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AIC V <br />11..� <br />AGENCY CUSTOMER ID: HUITTZOL _ <br />LOC #: <br />ADDITIONAL REMARKS SCHEDULE <br />Page 1 of 1 <br />AGENCY <br />MHBT,. a Marsh & McLennan Agency, LLC company <br />NAMED INSURED <br />Huitt-Zollars, Inc. <br />1717 McKinney Ave„ Ste. 1460 <br />Dallas TX 75202-1236 <br />POLICY NUMBER <br />CARRIER <br />NAIC CODE <br />EFFECTIVE GATE: <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 />Primary & Non -Contributory Auto Liability form #HA9916 edition 03/12. <br />Waiver of subrogation form #WC00 edition 03/13 and #WC04 edition 03/06 applies to the Workers Compensation policy. <br />Additional Insured form #XL0003 edition 06/05 applies to the Umbrella. policy. <br />Notice of Cancellation form #11-10307 edition 6/11 applies to the General Liability policy. <br />Notice of Cancellation form #WC99 edition 03/94 applies to the Workers Compensation policy. <br />Notice of Cancellation form #IH0307 edition 6/11.applies to the Umbrella Liability policy. <br />Notice of Cancellation form #IH0307 edition 06/11 applies to the Auto policy. <br />The General Liability policy contains language that provides additional Insured status to the certificate holder only when there is a written <br />contract between the named insured and the certificate holder that requires such status. <br />The General. Liability policy contains an endorsement with "Primary and Noncontributory" wording that may apply only when there is a written <br />contract between the named insured and the certificate holder that requires such wording. <br />The General liability policy contains a blanket waiver of subrogation endorsement that may apply only when there is a written contract <br />between the named Insured and the certificate holder that requires such wording, <br />The Automobile Liability policy contains language that provides additional Insured status to the certificate holder only when there is a written <br />contract between the named Insured and the certificate holder that requires such status, <br />The Automobile liability policy Includes waiver of subrogatlon wording that may apply only when there is a written contract between the named <br />insured and the certificate holder that requires such wording. <br />The Auto Liability policy contains an endorsement with "Primary and Non Contributory" wording that may apply only when there is a written <br />contract between the named Insured and the certificate holder that requires such wording. <br />The Worker's Compensation policy includes a waiver of subrogatlon endorsement that may apply only when there is a written contract <br />between the named insured and the certificate holder that requiressuch wording, <br />The Umbrella policy includes a blanket additional insured endorsement to the certificate holder only when there Is a written contract between <br />the named Insured and the certificate holder that requires such status. <br />The General Liability, Worker's Compensation and Umbrella liability policies includes a blanket notice of cancellation to the certificate holder <br />endorsement, providing for (30) days' advance written notice if the policy is canceled by the company, or 10 days' written notice before the <br />policy is canceled for nonpayment of premium. Notice is sent to certificate holders with mailing addresses on file with the agent or the <br />company. The endorsement does not provide for notice of cancellation to the certificate holder if the named insured requests cancellation. <br />Re: Santa Ana On -Call <br />Agreement: A-2011-247 and RFP #17.009 <br />REVIEWED BY: EUNICE HEREDIA(PGGFo. ,. <br />ACORD 101 (2008/01) 02008 ACORD CORPORATION. All rights reserved. <br />The ACORD name and logo are registered marks of ACORD <br />