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AGENCY CUSTOMER ID:VIDOSAM-01 ADIAZ3 <br /> LOC#: 1 <br /> A Oq ADDITIONAL REMARKS SCHEDULE Page 1 of 1 <br /> AGENCY NAMED INSURED <br /> HUB International Insurance Services Inc. Vido Samarzich,Inc. <br /> 515 Cabrillo Park Dr. Suite 315 <br /> POLICY NUMBER Santa Ana,CA 927Q'i' <br /> EE PAGE 1 Orange County <br /> CARRIER NAIC CODE <br /> EE PAGE 1 SEE P 1 EFFECTIVE DATE:SEE PAGE 1 <br /> ADDITIONAL REMARKS <br /> THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, <br /> FORM NUMBER: ACORI]25 FORM TITLE: Certificate of Liability Insurance <br /> Cancellation: <br /> *Except 10 days notice of Cancellation for non-payment of premium. <br /> *Should this policy be cancelled before the expiration date, HUB International Insurance Services, Inc.will mail 30(thirty)days <br /> written notice to those Certificate Holders which require such action per contract or agreement.* <br /> Pollution Liability limits: <br /> Occurrence$1,000,0001Aggregate$2,000,000 <br /> ACORD 101(2008101) a 2008 ACORD CORPORATION. All rights reserved. <br /> The ACORD name and logo are registered marks of ACORD <br />