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AGENCY CUSTOMER ID: 570000027366 <br />q ® LOC #: <br />ADDITIONAL REMARKS SCHFni n F <br />AGENCY <br />AGO Risk services Northeast, Inc. <br />POLICY NUMBER <br />see Certificate Number: 570083738856 <br />CARRIER <br />see certificate Number: 570083738856 <br />ennlnnuAI <br />LOS Angeles SMSA LP <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 police on the ACORD <br />certificate form for policy limits. <br />INSft <br />LTR <br />TYPE OF INSURANCE <br />ADDL <br />SDBR <br />wY'D <br />POLICY NUMBERNBD <br />POLICY' <br />EFFECTIVE <br />DATE <br />(MM/DD/Y)Y\'I <br />POLICY <br />EXPIRATION <br />DATE <br />tMM/DDAIII'I <br />LIaIITS <br />AUTOMOBILE LIABILITY <br />A <br />CA 4594301 <br />NH - Primary <br />06/30/2020 <br />06/30/2021 <br />A <br />CA 4594302 <br />NH - Excess <br />06/30/2020 <br />06/30/2021 <br />WORKERS COMPENSATION <br />B <br />N/A <br />WC045886579 <br />NY <br />06/30/2020 <br />06/30/2021 <br />B <br />N/A <br />WC045886577 <br />FL <br />06/30/2020 <br />06/30/2021 <br />D <br />N/A <br />WC045886578 <br />MA,ND,OH,WI,WY <br />06/30/2020 <br />06/30/2021 <br />B <br />N/A <br />WC04588657a <br />NI,TX,VA <br />06/30/2020 <br />06/30/2021 <br />The ACORD name and logo are registered marks of ACORD <br />©2008 ACORD Risk Meag adDhtion <br />REVIEWED 6 APPRCN® @Y: <br />3 F,..,� P- vj&4441 <br />® Risk Management Anaysl <br />10 <br />