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AGENCY CUSTOMER ID: 570000027366 <br />LOC #: <br />ADDITIONAL REMARKS SCHEDULE Page _ of _ <br />AGENCY <br />ADD Risk services Northeast, Inc. <br />NAMED INSURED <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 />1 <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 ADDL SLIBR FOLICYNUMBER EFFECTIVE EXPIRATION LIMrrS <br />LTR TYPE OF INSURANCE INSD WVD DATE DATE <br />(MMMDNWY) (MMMUNYYY) <br />AUTOMOBILE LIABILITY <br />A CA 4594301 Ub/30/2U2U U6/30/2U21 <br />NH - Primary <br />A CA 4594302 06/30/2020 06/30/2021 <br />NH - EXCeSS <br />g <br />N/A <br />wc045886579 <br />06/30/2020 <br />06/30/2021 <br />NY <br />g <br />N/A <br />wc045886577 <br />06/30/2020 <br />06/30/2021 <br />FL <br />D <br />N/A <br />wc045886578 <br />06/30/2020 <br />06/30/2021 <br />MA,ND,OH,WI,WY <br />g <br />N/A <br />wc045886574 <br />06/30/2020 <br />06/30/2021 <br />NJ, TX, VA <br />ACORD 101 (2008101) <br />The ACORD name and logo are registered marks of ACORD <br />©2008 ACORD "4 RIMt mane' �¢ on <br />+. `'4 RENEWED apAMIDII DBr. <br />alp-.:,'� `? � F4FK:id ram. V�WW. <br />' RDk ManagenentAnalysl <br />10 <br />