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AGENCY CUSTOMER ID: <br />LOC #: <br />,a © oR ® 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 CODE <br />EFFECTIVE DATE: <br />THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, <br />FORM NUMBER: NM FORM TITLE: Certificate of Casualty Insurance (07/10) <br />HOLDER: City of Santa Ana Public Works Agency M85 <br />ADDRESS: 220 South Daisy Avenue Building -A Santa Ana CA 92703 <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 />2008 ACORD CORPORATION. All rights reserved_ <br />The ACORD name and logo are registered marks of ACORD <br />92980230 1 LM 21119 1 7/18-7/19 - ./2/1, AL/2, WC/1, U/5 I Do— Cmitala 1 6/12/2018 12:05:13 PM (CDT) I Page 2 of 2 <br />ADDENDUM <br />reviewad ` n3 '1 2C4 b <br />