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AGENCY CUSTOMER ID: <br />LOC #: <br />oRO ADDITIONAL REMARKS SCHEDULE Page of <br />AGENCY NAMED INSURED <br />Business World Insurance Agency A & J Portables <br />POLICY NUMBER <br />CARRIER I 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 />AGREEMENT NUMBER: A-2020-131-07 <br />Riek M..gnati Doi. <br />IL7Qw '7az� P&waa <br />REVIEWED & APPROVED B'r' <br />ACORD 101 (2008/01) © 2008 ACORD C <br />The ACORD name and logo are registered marks of ACORD <br />