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AGENCY CUSTOMER ID: 570000027366 <br />LOC #: <br />ADDITIONAL REMARKS SCHEDULE <br />Page _ of _ <br />AGENCY <br />NAMEDINSURED <br />Aon Risk Services Northeast, Inc. <br />LDS Angeles SMSA LP <br />POLICY NUMBER <br />See certificate Number: 570083738856 <br />CARRIER <br />NAIL CODE <br />EFFECTIVE DATE. <br />See Certificate Number: 570083738856 <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 SUBR POLICYNUMBER EFFECTIVE EXPIRATION LIBIIIS <br />LTR TSPE OF INSURANCE INSD WVD DATE DATE <br />(MM/DD/YYYY (MM/DD/YY'YY) <br />AUTOMOBILE LIABILITY <br />A CA 4594301 06/30/2020 06/30/2U21 <br />NH - Primary <br />A CA 4594302 06/30/2020 06/30/2021 <br />rvH - Excess <br />WORKERS COMPENSATION <br />B <br />N/A <br />Wluq>oo.]'] <br />UO/JU/LV<V <br />VV/DU/LUG1 <br />NY <br />B <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 />M4,ND,OH,WI,WY <br />B <br />N/A <br />wc045886574 <br />06/30/2020 <br />06/30/2021 <br />NJ.TX.VA <br />ACORD 101 (2008/01) <br />© 2008 <br />The ACORD name and logo are registered marks of ACORD <br />ReAeLm 6 APPRw® Or <br />F u. c:.w Z V:L'vAt <br />Risk Management Analyst <br />