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AGENCY CUSTOMER ID: 00002920 <br />LOC #: <br />AC"RO� ADDITIONAL REMARKS SCHEDULE <br />Page 2 of 2 <br />AGENCY <br />NAMED INSURED <br />Baker, Romero & Associates Insurance Brokers, Inc. <br />Galvin Preservation Associates Inc. <br />DBA GPA Consulting <br />POLICY NUMBER <br />N/A <br />CARRIER <br />NAIC CODE <br />Multiple Carriers <br />EFFECTIVE DATE: <br />ADDITIONAL REMARKS <br />THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, <br />FORM NUMBER: 25 FORM TITLE: Certificate of Liability Insurance <br />Blanket Additional Insured CGD3810915; Coverage Xtend Endorsement CGD3790219; Aggregate Limit Per Project CGD4690219; Products/Completed <br />Ops Endt. CGD3090219; 30 Day Notice of Cancellation ILT4001209; Auto Coverage Plus Endorsement CAT4200215; Auto Blanket Additional Insured <br />Primary and Non -Contributory CAT4740216; Schedule of Underlying E000030818; Waiver of Rights UM04880708; Worker's Compensation Blanket <br />Waiver of Subrogation SCIF Form 10217. Coverage shall not be canceled, non -renewed or materially altered except after thirty (30) days prior written <br />notice has been given. <br />ACORD 101 (2008/01) © 2008 ACORD CO <br />The ACORD name and logo are registered marks of ACORD <br />Printed by <br />Risk Managzment Division <br />r. REVIEWED & APPROVED BY. - <br />Risk Management Analyst <br />