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AGENCY CUSTOMER ID: CLINLAB-01 <br /> LOC#: <br /> ACC o ADDITIONAL REMARKS SCHEDULE Page 1 of 1 <br /> AGENCY NAMED INSURED <br /> IAG Insurance Services Clinical Laboratory of San Bernardino <br /> Geo-Monitor, Inc. <br /> POLICY NUMBER 21881 Barton Road <br /> Grand Terrace CA 92313 <br /> CARRIER 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 /> Blanket Waiver of Subrogation for Professional Liability shall apply as required by written contract per the attached endorsement. <br /> 30-Day Notice of Cancellation applies. <br /> ACORD 101 (2008/01) ©2008 ACORD CORPORATION. All rights reserved. <br /> The ACORD name and logo are registered marks of ACORD <br />