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AGENCY CUSTOMER ID: <br />LOC #: <br />ADDITIONAL REMARKS SCHEDULE <br />AGENCYNAMED INSURED <br />POLICY NUMBER <br />NAIC CODE <br />CARRIER <br />EFFECTIVE DATE: <br /> ADDITIONAL REMARKS <br />THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, <br />ACORD 25Certificate of Liability Insurance <br />FORM NUMBER:FORM TITLE: <br />INSURER(S) AFFORDING COVERAGENAIC # <br />INSURER <br />INSURER <br />INSURER <br />INSURER <br />If a policy below does not include limit information, refer to the corresponding policy on the ACORD <br />ADDITIONAL POLICIES <br />certificate form for policy limits. <br />POLICY POLICY <br />INSR <br />ADDL SUBR POLICY NUMBERLIMITS <br />EFFECTIVE EXPIRATION <br /> TYPE OF INSURANCE <br />LTR <br />INSDWVD <br />DATE DATE <br />(MM/DD/YYYY)(MM/DD/YYYY) <br />ACORD 101 (2008/01)© 2008 ACORD CORPORATION. All rights reserved. <br />The ACORD name and logo are registered marks of ACORD <br /> <br />