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AGENCY CUSTOMER ID: 00002920 <br />LOC #: <br />ADDITIONAL REMARKS SCHEDULE <br />Page 2 of <br />AGENCY <br />NAMED INSURED <br />Baker, Romero & Associates Insurance Brokers, Inc. <br />Galvin Preservation Associates Inc. <br />DBA GPA Consulting <br />POLICY NUMBER <br />N/A <br />CARRIER <br />NAIC CODE <br />Multiple Carriers <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 />(continued from Description of Operations) <br />Workers Comp: Andrea Galvin <br />Richard Galvin <br />Additional Remarks: <br />Blanket Additional Insured CGD3810915; Coverage Xtend Endorsement CGD3790219; Aggregate Limit Per Project CGD4690219; Products/Completed Ops <br />Endt. CGD3090219; 30 Day Notice of Cancellation ILT4001209; Auto Coverage Plus Endorsement CAT4200215; Auto Blanket Additional Insured Primary and <br />Non -Contributory CAT4740216; Schedule of Underlying E000030818; Waiver of Rights UM04880708; Worker's Compensation Blanket Waiver of Subrogation <br />SCIF Form 10217. Coverage shall not be canceled, non -renewed or materially altered except after thirty (30) days prior written notice has been given. <br />101 <br />/ <br />I'ti?r'ORE D & APPROVET. far. <br />2008 ACORD C( <br />Risk Man genx tClerical Aide <br />The ACORD name and logo are registered marks of ACORD Zr <br />21 <br />Printed by CRS on March 21, 2022 at 10:23AM <br />