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AGENCY CUSTOMER ID: <br />LOC#: <br />A ADDITIONAL REMARKS SCHEDULE <br />Page -2 -of _.2 <br />AGENCY <br />NAMED INSURED <br />Willis Insurance Services of Georgia, Inc. <br />Commonwealth Land Title Company <br />Attn: Risk Mgmt Dept <br />601 Riverside Ave, Bldg 5 <br />Jacksonville, FL 32204 <br />POLICY NUMBER <br />See First Page <br />CARRIER <br />NAIC CODE <br />See First Page <br />Carrier & Policy Number <br />EFFECTIVE DATE; See First Page <br />AUUI 1 IUNAL KCMAKKS <br />THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, <br />FORM NUMBER: 25 FORM TITLE: CERTIFICATE <br />OF LIABILITY <br />INSURANCE <br />Property $200,000,000 Limit Quota Share <br />Carrier & Policy Number <br />Participation <br />Percentage <br />Allianz #CLP3017110 <br />20% of <br />200M <br />Liberty Mutual Fire #MJ2L9L448030026 <br />10% of <br />1200M <br />200M <br />Zurich American #PPR489174107 <br />20% of <br />Ace American Ins #CXD37839000006 <br />30% of$200M <br />Westport #NAP045198905 <br />20% of <br />200M <br />Special including Wind/Earthquake/Flood <br />Valuation - Property Damage Replacement Cost <br />The City of Santa Ana, 20 Civic Center Plaza, Santa Ana, California 92701; its officers, employees,' <br />aVents, volunteers and representatives are named as additional insureds ("additional insuredsll <br />with regard to liability and defense of suits arising from the operations and uses performed by or <br />on behalf of the named insured. <br />The General Liability coverage is written on a Primary and Non -Contributory basis with the <br />Separation of Insureds form. <br />ACORD101 (2008101) Coll:4991102 Tp1:2101013 Cert:24881255©2008ACORD CORPORATION. All rights reserved. <br />The ACORD name and logo are registered marks of ACOR <br />REVIEWED 1d"Vd D BY E U SIC E HERE DIA (d) 01 ) <br />