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ACCWO® <br />64.� <br />AGENCY CUSTOMER ID: RINCCON-01 <br />LOC #: 1 <br />ADDITIONAL REMARKS SCHEDULE <br />PHILLIPSC <br />Page 1 of 1 <br />AGENCY <br />Legends Environmental Ins. Services <br />9 <br />License # OE67768 <br />NAMED INSURED <br />Rincon Consultants, Inc. <br />210 N Ashwood Ave <br />Ventura, CA 93033 <br />POLICY NUMBER <br />SEE PAGE 1 <br />CARRIER <br />EE PAGE 1 <br />NAIC CODE <br />SEE P 1 <br />EFFECTIVE DATE: SEE PAGE 1 <br />THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, <br />FORM NUMBER: ACORD 25 FORM TITLE: Certificate of Liability Insurance <br />�n of Operations/LocationsIVehicles: <br />rd Non -Contributory as required by written contract, per endorsement EN0147.1111 & HA99160312. Blanket Waiver of <br />on applies to General Liability, Auto Liability and Workers Compensation as required by written contract, per Endorsement <br />111, HA99160312 & WC000313. Excess policy follows General Liability, Auto Liability and Employers Liability form. <br />ACORD 101 (2008101) © 2008 ACORD CORPORATION. All rights reserved. <br />The ACORD name and logo are registered marks of ACORD <br />