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AGENCY CUSTOMER ID: 570000027366 <br />LOC #: <br />"� �® ADDITIONAL REMARKS SCHEDULE <br />Page _ of <br />AGENCY <br />AOn Risk Services Northeast, Inc. <br />NAMEDINSURED <br />Los Angeles SMSA LP <br />POLICY NUMBER <br />See certificate Number: 570083738856 <br />CARRIER <br />See Certificate Number: 570083738856 <br />NAIC CODE <br />EFFECTIVE DATE: <br />ADDITIONAL REMARKS <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 />ADDITIONAL POLICIES If a policy below does not include limit information, refer to the corresponding policy on the ACORD <br />certificate form for policy limits. <br />POLICY POLICY <br />INSR ADVIL SUBR POLICY NUMBER EFFECTIVE EXPIRATION LIMITS <br />LTR TYPE OF INSURANCE INSD WVD DATE DATE <br />(MM/DD/YYYY) (MN1/DDNYYY) <br />AUTOMOBILE LIABILITY <br />A CA 4594301 06/30/20Z0 06/30/Z021 <br />NH - Primary <br />A CA 4594302 06/30/2020 06/30/2021 <br />NH - EXCeSs <br />COMPENSATION <br />8 <br />N/A <br />WLV4D0003/7 <br />VV/JV/LVLV <br />VV/JV/LVL1 <br />I <br />NY <br />B <br />N/A <br />wc045886577 <br />06/30/2020 <br />06/30/2021 <br />FL <br />0 <br />N/A <br />wc045886578 <br />06/30/2020 <br />06/30/2021 <br />MA,ND,OH,WI,WY <br />B <br />N/A <br />wc045986574 <br />06/30/2020 <br />06/30/2021 <br />NI,TX,VA <br />ACORD 101 (2008101) <br />02008 <br />TDe ACORD name and logo are registered marks of ACORD <br />cREvte&ED 6ppAPPRaMeD 8r. <br />r„ t 1FhO�K V&L ,Id <br />Rlfk ManagerDent Maly9 <br />