />ACORD 101 (2008/01) <br />c11988-2010 <br />The ACORD name and logo are registered marks of ACORD, <br />Ail Ai Me r... 'I <br />CALIFORNIA PROFESSION#L ENGINEERING, INC PROJECT NO 12-6761, 14-6814,14-6818 <br />REVIEWED BY Z, <br />11 ',t_ - EUNICE HEREDIA (PG 7 OF 7) <br />