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AGENCY CUSTOMER ID: 00064361 <br />LOC #: <br />o�® ADDITIONAL REMARKS SCHEDULE <br />Page 2 of <br />AGENCY <br />NAMED INSURED <br />Palm Valley Insurance <br />Vicente Martinez <br />DBA: Premier Pest Services West <br />POUCYNUMBER <br />MP0004010006031 <br />CARRIER <br />NAIC CODE <br />Mesa Underwriters Specialty Ins Co <br />EFFECWE DAM: 0810712021 <br />THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, <br />FORM NUMBER: 25 FORM TITLE: Certificate of Liability Insurance <br />(continued from Description of Operations) <br />30 Days Notice of Cancellation with 10 days Notice of Non-payment of premium In accordance with the policy provisions. <br />Ie[KG7 7sI11r71ff10*117T11111 <br />RukAlv�rgenadOsfillan ':; <br />RenE1[m6l1PPItJVIDBM. <br />tli� Ir %se PwrJae <br />n 2n ArAr()Rn (:r euk Marugemmtaa�oi/Ytle <br />The ACORD name and logo are registered marks of ACORD V _a <br />Printed by ANN on November 10, 2021 at 08:49AM <br />