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AGENCY CUSTOMER ID: S70000027366 <br />LOC #: <br />AADDITIONAL REMARKS SCHEDULE <br />AGENCY <br />AOn Risk services Northeast, Inc. <br />POLICY NUMBER <br />see certificate Number: 570083738856 <br />CARRIER <br />See Certificate Number: 570083738856 <br />AnnIT1AMAl PPMARK3 <br />NAIC <br />NAMED INSURED <br />LOS Angeles SMSA LP <br />EFFECTIVE DATE. <br />THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, <br />FORM NUMBER: ACORD 25 FORM TITLE: Certificate of Liability Insurance <br />INSURER(S) AFFORDING COVERAGE <br />NAIC # <br />INSURER <br />INSURER <br />INSURER <br />INSURER <br />Page _ of - <br />ADDITIONAL POLICIES If a policy helow does not include limit information. refer to the corresponding policy on the ACORD <br />certificate form for policy Iimits. <br />INSR <br />LTR <br />TI PE OF INSI' AASCE <br />ABEL <br />INSD <br />SCBR <br />NV\'D <br />POLICNNI: NIBER <br />POLICY <br />EFFECTIVE <br />DATE <br />(NIMDDAI'll) <br />POLIO) <br />EXPIRATION <br />DATE <br />(NI NI/DIVNAI'V') <br />LUMITS <br />AUTOMOBILE LIABILITY <br />A <br />CA 4594301 <br />NH - Primary <br />06/30/2020 <br />06/30/2021 <br />A <br />CA 4594302 <br />NH - EXCeSS <br />06/30/2020 <br />06/30/2021 <br />WORKERS COMPENSATION <br />R <br />N/A <br />wc045886579 <br />NY <br />06/30/2020 <br />06/30/2021 <br />g <br />N/A <br />WC045886577 <br />FL <br />06/30/2020 <br />06/30/2021 <br />D <br />N/A <br />wc045886578 <br />MA,ND,OH,WI.WY <br />06/30/2020 <br />06/30/2021 <br />R <br />N/A <br />wc045886574 <br />NJ,TX,VA <br />06/30/2020 <br />06/30/2021 <br />ACORD 101(2008101) ©2008 ACORD Rule ld.9arlod Division <br />The RIDAACORD name and logo are registered marks of ACORDrF� bD��w®� <br />CSH�LLL1Ll r'IEtG�� h, <br />900—:000' Risk Management Malysf <br />