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AGENCY CUSTOMER ID: 570000027366 <br />LOC M <br />ADDITIONAL REMARKS SCHEDULE <br />Page _ of _ <br />AGENCY <br />NAME DINSURED <br />Ann Risk services Northeast, Inc. <br />Los Angeles SMSA LP <br />POLICY NUMBER <br />see certificate Number: 570083738856 <br />CARRIER <br />NAIC CODE <br />EFFECTIVE DATE: <br />1 <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 POLICY NUMBER EFFECTIVE EXPIRATION LIMITS <br />LNSO TR TYPE OF INSURANCE IWVD DATE DATE <br />IMM/DDAYYY) (MMIDD/YYYY') <br />AUTOMOBILE LIABILITY <br />A cA 4594301 06/30/202U 06/30/LU21 <br />NH - Primary <br />A cA 459430t 06/30/2020 06/30/2021 <br />NH - Excess <br />COMPENSATION <br />R <br />N/A <br />WC045886579 <br />Ub/SU/LULU <br />Ub/SU/LUL1 <br />NY <br />R <br />N/A <br />wc045886577 <br />06/30/2020 <br />06/30/2021 <br />FL <br />D <br />N/A <br />lwc045886578 <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 />NI.TX.VA <br />ACORD 101 (2008101) <br />The ACORD name and logo are registered marks of ACORD <br />©2008 ACORD Mae DIanag�^`�"^' <br />REVIEWED S APPRw® Sr <br />i it <br />"it Managencnl Analyst <br />