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ACORO® <br />L____ <br />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 <br />NAIC CODE <br />EFFECTIVE DATE: <br />I-IJJIILei C/L1NN= <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 Additional Insured/ Primary & Non -Contributory as required by written <br />contract per form U -GL -1175-C CW (07/10) <br />General Liability Waiver of Subrogation as required by written contract per form U - <br />GL -1345-B CW (04/13) <br />Commercial Auto Liability Additional Insured/ Primary & Non -Contributory/ Waiver of <br />Subrogation as required by written contract per form U -CA -424-F CW (04/14) <br />Workers' Compensation Waiver of Subrogation as required by written contract per form WC 04 <br />03 06 <br />(Ed.4-84) <br />ACORD 101 (2008/01) © 2008 ACORD CORPORATION. All rights reserved. <br />The ACORD name and logo are registered marks of ACORD ATTACHMENT <br />REVIEWED BY: EUNICE HEREDIA (P OF ) <br />