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AGENCY CUSTOMER ID: 570000027366 <br />LOC #: <br />"k.--- ADDITIONAL REMARKS SCHEDULE <br />Page _ of _ <br />AGENCY <br />Aon Risk services Northeast, Inc. <br />NAMED INSURED <br />LOS Angeles SMSA LP <br />POLICY NUMBER <br />See Certificate Number: 570083738856 <br />CARRIER <br />See Certificate Number: 570083738856 <br />NAIC CODE <br />EFFECTIVE DATE: <br />1 <br />ADDITIONAL REMARKS <br />THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, <br />FORM NUMBER: ACORD 25 FORM TITLE: Certificate of Liability Insurance <br />INSURER(S) AFFORDING COVERAGE <br />NAIC # <br />INSURER <br />INSURER <br />INSURER <br />INSURER <br />ADDITIONAL POLICIES If a policy below does not include limit information, refer to the corresponding policy on the ACORD <br />certificate form for policy limits. <br />INSR <br />LTR <br />Tl'PE OFINSt1AANCE <br />ADDL <br />LNSD <br />SUBR <br />WVD <br />POLICY NUMBER <br />POLICY <br />EFFECTIVE <br />DATE <br />(MMIDDA'YYY) <br />POLICY <br />EXPIRATION <br />DATE <br />(MM/DDA'YYY) <br />LI]I Il'S <br />AUTOMOBILE LIABILITY <br />A <br />CA 4594301 <br />MIN - Primary <br />06/30/2020 <br />06/30/2021 <br />A <br />CA 4594302 <br />NH - Excess <br />06/30/2020 <br />06/30/2021 <br />WORKERS COMPENSATION <br />B <br />N/A <br />wc045886579 <br />NY <br />06/30/2020 <br />06/30/2021 <br />g <br />N/A <br />wc045886577 <br />FL <br />06/30/2020 <br />06/30/2021 <br />p <br />N/A <br />wc045886578 <br />MA,ND,OH,WI,WY <br />06/30/2020 <br />06/30/2021 <br />B <br />N/A <br />wc045886574 <br />N7,T%,VA <br />06/30/2020 <br />06/30/2021 <br />ACORD 101 (2008101) <br />The ACORD name and logo are registered marks of ACORD <br />C 2008 ACORD --m-19 r'ra1Y 1 <br />RE`AEWm 6 APPRovID BY: <br />®' RBk Management Analyst <br />