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AGENCY CUSTOMER ID: <br />LOC #: <br />A Roc Roc & ADDITIONAL REMARKS SCHEDULE <br />Page 2 Of 2 <br />AGENCY <br />NAMED INSURED <br />Willis In9nranCe $erV1Ce9 of California, Inc. <br />Taller San Jose Rope Builders <br />801 N. Broadway <br />Santa Ana, CA 92701 <br />POLICY NUMBER <br />See Page 1 <br />CARRIER <br />NAIC CODE <br />See Page 1 <br />See Page 1 <br />EFFECTIV DATE: See Page 1 <br />THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, <br />FORM NUMBER: 25 FORM TITLE: Certificate of Liability Insurance <br />Endorsement will follow from the insurance carrier upon receipt. <br />Z�2 <br />ACORD 101 12008/011 <br />ACnPD rn PPnPATinM All •inh+. •use —A <br />The ACORD name and logo are registered marks of ACORD <br />SR ID: 16945132 BATCH: 924350 CERT: W8611977 <br />