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AGENCY CUSTOMER ID: <br />LOC #: <br />A` oRo® ADDITIONAL REMARKS SCHEDULE <br />Page of <br />AGENCY <br />MJLA Insurance Services, Inc. <br />NAMEDINSURED <br />Learnet Academy, Inc <br />POLICY NUMBER <br />CARRIER <br />NAIC CODE <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 />10 days notice of cancellation for non-payment of premium. <br />Individual Excluded: Tia J Shin <br />„ Riak Managanent Division <br />�?- REVIEWED & APPROVED BY: <br />® Risk Management Specialist <br />ACORD 101 (2008/01) © 2008 ACORD <br />The ACORD name and logo are registered marks of ACORD <br />