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AGENCY CUSTOMER ID: <br />LOC#: <br />r� ryr <br />�k+f - ( �fel ) <br />� ADDITIONAL REMARKS SCHEDULE <br />Page 2 of 2 <br />AGENCY <br />NAMED INSURED <br />PLATINUM INSURANCE GROUP INC <br />WESTERN AV INC <br />1521 E ORANGETHORPE AVE STE A <br />POLICY NUMBER <br />SEE ACORD 25 <br />FULLERTON CA 92831-5203 <br />CARRIER <br />NAIC CODE <br />SEE ACORD 25 <br />EFFECTIVE DATE: SEE ACORD 25 <br />ADDITIONAL REMARKS <br />THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM <br />FORM NUMBER: ACORD 25 FORM TITLE: CERTIFICATE OF LIABILITY INSURANCE <br />Certificate holder is an additional insured per the Business Liability Coverage Form SL3032 attached to this policy. Waiver of <br />Subrogation applies in favor of the Certificate Holder per the Business Liability Coverage Form SL0000, attached to this policy. <br />Coverage is primary and noncontributory per the Business Liability Coverage Form SL0000, attached to this policy. Notice of <br />Cancellation will be provided in accordance with Form SL9013, attached to this policy. <br />ACORD 101 (2014/01) © 2014 ACORD CORPORATION. All rights reserved. <br />The ACORD name and logo are registered marks of ACORD <br />