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AGENCY CUSTOMER ID: ONE0000-01 <br />LOG #: 1- <br />DTORRE <br />ACC?RV ® <br />Ill <br />ADDITIONAL REMARKS SCHEDULE <br />AGENCY "��"�"• �' "' <br />iUB International Insurance Services Inc. <br />POLICY NUMBER <br />SEE PAGE 1 <br />CARRIER NAIC CODE <br />SEE PAGE 1 SEE P 1 <br />THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, <br />FORM NUMBER: ACORD 25 FORM TITLE: Certificate of Liability Insurance <br />Description of Operations/LocationsNehicles: <br />10 day Notice of Cancellation will follow from carrier. <br />Fourth Street, Suite 100 <br />na. CA 92705 <br />EFFECTIVE DATE: <br />ACORD 101 (2008101) © 2008 ACORD CC <br />The ACORD name and logo are registered marks of ACORD <br />Page <br />Of 1 <br />any RiekMar>agmnel>tDMalnn <br />REVIEWED&APPROVEDBY: <br />�'fir �(4p I�uaw44 <br />Risk Management Specialist <br />