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ACORD 101 (2008/01) <br />The ACORD name and logo are registered marks of ACORD <br />© 2008 ACORD CORPORATION. All rights reserved. <br />THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, <br />FORM NUMBER:FORM TITLE: <br />ADDITIONAL REMARKS <br />ADDITIONAL REMARKS SCHEDULE Page of <br />AGENCY CUSTOMER ID: <br />LOC #: <br />AGENCY <br />CARRIER NAIC CODE <br />POLICY NUMBER <br />NAMED INSURED <br />EFFECTIVE DATE: <br />GACHLAN-01 <br />1 1 <br />The Baldwin Group West,LLC Gachina Landscape Management,Inc. <br />1130 O'Brien Drive <br />Menlo Park CA 94025 <br />25 CERTIFICATE OF LIABILITY INSURANCE <br />Additional Insured and Primary Non-Contributory:CA T4 99 02 16 <br />Waiver of Subrogation:CA T3 53 02 15 <br />Short Term Lease Loss Payee:CA T4 52 02 16 <br />Workers'Compensation <br />Waiver of Subrogation:WC 99 03 76 A <br />Umbrella <br />Follow Form over GL,Auto and EL:EU 00 01 07 16 <br />RE:Project No:PWD 26.301 -Medians,Fire Stations &Main Street Landscape <br />The City,its officials,officers,employees,agents,and volunteers are named as Additional Insureds with respect to General and Auto Liability if required by <br />written contract and subject to terms,conditions,and exclusions of the policies.Coverage is provided on a Primary &Non-Contributory basis on General Liability <br />if required by written contract and subject to terms,conditions and exclusions of the policy.A Waiver of Subrogation in favor of the Additional Insureds applies to <br />General and Auto Liability,and Workers Compensation if required by written contract,and subject to terms,conditions,and exclusions of the policies. <br />Docusign Envelope ID: F7F9ED3E-EB07-824E-82A3-2EC213332F32