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AGENCY CUSTOMER ID: 570000027366 <br />LOC #: <br />A� �® ADDITIONAL REMARKS SCHEDULE <br />Page _ of _ <br />AGENCY <br />NAMEDINSURED <br />Aon Risk Services Northeast, Inc. <br />Los Angeles SMSA LP <br />POUCY NUMBER <br />See certificate Number: 570083738856 <br />CARRIER <br />NAICCODE <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 />INSR <br />LTR <br />TYPE OF mSUBANCE <br />ADDL <br />INSD <br />SUER <br />W\'D <br />POLICY NUMBER <br />POLICY <br />EFFECTIVE <br />DATE <br />(MM/DD/VY'YY) <br />POLICY <br />EXPIRATION <br />DATE <br />(MM/DUNYYY) <br />Lill I'IS <br />AUTOMOBILE LIABILITY <br />A <br />CA 4594301 <br />NH - Primary <br />06/30/2020 <br />06/30/2021 <br />A <br />CA 4S94302 <br />NH - Excess <br />06/30/2020 <br />06/30/2021 <br />WORKERS COMPENSATION <br />g <br />N/A <br />WC045886579 <br />NY <br />06/30/2020 <br />06/30/2021 <br />g <br />N/A <br />WC045896577 <br />FL <br />06/30/2020 <br />06/30/2021 <br />D <br />N/A <br />wc045886S78 <br />MA, ND, OH, WI, WY <br />06/30/2020 <br />06/30/2021 <br />g <br />N/A <br />WC04SB86574 <br />NI,TX,VA <br />06/30/2020 <br />06/30/2021 <br />ACORD 101 (2008)01) <br />The ACORD name and logo are registered marks of ACORD <br />©2008 ACORD _ RUY MatlaOa Drvcvwt <br />Y rhmeMvm&APPRclvED8YI: <br />o®' Rak Management Analyst <br />