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AGENCY CUSTOMER ID: KOACORPOR <br />LOC #: <br />A �® ADDITIONAL REMARKS SCHEDULE <br />Page 1 of 1 <br />AGENCY <br />NAMED INSURED <br />Dealey, Renton & Associates <br />KOA Corporation <br />1100 Corporate Center Drive #201 <br />POLICY NUMBER <br />Monterey Park, CA 91754 <br />(323) 260-4703 <br />CARRIER <br />NAIC CODE <br />EFFECTIVE DATE: <br />ADDITIONAL REMARKS <br />THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, <br />FORM NUMBER: 25 FORM TITLE: CERTIFICATE OF LIABILITY INSURANCE <br />a. As If each Named Insured were the only Named Insured; and <br />b. Separately to each insured against whom claim is made or suit is brought. <br />REVIEWED & APPROVED <br />By RISK MANACtEMENT DIVISION <br />UG 02 2019 <br />FRANC NE R. VILLAREAL <br />ACORD 101 (2008/01) © 2008 ACORD CORPORATION. All rights reserved. <br />The ACORD name and logo are registered marks of ACORD <br />