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I <br />AGENCY CUSTOMER ID: 570000027366 <br />LOC #: <br />ADDITIONAL REMARKS SCHEDULE <br />Page _ of _ <br />AGENCY <br />Aon Risk Services Northeast, Inc. <br />NAMEDINSURED <br />Los Angeles SMSA LP <br />POLICY NUMBER <br />See certificate Number: 570083738856 <br />CARRIER <br />See Certificate Number: 570083738856 <br />NAID CODE <br />EFFECTIVE DATE' <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 />POLICY POLICY <br />INSR ADDL SUBR POLICY NUMBER EFFECTIVE LCPIRATION LINIITS <br />LTR TYPE OF INSURANCE INSD N'VD DATE DATE <br />(MM/DDAYYY) (MM/DD/Y1'YY) <br />AUTOMOBILE LIABILITY <br />A CA 45943UI I <br />Ub/SU/LULUI Ub/SU/LULU <br />NH - Prim dry <br />f A CA 4594302 06/30/2020 06/30/2021 <br />I '1 INH - E%Ce55 <br />B <br />N/A <br />WCU4J560J 9 <br />UO/3U/LULU <br />VO/3V/LVLI <br />NV <br />B <br />N/A <br />wc045886577 <br />06/30/2020 <br />06/30/2021 <br />FL <br />D <br />N/A <br />wc045886578 <br />06/30/2020 <br />06/30/2021 <br />MA,ND,OH,WI,WY <br />g <br />N/A <br />WC045896574 <br />06/30/2020 <br />06/30/2021 <br />N],T%,VA <br />ACORD 101 (2008101) <br />The ACORD name and logo are registered marks of ACORD <br />©2008 ACORD <br />-'?,(1*I REvi6WID6 APPRw®Sr. <br />IIPI,LI '' Funo:r� R. V:11.40�[ <br />®' RLsk MaOagenelrt Malysl <br />