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AGENCY CUSTOMER ID: 570000027366 <br />LOC #: <br />ADDITIONAL REMARKS SCHEDULE Page _ of _ <br />AGENCY NAMED INSURED <br />ADD Risk services Northeast, Inc. Los Angeles SMSA LP <br />POLICY NUMBER <br />See certificate Number: 570083738856 <br />CARRIER NAIC CODE <br />see certificate Number: 570083738856 EFFECTIVE GATE: <br />THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, <br />FORM NUMBER: ACORD 25 FORM TITLE: Certificate of Liability Insurance <br />11 INSURER(S) AFFORDING COVERAGE I NAIC # <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 />TYPE OF INSURANCE <br />ABIDE <br />INSD <br />SUBR <br />WVD <br />POLICY NUMBER <br />POLICY <br />EFFECTIVE <br />DATE <br />(MNIMDAYYY) <br />POLICY <br />EXPIRATION <br />DATE <br />(MMMDNYYY) <br />LIMBS <br />AUTOMOBILE LIABILITY <br />A <br />CA 4594301 <br />NH - Primary <br />06/30/2020 <br />06/30/2021 <br />A <br />CA. 4594302 <br />NH - EXCe SS <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 />B <br />N/A <br />wc045986577 <br />FL <br />06/30/2020 <br />06/30/2021 <br />D <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 />NI,TX,VA <br />06/30/2020 <br />06/30/2021 <br />ACORD 101 (2008/01) © 2008 <br />The ACORD name and logo are registered marks of ACORD <br />RiskMvigenmt Division <br />REVIEWED 6 APPRcvED Sr. <br />J F4,cwt-wt PS. vjt'u <br />409W RDk Management Analyst <br />