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AGENCY CUSTOMER ID:CWE0000-01 KSITYAMALA <br /> Lac M 1 <br /> ADDITIONAL REMARKS SCHEDULE Page 1 of 1 <br /> AGENCY License#0757776 NAMED INSURED <br /> HUB International Insurance Services Inc. CWE <br /> 1561 E.Orangethorpe Avenue <br /> POLICY NUMBER Suite 240 <br /> SEE PAGE <br /> Fullerton,CA 92831 <br /> 1 <br /> CARRIER NAIC CDDE <br /> EE PAGE 1 ISEE P 1 EFFECTIVE DATE:SEE PAGE 1 <br /> ADDITIONAL REMARKS <br /> THIS ADDITIONAL REMARKS FORM 1S A SCHEDULE TO ACORD FORM, <br /> FORM NUMBER: &CORD 25 FORM TITLE: Certificate of Liability Insurance <br /> Description of Operations/LocationsNehicles: <br /> Waiver of Subrogation with regard to Auto Liability applies when required by written contract per the attached endorsement form <br /> #MCA85100817CA. <br /> Waiver of Subrogation with regard to Workers Compensation applies when required by written contract per the attached <br /> endorsement form WC990315A Ed. 05-2023. <br /> Waiver of Subrogation with regard to Professional Liability applies when required by written contract per endorsement to follow. <br /> ACORD 101 (2008/01) p 2008 ACORD CORPORATION. All rights reserved. <br /> The ACORD name and logo are registered marks of ACORD <br />