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AGENCY CUSTOMER ID: INDUS-1 <br />ACOR" <br />LOC #: <br />ADDITIONAL REMARKS SCHEDULE <br />Page 1 of 1 <br />AGENCY <br />Dodge Insurance Services, Inc. <br />NAMED INSURED <br />Industrial Medical Support, Inc. <br />3320 E. Airport Way <br />Long Beach CA 90806 <br />POLICY NUMBER <br />CARRIER <br />NAIC CODE <br />EFFECTIVE DATE: <br />THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, <br />FORM NUMBER: 25 FORM TITLE: CERTIFICATE OF LIABILITY INSURANCE <br />I by or on behalf of the named insured including materials, parts, or equipment furnished in connection with such work or operations. General Liabil <br />is primary and non-contributory. General Liability Waiver of Subrogation applies. 30 days notice of cancellation except 10 days for non-payment of <br />ACORD 1n1 t2nnR/MI <br />The ACORD name and logo are registered marks of ACORD <br />_ Risk MarugementDivisian <br />_ REVIEWED E,IAPPR.�Oe�v�EO BY: <br />r4mlcY �! R. V�Lr/l�iUll <br />Rizk Nlrnrgeliren[ Analys[ <br />