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AGENCY CUSTOMER ID: MARKT-1 <br />LOC #: <br />ADDITIONAL REMARKS SCHEDULE Page of <br />AGENCY <br />Asero Insurance Services <br />NAMED INSURED <br />Mark Thomas & Company Inc. <br />2290 North First Street, Suite 304 <br />San Jose CA 95131 <br />POLICY NUMBER <br />CARRIER JRAIC <br />CODE <br />EFFECTIVE DATE: <br />AUDI I IUINAL KtIV1AKMb <br />THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, <br />FORM NUMBER: 25 FORM TITLE: Certificate of Liability (03/16) <br />HOLDER: City of Santa Ana <br />ADDRESS: 20 Civic Center Plaza Santa Ana CA 92702 <br />General Liability Waiver of Subrogation / Primary & Non -Contributory <br />as required by written contract per form CG D3 81 09 07 <br />Commercial Auto Liability Additional Insured / Waiver of Subrogation as required by <br />written contract per form CA T3 53 02 15 <br />Workers' Compensation Waiver of Subrogation as required by written contract per form WC 99 <br />03 76 (A)-001 <br />General Liability Additional Insured per form CG 20 10 10 01 <br />REVIEW EI BY V E UNICE HEREDIA (PG OF C <br />ACORD 101 (2008/01) Q 2008 ACORD CORPORATION. All rights reserved. <br />The ACORD name and logo are registered marks of ACORD ATTACHMENT <br />377;P296 1 HARRT-1 117/18 Meat C-Tt1.`.ioat8 I S ephan,, S hellY 19/15/2017 10:21:21 AM (PDT) I Fagg 2 of 10 <br />