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AGENCY CUSTOMER ID: LM 2819 <br />LOC #: <br />ADDITIONAL REMARKS SCHEDULE <br />Page —of <br />AGENCY <br />Liberty Mutual Insurance Co. National Insurance West <br />NAMED INSURED <br />WEST COAST ARBORISTS, INC <br />2200 EAST VIA BURTON <br />ANAHEIM CA 92806 <br />POLICY NUMBER <br />CARRIER <br />NAIC CODS <br />EpPECTIVE DATE: <br />THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, <br />HOLDER: <br />Re: All jobs performed by the named insured during the policy term <br />City of Santa Ana, its officers, employees, agents, volunteers and representatives are <br />additional insureds with regards to general liability as their interest may appear where <br />required by written contract. <br />The insurance afforded by the GL policy for the benefit of the additional insured shall be <br />primary and non-contributory. <br />ACORD 101 (2008101) <br />The ACORD name and logo are registered marks of ACORD <br />-12480200 1 wa_281s 1 )/1B -1/1s - ./2/1, AL/z, WC/1, U/E I omnia 8mic41a I 6/12/2oae 12:05:13 PM (coa) I saa� 2 of 2 <br />ADDENDUM <br />reviewact WA 204(o <br />