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AGENCY CUSTOMER ID: 570000027366 <br />_1 LOC #: <br />ADDITIONAL REMARKS SCHEDULE <br />Page _ of _ <br />AGENCY <br />Aon Risk Services Northeast, Inc. <br />NAMEDINSURED <br />LOS Angeles SMSA LIP <br />POLICY NUMBER <br />See Certificate Number: 570083738856 <br />CARRIER <br />see Certificate Number: 570083738856 <br />NAIC 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 POLICYNUMBER EFFECTIVE ESPIRATION LINIIIS <br />LTR TYPE OF INSURANCE INSD WVD DATE DATE <br />(MMMDA'YYY) (MM/DDM'YY) <br />AUTOMOBILE LIABILITY <br />A cA 4594301 06/30/2020 06/30/2021 <br />NH - Primary <br />A CA 4594302 06/30/2020 06/30/2021 <br />NH - EXCe55 <br />WORKERS COMPENSATION <br />g <br />N/A <br />wc045886579 <br />06/30/2020 <br />06/30/2021 <br />NY <br />g <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 />wc045886574 <br />06/30/2020 <br />06/30/2021 <br />NJ, TX,VA <br />ACORD 101 (2008101) <br />© 2008 <br />The ACORD name and logo are registered marks of ACORD <br />REv1EwPD E. APPRovED BY: <br />F,*44-'P,VtGW1 <br />Rnk Management Analyst <br />