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of <br />Page <br />© 2008 ACORD CORPORATION. All rights reserved. <br />00106559 <br />LOC #: <br />NAMED INSUREDEFFECTIVE DATE: <br />AGENCY CUSTOMER ID: <br />NAIC CODE <br />Certificate of Liability Insurance <br />The ACORD name and logo are registered marks of ACORD <br />ADDITIONAL REMARKS SCHEDULE <br />FORM TITLE: <br />25 <br />AGENCYPOLICY NUMBERCARRIER ADDITIONAL REMARKSTHIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM,FORM NUMBER:ACORD 101 (2008/01) <br />North Risk Partners <br />00 03 13, when required by prior written agreement. Workers' Compensation coverage is not provided in the following monopolistic states: ND; OH, WA;and WY. <br /> <br />