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AGENCY CUSTOMER ID: <br />LOC #: <br />ADDITIONAL. REMARKS SCHEDULE <br />Page 1 of 1 <br />AGENCY ^�— <br />Arthur J. Gallagher Risk Management Services, Inc. <br />NAMEDINSURED <br />Greyhound Lines, Inc. <br />350 N. St. Paul Street <br />Dallas, TX 75201 <br />POLICY NUMBER <br />CARRIER <br />NAIC CODE <br />EFFECTIVE DATE: <br />ADDITIONAL REMARKS <br />THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, <br />FORM NUMBER: 25 FORM TITLE: CERTIFICATE OF LIABILITY INSURANCE <br />Re, Leased location - The Depot at Santa Ana; 1000 East Santa Ana Boulevard, Santa Ana CA. <br />City of Santa Ana, Its agents, officers, employees and volunteers are Included as Additional Insured as <br />respects General Llability(blanket endorsement-GL#83644) Policy as evidenced herein on a <br />primary/non-contributory basis as required by written contract with respect to Lease Agreement for the <br />above location mentioned, A waiver of subrogation included under the Workers' Compensation <br />Policy(blanket end't) as required by written contract with respect to Lease Agreement. <br />Notice of cancellation 30 days written notice/10 days for non -pay <br />l <br />Age rir <br />ACORD 101 (2008/01) © 2008 ACORD CORPORA iON(,AII dill <br />res rved. <br />The ACORD name and logo are registered marks of ACORD <br />