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AGENCY CUSTOMER ID: 570000027366 <br />LOC #: <br />A✓ �® ADDITIONAL REMARKS SCHEDULE <br />Page _ of <br />AGENCY <br />ADD Risk services Northeast, Inc. <br />NAMED INSURED <br />Los Angeles SMSA LP <br />POLICY NUMBER <br />See Certificate Number: 570083738856 <br />CARRIER <br />See Certificate Number: 570083738856 <br />NAIL CODE <br />EFFECTIVE DATE. <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 belmN does not include limit information. refer to the corresponding policy on the ACORD <br />certificate form for policy limits. <br />INSR <br />LTR <br />TSPEOFINSURANCE <br />.4ODL <br />INSD <br />sl!HR <br />WVD <br />POLICY NUMBER <br />POLICY <br />EFFECTIVE <br />DATE <br />(MMH)D/Y\'YYI <br />POLICY <br />EXPIRATION <br />DATE <br />(h1M/DDI\l'\'Y) <br />LIMITS <br />AUTOMOBILE LIABILITY <br />A <br />CA 4594301 <br />NH - Primary <br />06/30/202C <br />06/30/2021 <br />A <br />CA 4594302 <br />NH - Excess <br />06/30/2020 <br />06/30/2021 <br />WORKERS COMPENSATION <br />6 <br />N/A <br />wc045886579 <br />NY <br />06/30/2020 <br />06/30/2021 <br />8 <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 />8 <br />N/A <br />wc045886574 <br />NI,TX,VA <br />06/30/2020 <br />06/30/2021 <br />ACORD 101 (2008101) <br />The ACORD name and logo are registered marks of ACORD <br />REVIEWED & APPRcvEo Br. <br />F4/.1.G..M Z vj&44,1 <br />Risk Management Analyst <br />