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AGENCY CUSTOMER ID: <br />LOC #: <br />ADDITIONAL REMARKS SCHEDULE <br />AGENCY INAMED INSURED <br />POLICY NUMBER <br />CARRIER I NAIC CODE <br />EFFECTIVE DATE: <br />Page of <br />AUUI IIONAL REMARKS <br />THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, <br />FORM NUMBER: FORM TITLE: <br />Certificate holder is listed as an Additional Insured on a primary non-contributory basis on the General Liability and Auto Liability policies as per written <br />contract. <br />Notice of cancellation applies in the favor of the certificate holder. <br />Ir <br />REVIEwEov <br />Risk Manrgemenr Supervu« <br />The ACORD name and logo are registered marks of ACORD <br />